This study assessed sexual function in premenopausal women with breast cancer diagnosis treated at a large, public cancer center in a south European country. FSFI scores met the clinical cutoff score for sexual dysfunction in more than half (58.4%) of the 166 sexually active women in the study. This high prevalence of sexual dysfunction may be due to their Breast Cancer-specific treatment experiences, such as body image changes after breast surgery, hormone treatments, and the physiological and psychological effects of chemoradiotherapy. [11] Given these findings, it is important that greater attention be paid to the sexual function changes affecting women with breast cancer. These results may thereby help to increase the availability of assistance for women with BC who are facing sexual health problems.
Subgroup analysis showed that regarding FSFI score in women with Breast Cancer, there were statistically significant differences between women that did radiotherapy when compared to those who did not. Breast irradiation usually is given daily for about 3 to 6.5 weeks. It is associated with short term side effects (first three months after treatment) of fatigue and skin erythema, and long term side effects (3 months to 3 years after treatment) of breast edema, pain, fibrosis, and telangiectasia. Studies of patients treated with mastectomy have suggested that the addition of postoperative radiotherapy was associated with a higher incidence of psychological morbidities, such as depression and anxiety. [12–13] Breast-conserving therapy (lumpectomy plus breast irradiation) also have been suggested, when compared with mastectomy or lumpectomy alone, to be associated with an increase in affective symptoms. [14–15] Other studies have not shown any effect of postoperative radiation therapy on psychological distress but have suggested significant effects on physical symptoms, in particular, fatigue. [14–15]
Our results demonstrate a lower FSFI score in patients treated with radical mastectomy and lumpectomy when compared to mastectomy with immediate reconstruction. Women who undergo mastectomy with immediate reconstruction have the greatest opportunity for preservation of their native skin envelope, and theoretically, a natural cosmetic outcome. Given body image dissatisfaction has been linked to a more prevalence of sexual dysfunction, this fact might explain the outcomes for mastectomy patients [26–28]. Otherwise, radiotherapy was offered to all patients that had lumpectomy as breast surgery, conditions that could contribute to a higher prevalence of sexual dysfunction in this group of patients.
This study also investigated women's care needs and their experience with health professionals regarding the inclusion of problems with sexual functioning as part of treatment. The results showed that out of the 97 women that met the FSFI criteria for sexual dysfunction, 60 (61.9%) of the women with sexual functioning problems felt a need for a specific medical appointment related to sexual dysfunction. One hundred and thirty-eight women (69.3%) were never or rarely questioned about their sexual health during their medical oncology appointment. This means that these women were deprived of care. Discussing sexual issues is difficult for both patients and for health care providers, and sexual concerns often remain unaddressed during treatment [18–21]. Although there is a tendency to consider sexual issues as taboo, our study found that cancer patients' opinions are different. Patients expressed a great desire to discuss and disclose information concerning their sexual life, as shown by the high percentage of study participants (71.2%). Based on the findings from this study, health care professionals should be encouraged to inquire about their patients' sexual concerns.
The participants in this study reported feeling comfortable answering the questionnaire, that the questions were easy to complete, relevant to their experiences, and the questionnaire was about the right length. These findings demonstrate that the FSFI has favorable psychometric properties and is acceptable for use by premenopausal women with breast cancer. The FSFI is, therefore, eminently suited for routine administration to screen for sexual dysfunction in clinical and research settings. The measure is simple to administer and score and is suitable for use by health professionals as a screening tool. As the FSFI is a self-report scale, it will take no additional practitioner time to administer, which is important for busy clinical practices.
This study has some strengths, including the prospective design, the use of a validated measure of sexual function, and the sample size. However, the present study suffers from certain limitations. Firstly, the subgroup sizes make comparisons among treatment groups difficult. Secondly, our analysis did not include medical comorbidities, which in turn might have affected sexual function. The third limitation concerns the use of FSFI, which, albeit criticized as not being the most suitable instrument for sexually inactive participants, has thus far been the better validated instrument for assessing sexual function available in Portugal.