Sexual function and satisfaction in young women with breast cancer: a 5-year prospective study

Abstract

Background: Young women with breast cancer (YWBC) face unique challenges that can affect their sexual health. This study aimed to identify factors associated with sexual activity, function, and satisfaction in YWBC up to 5 years postdiagnosis.

Methods: We conducted a prospective cohort study of 474 women 40 years of age or younger diagnosed with nonmetastatic breast cancer in Mexico. Sexual function and satisfaction were assessed using the Female Sexual Function Index and the Sexual Satisfaction Inventory, respectively. Factors associated with sexual health outcomes were examined using mixed-effects models.

Results: The prevalence of sexual dysfunction increased from 33.6% at baseline to 52.9% at 4-5 years postdiagnosis. Factors associated with worse sexual function included older age (mean predicted FSFI score = -1.35, P = .037), treatment-induced amenorrhea (-2.86, P < .001), depression (-4.11, P < .001), and anxiety (-2.13, P < .001). Lower sexual satisfaction was associated with lower educational attainment (mean predicted SSI score = -5.61, P = .002), being single (-6.41, P < .001), treatment-induced amenorrhea (-3.76, P = .004), bilateral oophorectomy (-8.21, P = .017), depression (-11.29, P < .001), and anxiety (-7.50, P < .001). Quality of life, body image, and systemic therapy side effects significantly affected both outcomes. Three distinct trajectories of sexual function were identified: high (62.2%), intermediate (24.3%), and markedly declining (13.5%). Four trajectories of sexual satisfaction were found, ranging from intermediate-to-high (57.3%) to progressively worsening (27.5%).

Conclusion: Sexual dysfunction is prevalent and persistent among YWBC. Multiple biological, psychological, and social factors influence sexual health outcomes in this population. These findings highlight the importance of routine screening and tailored interventions to address the sexual health of YWBC throughout survivorship.

Figure 1.

Number of patients sexually active (A), with an FSFI total score indicative of female sexual dysfunction (B), and different levels of sexual satisfaction as measured by SSI (C) at each timepoint assessed. Abbreviations: FSFI = Female Sexual Function Index; FSD = female sexual dysfunction; SSI = Sexual Satisfaction Inventory.

Figure 2.

Predicted probability of being sexually inactive and mean FSFI and SSI scores according to QoL as measured by QLQ C30, and burden of systemic therapy side effects and body image as measured by the QLQ-BR23. Abbreviations: FSFI = Female Sexual Function Index; SSI = Sexual Satisfaction Inventory; QLQ-SumScore = QLQ-C30 summary score; BRST = score of the systemic therapy side effects symptom subscale of QLQ-BR23; BRBI = score of the body image functional subscale of QLQ-BR23.

Figure 3.

Mean scores with standard error at each follow-up. Abbreviations: FSFI = Female Sexual Function Index; SSI = Sexual Satisfaction Inventory.

Figure 4.

Contrasts of mean predicted Female Sexual Function Index score (A), Sexual Satisfaction Inventory score (B), and probability of being sexually inactive (C) by mixed models according to type of hormone therapy received.

Figure 5.

Distinct trajectories for sexual function (A) and sexual satisfaction (B) identified in the first 5 years postdiagnosis. In part A, 3 groups are identified: those with relatively stable Female Sexual Function Index (FSFI) score throughout follow-up (groups 1 and 3, red and blue) and those with marked worsening with longer follow-up (group 2, green). In part B, 4 groups are identified: those with worsening Sexual Satisfaction Inventory (SSI) score with longer follow-up (group 2, green), those with intermediate-to-high sexual satisfaction (group 4, light blue), those with low sexual satisfaction (group 3, darkblue), and those with high sexual satisfaction (group 1, red).