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. 2025 Jan-Dec:21:17455057241310271.
doi: 10.1177/17455057241310271. Epub 2025 Apr 18.

Sexuality after breast cancer treatment: An experience of asymmetry

Nynke Willers  1   2 , Paul Enzlin  3 , Patrick Neven  1   4 , Sileny N Han  1   4
Affiliations

Sexuality after breast cancer treatment: An experience of asymmetry

Nynke Willers et al. Womens Health (Lond). 2025 Jan-Dec.

Abstract

Background: Breast cancer survivorship is often associated with a negative impact on sexual function and sexual well-being. Given that sexual well-being contributes to quality of life-including for breast cancer survivors-it is important to address survivors' sexual worries during the treatment process.

Objective: This study explored factors that contribute to changes in sexual functioning and sexual well-being after breast cancer diagnosis and treatment in otherwise healthy patients.

Design: Narrative qualitative study using thematic analysis.

Method: We included 25 breast cancer survivors without severe comorbidities for individual interviews (N = 16) and 2 focus group discussions (N = 4 and N = 6). One participant attended both an individual interview and a focus group discussion.

Results: After the diagnosis of breast cancer, a sudden shift emerged in relation to life before and after breast cancer. A thematic analysis resulted in the identification of one high-level theme: asymmetry. This asymmetry was experienced in the following domains: (1) physical asymmetry in the chest region after surgery and radiotherapy, (2) sexual asymmetry; differences in how the body and mind react to sexual stimuli due to residual physical side effects and the effects of ongoing treatment: a lack of sexual desire, severe vaginal dryness and/or dyspareunia, and lack of vaginal arousal response during sexual activity, (3) life asymmetry in time- and self-management, which deprives patients from experiences that make someone feel good about oneself, (4) asymmetry in the experience in invulnerability: the reality of the sexual side effects of treatment and expectations of these side effects after being informed by a healthcare professional, and (5) relational asymmetry: asymmetry between the partners in their relationship due to role confusion and role changes.

Conclusion: Breast cancer diagnosis and treatment have a distinct impact on sexual function and sexual well-being. Changes in social relationships due to the diagnosis and the physical side effects of treatment are associated with a decline in sexual well-being, which should receive more attention in research and clinical care.

Keywords: breast cancer; breast cancer treatment; qualitative research; quality of life; sexuality.

Plain language summary

Sexuality after breast cancer treatment: an experience of asymmetryMost breast cancer patients experience sexual side effects when they are treated for breast cancer. These side effects may negatively impact their sexual well-being. This study explores what changes in sexual function and sexual well-being during breast cancer treatment in otherwise healthy patients. The information from this study can be used to better address sexual worries during and after treatment.Twenty-five participants who were treated for breast cancer less than 5 years ago, shared their experiences with sexuality in an individual interview or focus group. The questions that guided these interviews and focus groups were based on a framework describing the link between illness and sexuality.We learned that patients experienced an asymmetry when compared with their life before their breast cancer diagnosis.Asymmetry was experienced in the following domains:1. Physical asymmetry: physical changes in the breast area result for some in the fact that this area is no longer an erogenous zone.2. Sexual asymmetry: differences in how the body (e.g., a lack of sexual desire, severe vaginal dryness, pain with intercourse, and a lack of vaginal arousal response during sexual activity) and mind (e.g., willingness to experience intimacy and sexuality) react to sexual stimuli as a consequence of the side-effects of (ongoing) treatment(s).3. Life asymmetry in time- and self-management: breast cancer is a turning point in life demarcating of a life before and after, and in the ‘after life’ the inability to plan one’s own work (time management) or fun activities (self-management) deprives patients from experiences that make someone feel good about oneself.4. Asymmetry in the experience in invulnerability: the difference between the reality of the sexual side effects of BCT and the expectations of these side effects based on the information about these sexual side effects by healthcare professionals undermines the sense of invulnerability or invincibility5. Relational asymmetry: asymmetry between the partners in their relationship due to role confusion and role changesWe believe that it is important for healthcare professionals to be aware of the negative effects of breast cancer treatment on sexuality: to better inform patients who start treatment. If you, as a healthcare provider or as a patient, are aware of the negative effects of breast cancer therapy on sexual health, it may be easier to discuss alterations in sexuality during and after the treatment.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

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Figure 1.
Process of inclusion in this study.
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