Sexual Well-being in Patients following Breast Cancer Surgery: Trends, Associated Factors, and Interventions.

Purpose: Up to 85% of breast cancer patients report sexual health concerns, yet sexual health concerns remain understudied. This study aims to understand sexual health in breast cancer patients who undergo breast conserving therapy (BCT) or postmastectomy breast reconstruction (PMBR), including trends in PROs, associated demographic and clinical factors, and the role of sexual medicine consultations on sexual health.

Method: A retrospective analysis of patients who underwent BCT or BR and completed the BREAST-Q Sexual Well-being module between 2010 and 2021 was performed. We compared Sexual Well-being among BCT and PMBR patients over time, delineated associated demographic and clinical factors with Sexual Well-being scores, and evaluated the incidence and impact of sexual medicine consultations.

Results: Overall, 15,857 patients were captured in the database, of which 8,510 (53.7%) were BCT and 7,347 (46.3%) were PMBR. PMBR patients had consistently lower Sexual Well-being scores across time than BCT patients, from preoperative to 5-year postoperative follow-up (p<0.001). Single marital status, increased BMI, and a history of psychiatric diagnoses were associated with decreased Sexual Well-being preoperatively and at 1-year postoperatively. 400 (5.4%) of 7,347 PMBR patients received a sexual medicine consultation.

Conclusion: Sexual Well-being is an essential component in caring for breast cancer patients. Sexual dysfunction is imperative to consider in PMBR patients, particularly among those who are single, have higher BMI, or have psychiatric disorders. Only a small fraction of patients receives a sexual medicine consultation. We encourage providers to assess Sexual Well-being among breast cancer patients and refer for sexual medicine consultations when appropriate.