ORIGINAL ARTICLE – BREAST ONCOLOGY
Trends in Sexual Function After Breast Cancer Surgery
Lauren F. Cornell, MD
, Dawn M. Mussallem, MD
, Tammeza C. Gibson, PA-C
, Nancy N. Diehl, BS
Sanjay P. Bagaria, MD
, and Sarah A. McLaughlin, MD
Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL;
Division of General Surgery, Mayo
Clinic, Jacksonville, FL;
Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL
Purpose. Sexual dysfunction is assumed to be common,
but understudied, in breast cancer patients. Herein, we use
the validated female sexual functioning index (FSFI) to
evaluate changes in female sexual function after breast
Methods. The FSFI assesses sexual function in six
domains (desire, arousal, lubrication, orgasm, satisfaction,
pain) on a 36-point scale, with scores
better sexual function. We identiﬁed 226 women with
unilateral breast cancer undergoing surgery at our institu-
tion from June 2010–January 2015. All completed the FSFI
preoperatively and at a median of 13 months postopera-
tively. We quantiﬁed declines in FSFI scores and
considered p-values \0.05 statistically signiﬁcant.
Results. Overall, 119 women had breast-conserving sur-
gery (BCS), 40 had unilateral mastectomy (UM), and 67
had UM plus contralateral prophylactic mastectomy
(CPM). All women had similar baseline FSFI scores (me-
dians: BCS, 26.3; UM, 25.2; UM?CPM, 23.7; p = 0.23).
At follow-up, sexual function had declined signiﬁcantly in
BCS (23.5; p \ 0.001) and UM (17.4; p = 0.010), but was
unchanged in UM?CPM (22.8; p = 0.74) women. Inter-
estingly, all women maintained their desire for sex
(p = 0.17). BCS and UM women demonstrated signiﬁcant
declines in all other subscale domains (all p \ 0.045).
UM?CPM women demonstrated no decline in any sub-
scale domain, yet did not exhibit superior sexual function
to those having UM or BCS (medians: BCS, 23.5; UM,
17.4; UM?CPM, 22.8; p = 0.21).
Conclusions. Baseline sexual dysfunction exists in women
diagnosed with breast cancer. Surgery negatively impacts
sexual function. Patients who choose mastectomy do not
exhibit superior sexual function over those having BCS at
13 months following surgery.
Strategies to detect and treat breast cancer have
improved dramatically over the last several decades.
Mortality has declined and interest in issues of survivorship
beyond treatment continues to grow.
As of January 2014,
DeSantis et al.
estimated there were more than 14.5 mil-
lion cancer survivors living in the US, with breast cancer
survivors accounting for more than 3 million. As these
numbers increase, awareness of the challenges faced by
survivors and the importance of regaining meaningful
quality of life after cancer treatment has become more
Symptoms experienced by cancer survivors encompass
both physical and psychosocial domains. Sexual health is
frequently affected, with 50–90% of women with breast
cancer experiencing sexual dysfunction.
The impact of
diagnosis and various cancer treatments remains poorly
understood despite the high prevalence of sexual com-
This may be attributed in part to failure of
providers to address sexual health in patients in the com-
Dizon et al.
reported that less than half of
physicians actually take a detailed sexual history. Com-
plaints that have been reported consist of decreased libido,
disorders of sexual arousal, lubrication, dyspareunia, and
anorgasmia. Suggested sources to account for these com-
plaints include surgery, use of anti-estrogen therapy,
chemotherapy, and psychological distress related to cancer
It has been previously reported that more aggressive
surgical interventions lead to more sexual dysfunction;
however, this has been contradicted by several studies that
have found no difference in sexual functioning between
Ó Society of Surgical Oncology 2017
First Received: 7 March 2017;
Published Online: 30 May 2017
S. A. McLaughlin, MD
Ann Surg Oncol (2017) 24:2526–2538