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Sexual Function Concerns in Women Presenting for Breast Reconstruction
Purpose
While reconstructive surgery strives to balance form and function, breast reconstruction focuses mainly on form. In terms of function other than lactation, the breast is a sexual organ. The sequelae of surgical extirpation of this sexual organ can be further compounded by side effects from adjuvant therapies of breast cancer (chemotherapy and anti-hormone therapies). Patient satisfaction with breast reconstruction may be affected by positive or negative changes in sexual function of the breast post-surgery. To begin to understand the relationship between breast reconstruction and sexual function, this study quantified the prevalence of sexual problems and interest in receiving care for these problems among women presenting for breast reconstruction.
Materials and Methods
Women with either breast cancer or a family history of breast cancer presenting for breast reconstruction at an urban academic medical center were sequentially recruited (9/10-11/11). Participants completed an anonymous, self-administered questionnaire eliciting sociodemographics, menopause status, reconstructive treatment, sexual problems, and interest in care for sexual problems. We quantified the presence of sexual problems (yes/no) by sociodemographics (age, partnership), menopause status, reconstructive treatment (delayed versus immediate reconstruction), and interest in care for sexual problems.
Results
Of 185 patients, 164 completed the questionnaire (89%). Mean age was 50 years (22-74 years). 73% had experienced menopause (30% naturally, 70% therapy -induced) and 73% had a current intimate partner. Of the women under the age of 50 (n=82, 50%), 94% experienced menopause due to therapy. 52% of patients presented for immediate reconstruction. Almost half of respondents had at least one sexual problem (49%); 43% of these patients attributed the problem(s) to breast cancer or cancer treatment, 29% attributed the problem to breast cancer in addition to other issues. Compared to those without sexual problems, women with sexual problems were more likely to be menopausal (56% versus 44%, p = 0.01) and have intimate partners (53% versus 47%, p = 0.01). Age and reconstructive treatment (delayed versus immediate) were not significantly associated with sexual problems. Almost half of respondents (42%) reported interest in seeking care for sexual problems. Of the women reporting sexual problems, 64% were interested in care, but only 4 had previously sought care.
Conclusions
Surgical and medical therapies for breast cancer can have deleterious effects on women’s sexual health. Almost half of women presenting for breast reconstruction at our institution reported having sexual problems, which is similar to a nationally representative sample of sexually active older women in the US. Menopause, which for most women under 50 was iatrogenic, was significantly associated with having a sexual problem. The presence of sexual problems was not associated with age alone or whether or not the patient was having a delayed versus immediate reconstruction. Breast reconstruction has focused primarily on form; yet the sexual function of the breast goes beyond cosmesis. Therefore, consultation for breast reconstruction presents an opportunity to identify patients with sexual concerns and to refer patients to appropriate care.