title: Sexual function after breast cancer.
abstract: BACKGROUND
  Breast cancer (BC) remains the most common non-skin cancer in women and an increasing number are living as BC survivors.
  
  
  OBJECTIVE
  The aim of this article is to evaluate the impact of the first diagnosis of invasive BC and its treatment, menopausal symptoms, and body image on sexual function.
  
  
  METHODS
  The BUPA Foundation Health and Wellbeing after Breast Cancer Study is a prospective cohort study of 1,684 women recruited within 12 months of their first diagnosis with invasive BC. Each participant completed an enrollment questionnaire (EQ) and first follow-up questionnaire (FQ1) 12 months post-EQ.
  
  
  METHODS
  Sexual function was evaluated by the Menopause-Specific Quality of Life Questionnaire embedded within the FQ1.
  
  
  RESULTS
  Of the 1,011 women in the analyses, 70% experienced sexual function problems and 77% reported vasomotor symptoms. Women experiencing sexual function problems were postmenopausal (P = 0.02), experienced vasomotor symptoms (P < 0.01), and used aromatase inhibitors (P = 0.03). Women with vasomotor symptoms were twice as likely to experience sexual function problems (odds ratio [OR] 1.93, 95% confidence interval [CI] 141, 2.63; P < 0.001). This association was more extreme for women on aromatase inhibitors (OR 3.49, 95% CI 1.72, 7.09; P = 0.001) but did not persist in women not using endocrine therapies (OR 1.41, 95% CI 0.84, 2.36; P = 0.19). Women on aromatase inhibitors were more likely to report sexual function problems (OR 1.50, 95% CI 1.0, 2.2, P = 0.04) and women with body image issues were 2.5 times more likely to report sexual function problems (OR 2.5 95% CI 1.6, 3.7, P < 0.001). Women using tamoxifen were not more likely to experience sexual function problems (OR 1.1, 95% CI 0.8, 1.5, P = 0.6); however, women with body image issues were twice as likely to experience sexual function problems (OR 2.1, 95% CI 1.5, 3.0, P < 0.001).
  
  
  CONCLUSIONS
  Seventy percent of partnered BC survivors less than 70 experienced sexual function problems. Sexual problems are related to the use of aromatase inhibitors which can exacerbate menopausal symptoms.
authors.affiliation: Monash University Medical School, Alfred Hospital-Women's Health Program, Department of Medicine, Prahran, Victoria, Australia. mary.panjari@monash.edu
authors.forename: Mary
authors.initials: M
authors.lastname: Panjari
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Bell
authors.forename: Susan R
authors.initials: SR
authors.lastname: Davis
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D047072:Aromatase Inhibitors / Q000009:adverse effects; D001828:Body Image; D001943:Breast Neoplasms / Q000150:complications* / Q000523:psychology*; D015914:Estrogen Replacement Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008408:Mastectomy / Q000523:psychology; D008875:Middle Aged; D015999:Multivariate Analysis; D011788:Quality of Life; D012735:Sexual Dysfunction, Physiological / Q000209:etiology*; D019529:Sexuality; D017741:Survivors / Q000523:psychology; D013629:Tamoxifen / Q000009:adverse effects; D014739:Victoria
chemical_list: D000970:Antineoplastic Agents; D047072:Aromatase Inhibitors; D013629:Tamoxifen