Breast cancer is the most common cancer in women, threatening various aspects of personal and mental health, life quality, sexual function and sexual satisfaction, because of such complications as mastectomy. Considering the importance of sexual function and sexual satisfaction and its effect on quality of life, the present study is conducted with the goal of studying the effect of group counseling on sexual function and sexual satisfaction of women who had mastectomy surgery. 40% of patients afflicted to breast cancer, suffer sexual dysfunction upon commencement of treatment and 50% of women who are afflicted to breast cancer experience these disorders in long time. Usually the treatment team focus on preserving and continuing patient’s life and less attention is paid to patients’ sexual function. Depression and stress after diagnosis of breast cancer, side effects of chemotherapy medicines during treatment, and disorder of mental image of the body after mastectomy are all causes of sexual dysfunction (22). Significant difference was created in all 6-fold areas of sexual function and those tested achieved higher grades in each phase and this shows that counseling has improved their sexual function. In a study conducted by Rostamkhani et al. in the stages of two weeks and four weeks after counseling, significant difference was observed between the average score of sexual function in the two intervention and observation group. Also in the intervention group, significant difference was created between the average scores of the areas of sexual desire, sexual arousal, wetness during sexual intercourse, orgasm, sexual satisfaction and pain before and after counseling, and the scores after counseling had significantly increased (23). Results of the study performed by Heravi Karimoi et al. who identified the effect of group counseling on quality of sexual life in those who suffer from cancer, showed that group counseling will improve the scales of body image, sexual function and sexual enjoyment and the quality of sexual life of afflicted individuals have improved as a result of group counseling (24). In the present study, 21.9% of individuals suffered from sexual function disorder. There was 93.8% improvement in sexual function before intervention compared to the function one month after the intervention (based on total numbers of questionnaires in three time intervals per individual persons). Highest degree of disorder was related to sexual desire and the lowest degree was related to sexual stimulation. This disorder can be resulted from stress, diagnosis and treatment of breast cancer or complications of chemotherapy and surgery operation. In a study conducted by Kedde and et al (2013) in the Netherlands, women who had afflicted to breast cancer in the past 6 years and who were younger than 45 years old, participated in this study. Considering all disorders studied in women of Netherlands’ population, breast cancer was more common among young women. 64% of women who were still under breast cancer treatment, had sexual dysfunction and this disorder was 45% for those women whose treatment was over and they were no longer under treatment. Hormone therapy resulted in permanent genital arousal disorders (PGAD), radical mastectomy resulted in long disorder of female orgasm and painful intercourse and in beginning of menopause half of the women reported that the issue of “changes in sexual function” was observed during treatment. Results showed that sexual disorders among young women who suffered from breast cancer are mostly common and sexual counseling sessions were advised in these people in order to improve the sexual function (25). Results of the study conducted by Wang et al (2013), showed that decreased frequency of sexual relation, sexual unwillingness, menopause symptoms, change in body image, effect on matrimonial relations and wrong imaginations and conceptions regarding the sexual relations were shown (26). In a study conducted by Reese et al. (2020), in order to evaluate an intervention based on couple in addressing the sexual concerns for survivors of breast cancer, 120 couples were studied. This study evaluated the efficiency of a four-session intervention for the couple, carried out via telephone as increasing intimacy. The intervention was performed with full concentration on matrimonial relation and full participation of sexual partners in targeted activities and it improved the matrimonial skills for confronting with sexual issues and increasing intimacy. Using telephone had much more advantages compared to face-to-face methods and based on network. This method was evaluated to be much more appropriate for studies after treatment. Results of the study showed that sexual concerns for breast cancer survivors are not mostly removed and evidence-based interventions are necessary, particularly in those cases that the survivors have partners (27). Thus breast cancer and its normal treatments create disorder in sexual function. This group of patients are afflicted to early menopause, and as a result reduced estrogen will cause vaginal atrophy and reduced androgen will cause reduced sexual desire and arousal.
In the studies carried out in different countries, it has been repeatedly stated that women feel their sexual function is affected by mastectomy (28, 29). Fobair et la. Showed that sexual function problems and the mental image of the body, are the common problems of patients with breast cancer (30). In this study, before intervention 90.6% of persons had low sexual satisfaction and 9.4% had good sexual satisfaction. This is while one month after the intervention, 84.4% of the units subject of research had low sexual satisfaction and 12.5% had good sexual satisfaction, and this was the highest degree of sexual satisfaction in three time periods.
In a study performed by Vardanjani et al (2013), mastectomy surgery in comparison with lumpectomy had noticeable influence on sexual satisfaction of couples and after mastectomy, people suffered from sexual dysfunction (31).
Group counseling is a bilateral process, in which the counselor and a similar group study problems and concerns. In group counseling, members show more reaction to each other and this issue will lead to obtaining insight. Counseling programs, used to improve level of sexual performance and satisfaction, will increase sexual function and sexual satisfaction (15).
Through counseling process, we can teach patients who suffer from cancer, how to live with their disease. As a dynamic process for solving the problem, a counselor can improve the quality of sexual life and significantly reduce stress, increase knowledge, knowledge and strengthen the personal perception of the life targets and improve the patient’s compatibility and capability compliance behaviors(32).
Due to high outbreak and importance of sexual problems and absence of necessary and adequate trainings, group therapy sessions are recommended to be considered for the couples. Problem-solving skills to be trained for women with cancer, beside other therapies, and planning for training psycho-cognitive intervention, specially the problem-solving skill for patients with breast cancer to be carried out.
Among the limitations of this research, we can mention: having no access to patients with breast cancer record, who were not member of the Center, holding no classes for the husbands of these women, because the main focus of this study was on the patients themselves, carrying out study on husbands as care giver will increase participation and boost their motivation, which results in more influence on patients, limited number of studies carried out in the area of specifying the effect of group counseling with the approach of problem solving on sexual function and sexual satisfaction of women who had mastectomy surgery in Iran. Considering the limitations and considerations that this group of recovered patients have, and due to the fact that doing a research in a metropolitan city like Tehran, has many transportation problems, it is recommended that for carrying out group therapy sessions, some centers or institutes to be used.