Our study demonstrates that breast cancer survivors have a high rate of sexual inactivity (58.7%) and sexual satisfaction (43.8%), which is consistent with previous research reports [13, 25, 26]. We found that despite the prevalence of sexual health problems, there were differences in the variables affecting sexual inactivity and satisfaction.
Sexual dissatisfaction and sexual inactivity after a breast cancer diagnosis are a common phenomenon that is undertreated, especially in breast cancer survivors. Through a cohort study, Wettergren et al. has shown that body image, anxiety, and depression were associated with sexual dissatisfaction and have lasting effects on it . Karin et al. suggested that treatment-induced symptoms, depression, and age were predictors of sexual problems . Through a qualitative study, Maryam et al. indicated that adverse sexual function (vaginal dryness or pain, changes in sexual desire, and decreased sexual arousal) leads to decreased sexual satisfaction among survivors . Jennifer et al. concluded that a quarter of couples are not having sex because they are uninterested in it (78%) and too tired (44%) . In the present study, in addition to the previous findings from other scholars, we found that misguided sexual thinking was strongly associated with sexual inactivity. Meanwhile, body image, psychology, and lack of sexual information from health care providers were more significant for sexual dissatisfaction. We also identified that the sexual demands of the partner led to increased sexual dissatisfaction among the survivors.
The impact of changes in mental and body image and intimacy on sexual dissatisfaction in breast cancer survivors after treatment has received attention, but misinformation about sex has been ignored. In our study, a particularly important finding is that sexual inactivity is associated with misleading sexual thinking. We investigated misconceptions about sexual activity to cancer recovery, recurrence, metastasis, and stimulating estrogen growth. Nearly half of the participants reported that they believed sexual activity can affect their recovery from the disease (49.8%), causes cancer recurrence or metastasis (41.6%), and may alter estrogen levels and stimulate tumor growth (48.9%). However, sexuality is not a taboo for breast cancer survivors, and no research revealed that sexual activity was related to breast cancer recurrence and metastasis. Changing this misleading thinking of cancer patients needs essential education to the patients and their partners.
Although guidelines for sexual health care for cancer survivors clearly suggest that sexual health resources should be conducive to sexual health [3, 28]. In our study, most participants were not provided with therapeutic sexual aids or any other sexual health resources (89.3%). Similar results were found in a study by Sharon et al., which surveyed 25 comprehensive cancer centers affiliated with both the National Cancer Institute and the National Comprehensive Care Network. They identified that 72% of hospitals did not provide therapeutic sexual aids or any other sexual health resources. Nowadays, health care providers in China pay less concerned about sexual function when treating breast cancer . In our study, the majority of survivors expected health care workers to ask about sexual health regularly (66.0 %). In the present study, our participants reported a higher degree of embarrassment around provider discussions (86.1%), which is contrary to the finding (12.0% )of Chapman et al. . This difference may be caused by the taboo on sex in Chinese culture. This disparity should be further explored and taboos in communication between patients and healthcare providers improved.
Partnered sexual activity was strongly associated with the recovery of sexual function in patients with breast cancer after treatment [6, 32]. Partners' initiation of sex predicted a positive trend in the sexual health of breast cancer patients[33, 34]. Similarly, intimate partners can buffer patients’ cancer-related stress and promoting positive sexual relationships. In the present study, sexual dissatisfaction increases as partner-requested sexual demand. One possible explanation is that problems that don't improve during breast cancer treatment, such as sexual discomfort, anxiety, depression, and self-image issues, all negatively affect a couple's sexual satisfaction . Another possible explanation is that simply dealing with a patient's sexual relationship with an intimate partner may not improve the sexual problems of breast cancer survivors [33, 34].
There were a few predictive demographic variables of note in our study, particularly related to residence and education level. Those with higher levels of education and living in cities reported more sexual dissatisfaction than those with lower levels of education and living in the countryside. This disparity should be explored further because it might suggest that patients with lower levels of education are at even higher risk for neglect of discussion and treatment of sexual dysfunction.
In practice, there is a lack of health care in cancer management in China . According to our findings, the professional sexual education and consultation should be an effective therapy to improve the sexual knowledge of breast cancer survivors. In addition, the impact of the partner's proactive needs on sexual satisfaction also needs to be taken into account when developing couples' therapy together.
To our best knowledge, the present study is the first cross sectional study to explore the possible factors associated with sexual inactivity and sexual dissatisfaction. As an instinct problem of the observational study, there were unrealized confounders which may decrease the evidence quality of our findings. Future high-quality longitudinal studies are needed to confirm our findings.