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Breast cancer

Breast cancer management can involve a variety of treatment modalities including surgery, chemotherapy, radiotherapy and endocrine therapies. Any of these treatments, alone or combined, can impact on sexual function. Sexual difficulties related to breast cancer treatment can include changes in body image, self‐esteem, desire, arousal and vaginal function (dryness and atrophic changes), and intimacy and relationship problems (Katz [137]).
The surgical management of breast cancer may consist of breast conservation (lumpectomy, wide local excision) or mastectomy with or without breast reconstruction (autologous tissue reconstruction or implant). All of these procedures cause scars and can result in sensation changes. Sexual function can be negatively affected due to the development of body image concerns and changes to sexual satisfaction related to impaired erogenous zones in the body and pain (Schlenz et al. [248]).
Chemotherapy can cause significant body image changes due to chemotherapy‐induced alopecia and weight gain. The impact of cytotoxic drugs on ovarian function or the inclusion of ovarian suppression during chemotherapy can result in changes in desire, arousal, vaginal lubrication, pain, sexual satisfaction and orgasm (Ochsenkuhn et al. [212]).
Radiation treatment can impact on sexual function due to fatigue and pain that can affect desire and arousal. Skin changes and tattoos can lead to body image concerns and lowered self‐esteem (Varela et al. [279]).
Endocrine therapy is an important treatment modality in patients with hormone‐sensitive breast cancers, working by blocking oestrogen receptors or eliminating oestrogen production. These therapies can result in significant sexual difficulties as a consequence of treatment‐related menopausal symptoms including loss of desire, vaginal dryness and atrophy, pain and hot flushes (Derzko and Elliott [79]).
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