Sexual activity and functioning after breast cancer treatment: perspectives on the importance of pleasure from a radiotherapy cohort.

BACKGROUND: Breast cancer affects millions of women and while treatment can be lifesaving, it also has numerous side effects, including those related to sexual function, which often impact the ability to experience pleasure from sex. This study aimed to understand how breast cancer survivors define sexual activity, identify important aspects, and ascertain perceived impacts of treatment on sexual activity and function, particularly related to pleasure. METHODS: Semi-structured interviews were conducted with women who were breast cancer survivors at least one-year post-radiation. Priority populations were oversampled (racial/ethnic/sexual/gender minorities, those aged over 65 or under 45). The sample included 23 participants: 11 Non-Hispanic White, 8 Non-Hispanic Black, 2 Non-Hispanic Asian, 2 Hispanic/Latinx, and 1 transgender participant. Mean age was 58.6 years (range 34-77, SD = 12.2). RESULTS: Four themes were identified: 1) Sexual activity is defined broadly, and intimacy and pleasure are key. Participants defined sex in broad terms and highlighted the importance of being close with partners and pleasure. Sex was important across the lifespan and among participants from different backgrounds, 2) Few anticipated sexual side effects: Although treatment side effects were common, few expected them, 3) Clinician communication is lacking or mistimed: Participants did not remember conversations about potential side effects because they did not happen, or they were not in a mental space to process them, 4) Sexual health side effects are plentiful and for many, long-lasting. Changes to breast sensitivity and ability to achieve orgasm were reported. Breast cancer survivors conceptualized sexual activity through a broad lens and highlighted the importance of sex, particularly pleasure and intimacy. Participants reported a variety of negative effects from treatment that impacted pleasure, and patient/clinician communication on sexual health was perceived to be lacking. CONCLUSION: Clinicians may improve survivors' quality of life by acknowledging clinical origins of sexual dysfunction, prioritizing pleasure and intimacy in the development of interventions to prevent or mitigate sexual side effects and fostering open communication.