| Peer-Reviewed

Sexual Functioning in Women with Breast Cancer: Role of Depression, Anxiety and Coping Styles

Received: 3 March 2022    Accepted: 17 March 2022    Published: 23 March 2022
Views:       Downloads:
Abstract

Sexual dysfunction encompasses a broad spectrum of issues, all of which are susceptible to insult after treatment for cancer. Sexual dysfunction affects up to 90% of women treated for breast cancer, and sexual quality of life is a significant concern for breast cancer survivors. This study investigated role of depression, anxiety and coping styles in developing sexual dysfunctions in 210 women with breast cancer, one year after diagnosis. The median age was 58. Female Sexual Functioning Index (FSFI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Coping Inventory for Stressful Situations (CISS) were used for this purpose. All women stated that before breast cancer they did not have significant sexual problems that would interfere with sexual pleasure. It is noticeable that women included in this study report high levels of pain and discomfort during and after vaginal penetration have low levels of sexual arousal and have significant difficulty achieving orgasm and lubrication, which is significantly associated with high levels of anxiety and moderate to high levels of depression. They are more likely to use a task-oriented coping strategy, and within avoidance as a coping strategy, they are more likely to use a distraction. More frequent use of avoidant strategies and less propensity for emotion-oriented strategies is associated with greater sexual desire. Women who used emotion-oriented coping strategies have more pronounced symptoms of depression and anxiety. Lower levels of overall sexual function were found in women who had a mastectomy (total and partial). Breast reconstruction after mastectomy has a positive influence on sexual functioning, especially on sexual arousal and pleasure, and women who have not had a mastectomy report greater sexual desire and arousal, and less pain during sexual intercourse. Participants who were not exposed to radiotherapy during treatment expressed greater satisfaction with achieving orgasms and lubrication during sexual intercourse. Hierarchical regression analysis indicated that depression, anxiety and coping styles significantly contribute to all domains of sexual functioning. These results add to growing evidence that sexual quality of life is a multidimensional construct with aspects differentially affected by variables related to cancer survivorship.

Published in Psychology and Behavioral Sciences (Volume 11, Issue 2)
DOI 10.11648/j.pbs.20221102.13
Page(s) 58-67
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Breast Cancer, Sexual Dysfunctions, Anxiety, Depression, Coping Style

References
[1] World Cancer Research Fund International (2018). https://www.wcrf.org/dietandcancer/cancer-trends/worldwide-cer-data. Accessed January 31, 2022.
[2] Ferlay, J., Shin, H. F., Bray, F., Forman, D., Mathers, C., & Parkin, D. M. (2010). Estimates Of Worldwide Burden Of Cancer In 2008: GLOBOCAN 2008. International Journal Of Cancer. 127, 2893-917.
[3] Hrvatski zavod za javno zdravstvo, Registar za rak Republike Hrvatske. Incidencija raka u Hrvatskoj 2017., Bilten 42, Zagreb, 2020. https://www.hzjz.hr/wp-content/uploads/2017/01/Bilten-2017-final.pdf. Accesse February 15, 2022.
[4] Gandhi, C., Butler, E., Pesek, S., Kwait, R., Edmondson, D., Raker, C., Clark, M. A., Stuckey, A., & Gass, J. (2019). Sexual Dysfunction in Breast Cancer Survivors: Is it Surgical Modality or Adjuvant Therapy? American Journal of Clinical Oncology, 42 (6), 500-506.
[5] Boswell, E. N., & Dizon, D. S. (2015). Breast cancer and sexual function. Translational Andrology and Urology, 4 (2), 160-168. doi: 10.3978/j.issn.2223-4683.2014.12.04.
[6] Begović-Juhant, A., Chmielewski, A., Iwuagwu, S. & Chapman, L. A. (2012). Impact of body image on depression and quality of life among women with breast cancer. Journal of psychosocial oncology, 30 (4), 446-460. doi: 10.1080/07347332.2012.684856.
[7] Berterö, C. M. (2002). Affected self-respect and self-value: the impact of breast cancer treatment on self-esteem and QoL. Psycho-Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 11 (4), 356-364. doi: 10.1002/pon.577.
[8] Perry, S., Kowalski, T. L., & Chang, C. H. (2007). Quality of life assessment in women with breast cancer: benefits, acceptability and utilization. Health Quality Of Life Outcomes, 5, 24. doi: 10.1186/1477-7525-5-24.
[9] Paraskevi, T. (2012). Quality of life outcomes in patients with breast cancer. Oncology Reviews, 6 (1), e2. doi: 10.4081/oncol.2012.e2.
[10] Sorouri, F., & Yaghubi, H. (2019). Comparing the Negative Emotions, Body Image, Sexual Schemas and Sexual Function in Women with Breast Cancer and Healthy Women. Archives of Psychiatry Research: An International Journal of Psychiatry and Related Sciences, 55 (1), 49-60. https://doi.org/10.20471/may.2019.55.01.04
[11] World Health Organization, “Defining sexual health,” WHO, 2006, http://www.who.int/reproductivehealth/topics/sexual_health/sh_definitions/en/index.html. Accessed February, 15, 2022.
[12] Fobair, P., Stewart, S. L., Chang, S., D'Onofrio, C., Banks, P. J. & Bloom, J. R. (2006). Body image and sexual problems in young women with breast cancer. Psycho-Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 15 (7), 579-594. https://doi: 10.1002/pon.991.
[13] Emilee, G., Ussher, J. M. & Perz, J. (2010). Sexuality after breast cancer: a review. Maturitas, 66 (4), 397-407. doi: 10.1016/j.maturitas.2010.03.027.
[14] Wang, F., Chen, F., Huo, X., Xu, R., Wu, L., Wang, J. i Lu, C. (2013). A neglected issue on sexual well-being following breast cancer diagnosis and treatment among Chinese women. PloS one, 8 (9), e74473. doi: 10.1371/journal.pone.0074473.
[15] Fleming, M. P. & Kleinbart, E. (2001). Breast cancer and sexuality. Journal of sex Education and Therapy, 26 (3), 215-224. https://doi.org/10.1080/01614576.2001.11074416
[16] Blouet, A., Zinger, M., Capitain, O., Landry, S., Bourgeois, H., Seegers, V. T. & Pointreau, Y. (2019). Sexual quality of life evaluation after treatment among women with breast cancer under 35 years old. Supportive Care in Cancer, 27 (3), 879-885. doi: 10.1007/s00520-018-4374-z.
[17] Beckjord, E. & Compas, B. E. (2007). Sexual quality of life in women with newly diagnosed breast cancer. Journal of psychosocial oncology, 25 (2), 19-36. doi: 10.1300/J077v25n02_02.
[18] Hopwood, P., Fletcher, I., Lee, A. i Al Ghazal, S. (2001). A body image scale for use with cancer patients. European journal of cancer, 37 (2), 189-197. doi: 10.1016/s0959-8049(00)00353-1.
[19] Kostov, T., & Tucak Junaković, I. (2018). Zadovoljstvo životom, tjelesnim izgledom i samopercepcija seksualne privlačnosti žena operiranih zbog raka dojke. Hrvatska Revija za Rehabilitacijska Istraživanja, 54 (2), 12-27. https://doi.org/10.31299/hrri.54.2.2
[20] Gopie, J. P., Mureau, M. A., Seynaeve, C., ter Kuile, M. M., Menke-Pluymers, M. B., Timman, R. & Tibben, A. (2013). Body image issues after bilateral prophylactic mastectomy with breast reconstruction in healthy women at risk for hereditary breast cancer. Familial cancer, 12 (3), 479-487. doi: 10.1007/s10689-012-9588-5.
[21] Helms, R. L., O'Hea, E. L. i Corso, M. (2008). Body image issues in women with breast cancer. Psychology, Health and medicine, 13 (3), 313-325. doi: 10.1080/13548500701405509.
[22] Burgess, C., Cornelius, V., Love, S., Graham, J., Richards, M. & Ramirez, A. (2005). Depression and anxiety in women with early breast cancer: five years observational cohort study. British Medical Journal, 330 (7493), 702. doi: 10.1136/bmj.38343.670868.D3.
[23] Leila, M., Nada, C., Kais, C., & Jaweher, M. (2016). Sexuality after breast cancer: cultural specificities of Tunisian population. Pan African Medical Journal, 25 (17). doi: 10.11604/pamj.2016.25.17.10399.
[24] Engel, J., Kerr, J., Schlesinger-Raab, A., Sauer, H., & Holzel, H. (2004). Quality of life following breast-conserving therapy or mastectomy: results of a 5-year prospective study. Breast Journal, 10 (3), 223-231. doi: 10.1111/j.1075-122X.2004.21323.x.
[25] Atisha, D., Alderman, A. K., Lowery, J. C., Kuhn, L. E., Davis, J., & Wilkins, E. G. (2008). Prospective analysis of long-term psychosocial outcomes in breast reconstruction: two-year postoperative results from the Michigan Breast Reconstruction Outcomes Study. Annual Surgery, 247, 1019-1028. doi: 10.1097/SLA.0b013e3181728a5c.
[26] Metcalfe, K. A., Semple, J., Quan, M. L., Vadaparampil, S. T., Holloway, C., Brown, M., Bower, B., Sun, P., & Narod, S. A. (2012). Annals of Surgical Oncology, 19 (1), 233-241. doi: 10.1245/s10434-011-1828-7.
[27] Albornoz, C. R., Matros, E., McCarthy, C. M., Klassen, A., Cano, S. J., Alderman, A. K., VanLaeken, N., Lennox, P., Macadam, S. A., Disa, J. J., Mehrara, B. J., Cordeiro, P. G., & Pusic, A. L. (2014). Implant breast reconstruction and radiation: a multicenter analysis of long-term health-related quality of life and satisfaction. Annals of Surgical Oncology, 21 (7): 2159-2164. doi: 10.1245/s10434-014-3483-2.
[28] Biglia, N., Moggio, G., Peano, E., Sgandurra, P., Ponzone, R., Nappi, R. E., & Sismondi, P. (2010). Effects of surgical and adjuvant therapies for breast cancer on sexuality, cognitive functions, and body weight. Journal of Sexual Medicine, 7 (5), 1891-1900. doi: 10.1111/j.1743-6109.2010.01725.x.
[29] Bartula, I., & Sherman, K. A. (2013). Screening for sexual dysfunction in women diagnosed with breast cancer: systematic review and recommendations. Breast Cancer Research Treatment, 141 (2), 173-185. doi: 10.1007/s10549-013-2685-9.
[30] Brandão, T., Schulz, M. S., & Matos PM. (2017). Psychological adjustment after breast cancer: a systematic review of longitudinal studies. Psychooncology, 26 (7), 917-926. doi: 10.1002/pon.4230.
[31] Watson, M., Homewood, J., & Haviland, J. (2012). Coping response and survival in breast cancer patients: a new analysis. Stress Health, 28 (5), 376-80. doi: 10.1002/smi.2459.
[32] Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck depression inventory (BDI-II). Pearson.
[33] Wiebe, J. S. & Penley, J. A. (2005). A psychometric comparison of the Beck Depression Inventory-II in English and Spanish. Psychological assessment, 17 (4), 481. https://doi.org/10.1037/1040-3590.17.4.481
[34] Stapleton, L. M., Sander, J. B. & Stark, K. D. (2007). Psychometric properties of the Beck Depression Inventory for Youth in a sample of girls. Psychological Assessment, 19 (2), 230. https://doi.org/10.1037/1040-3590.19.2.230
[35] Beck, A. T., & Steer, R. A. (1990). Manual for the Beck Anxiety Inventory. San Antonio, TX: Psychological Corporation.
[36] Endler, N. S., & Parker, J. D. A. (1990). Coping Inventory for Stressful Situations (CISS): Manual. Toronto: Multi-Health Systems.
[37] Rosen, R., Brown, C., Heiman, J., Leiblum, S., Meston, C., Shabsigh, R., Ferguson, D., & D'Agostino, R. Jr. (2000). The Female Sexual Function Index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function. Journal of Sex & Marital Therapy, 26 (2), 191–208. doi: 10.1080/009262300278597.
[38] Field, A. (2018). Discovering statistics using IBM SPSS statistics. SAGE Publications.
[39] Aron, A. & Aron, E. N. (1994). Statistics for psychology. Prentice Hall, Englewood Cliffs, New Jersey.
[40] Kline, R. B. (2011). Methodology in the social sciences. Principles and Practice of Structural Equation Modelling (3rd ed.). New York: Guilford Press.
[41] Ooi, P. S., Draman, N., Muhamad, R., Yusoff, S. S. M., Noor, N. M., Haron, J., & Hadi, I. S. A. (2021). Sexual Dysfunction Among Women With Breast Cancer in the Northeastern Part of West Malaysia. Sexual Medicine, 9 (3), 100351. doi: 10.1016/j.esxm.2021.100351.
[42] Canzona, M. R., Fisher, C. L., Wright, K. B. & Ledford, C. J. (2019). Talking about sexual health during survivorship: understanding what shapes breast cancer survivors’ willingness to communicate with providers. Journal of Cancer Survivorship, 13 (6), 932-942. doi: 10.1007/s11764-019-00809-2.
[43] Bakewell, R. T. & Volker, D. L. (2005). Sexual dysfunction related to the treatment of young women with breast cancer. Clinical Journal of Oncology Nursing, 9 (6), 697-702. doi: 10.1188/05.CJON.697-702.
[44] Telli, S. & Gürkan, A. (2020). Examination of Sexual Quality of Life and Dyadic Adjustment among Women with Mastectomy. European Journal of Breast Health, 16 (1), 48. doi: 10.5152/ejbh.2019.4969.
[45] Faghani, S. & Ghaffari, F. (2016). Effects of sexual rehabilitation using the PLISSIT model on quality of sexual life and sexual functioning in post-mastectomy breast cancer survivors. Asian Pacific journal of cancer prevention, 17 (11), 4845. doi: 10.22034/APJCP.2016.17.11.4845.
[46] Rezaei, M., Elyasi, F., Janbabai, G., Moosazadeh, M. & Hamzehgardeshi, Z. (2016). Factors influencing body image in women with breast cancer: a comprehensive literature review. Iranian Red Crescent Medical Journal, 18 (10), e39465. doi: 10.5812/ircmj.39465.
[47] Parker, J. D. A., & Endler, N. S. (1992). Coping with coping assessment: a critical review. European Journal of Personality, 6, 321–344. doi: 10.1002/per.2410060502.
[48] Che Ya, S. N., Muhamad, R., Mohd Zain, N., Zakaria, R., Ishak, A., Hassan, I. I., Ab Hadi, I., Yahya, M. M., Low, W. Y. & Liamputtong, P. (20219. Coping Strategies for Sexual Problems and Sexual Dysfunction Amongst Malay Women With Breast Cancer. A Qualitative Study. Sexual Medicine, 9 (3), 100336. doi: 10.1016/j.esxm.2021.100336.
Cite This Article
  • APA Style

    Lovorka Brajkovic. (2022). Sexual Functioning in Women with Breast Cancer: Role of Depression, Anxiety and Coping Styles. Psychology and Behavioral Sciences, 11(2), 58-67. https://doi.org/10.11648/j.pbs.20221102.13

    Copy | Download

    ACS Style

    Lovorka Brajkovic. Sexual Functioning in Women with Breast Cancer: Role of Depression, Anxiety and Coping Styles. Psychol. Behav. Sci. 2022, 11(2), 58-67. doi: 10.11648/j.pbs.20221102.13

    Copy | Download

    AMA Style

    Lovorka Brajkovic. Sexual Functioning in Women with Breast Cancer: Role of Depression, Anxiety and Coping Styles. Psychol Behav Sci. 2022;11(2):58-67. doi: 10.11648/j.pbs.20221102.13

    Copy | Download

  • @article{10.11648/j.pbs.20221102.13,
      author = {Lovorka Brajkovic},
      title = {Sexual Functioning in Women with Breast Cancer: Role of Depression, Anxiety and Coping Styles},
      journal = {Psychology and Behavioral Sciences},
      volume = {11},
      number = {2},
      pages = {58-67},
      doi = {10.11648/j.pbs.20221102.13},
      url = {https://doi.org/10.11648/j.pbs.20221102.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.pbs.20221102.13},
      abstract = {Sexual dysfunction encompasses a broad spectrum of issues, all of which are susceptible to insult after treatment for cancer. Sexual dysfunction affects up to 90% of women treated for breast cancer, and sexual quality of life is a significant concern for breast cancer survivors. This study investigated role of depression, anxiety and coping styles in developing sexual dysfunctions in 210 women with breast cancer, one year after diagnosis. The median age was 58. Female Sexual Functioning Index (FSFI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Coping Inventory for Stressful Situations (CISS) were used for this purpose. All women stated that before breast cancer they did not have significant sexual problems that would interfere with sexual pleasure. It is noticeable that women included in this study report high levels of pain and discomfort during and after vaginal penetration have low levels of sexual arousal and have significant difficulty achieving orgasm and lubrication, which is significantly associated with high levels of anxiety and moderate to high levels of depression. They are more likely to use a task-oriented coping strategy, and within avoidance as a coping strategy, they are more likely to use a distraction. More frequent use of avoidant strategies and less propensity for emotion-oriented strategies is associated with greater sexual desire. Women who used emotion-oriented coping strategies have more pronounced symptoms of depression and anxiety. Lower levels of overall sexual function were found in women who had a mastectomy (total and partial). Breast reconstruction after mastectomy has a positive influence on sexual functioning, especially on sexual arousal and pleasure, and women who have not had a mastectomy report greater sexual desire and arousal, and less pain during sexual intercourse. Participants who were not exposed to radiotherapy during treatment expressed greater satisfaction with achieving orgasms and lubrication during sexual intercourse. Hierarchical regression analysis indicated that depression, anxiety and coping styles significantly contribute to all domains of sexual functioning. These results add to growing evidence that sexual quality of life is a multidimensional construct with aspects differentially affected by variables related to cancer survivorship.},
     year = {2022}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Sexual Functioning in Women with Breast Cancer: Role of Depression, Anxiety and Coping Styles
    AU  - Lovorka Brajkovic
    Y1  - 2022/03/23
    PY  - 2022
    N1  - https://doi.org/10.11648/j.pbs.20221102.13
    DO  - 10.11648/j.pbs.20221102.13
    T2  - Psychology and Behavioral Sciences
    JF  - Psychology and Behavioral Sciences
    JO  - Psychology and Behavioral Sciences
    SP  - 58
    EP  - 67
    PB  - Science Publishing Group
    SN  - 2328-7845
    UR  - https://doi.org/10.11648/j.pbs.20221102.13
    AB  - Sexual dysfunction encompasses a broad spectrum of issues, all of which are susceptible to insult after treatment for cancer. Sexual dysfunction affects up to 90% of women treated for breast cancer, and sexual quality of life is a significant concern for breast cancer survivors. This study investigated role of depression, anxiety and coping styles in developing sexual dysfunctions in 210 women with breast cancer, one year after diagnosis. The median age was 58. Female Sexual Functioning Index (FSFI), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and Coping Inventory for Stressful Situations (CISS) were used for this purpose. All women stated that before breast cancer they did not have significant sexual problems that would interfere with sexual pleasure. It is noticeable that women included in this study report high levels of pain and discomfort during and after vaginal penetration have low levels of sexual arousal and have significant difficulty achieving orgasm and lubrication, which is significantly associated with high levels of anxiety and moderate to high levels of depression. They are more likely to use a task-oriented coping strategy, and within avoidance as a coping strategy, they are more likely to use a distraction. More frequent use of avoidant strategies and less propensity for emotion-oriented strategies is associated with greater sexual desire. Women who used emotion-oriented coping strategies have more pronounced symptoms of depression and anxiety. Lower levels of overall sexual function were found in women who had a mastectomy (total and partial). Breast reconstruction after mastectomy has a positive influence on sexual functioning, especially on sexual arousal and pleasure, and women who have not had a mastectomy report greater sexual desire and arousal, and less pain during sexual intercourse. Participants who were not exposed to radiotherapy during treatment expressed greater satisfaction with achieving orgasms and lubrication during sexual intercourse. Hierarchical regression analysis indicated that depression, anxiety and coping styles significantly contribute to all domains of sexual functioning. These results add to growing evidence that sexual quality of life is a multidimensional construct with aspects differentially affected by variables related to cancer survivorship.
    VL  - 11
    IS  - 2
    ER  - 

    Copy | Download

Author Information
  • Faculty of Croatian Studies, University of Zagreb, Zagreb, Croatia

  • Sections