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    Sexuality and Reproductive Issues (PDQ®): Supportive care - Health Professional Information [NCI] - Factors Affecting Sexual Function in People With Cancer

    Sexual dysfunction may be multifactorial; both physical and psychological factors contribute to its development. Physical factors include the following:

    • Functional damage secondary to cancer therapies.
    • Fatigue.
    • Pain.

    In addition, cancer therapies such as surgery, chemotherapy, radiation therapy, and bone marrow transplantation may have a direct physiologic impact on sexual function.[1] Medications used to treat pain, depression, and other symptoms may contribute to sexual dysfunction.

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    Psychological factors include the following:[2,3]

    • Misbeliefs about the origin of the cancer.
    • Guilt related to these misbeliefs.
    • Coexisting depression.
    • Changes in body image after surgery.
    • Stresses to personal relationships that occur secondary to cancer.

    Increasing age is often believed to be associated with decreased sexual desire and performance; however, in one study, elderly men reported that sex remains important to their quality of life, that performance can be maintained into the 70s and 80s, and that altered sexual function is distressing.[4]

    Treatment-related Factors Secondary to Surgery

    A number of cancer treatments have a direct physiologic impact on sexual function. As treatment success has improved for some sites, attempts have been made to modify treatment to reduce sexual morbidity. Several predictors of postoperative sexual functioning include the following:

    • Patient's age.
    • Premorbid sexual and bladder functioning.
    • Tumor location.
    • Tumor size.
    • Extent of surgical resection.

    Breast cancer

    Sexual function after localized treatment for breast cancer has been the subject of a good deal of research. Several reviews concur that breast conservation or reconstruction have only a minor impact in preserving sexual function compared with a mastectomy alone.[5,6] Women who have breast conservation, in particular, are more likely to continue to enjoy breast caressing, but groups typically do not differ on less subtle variables such as the frequency of sex, ease of reaching orgasm, or overall sexual satisfaction.

    A cross-sectional survey of younger women (aged 50 years or younger) with breast cancer found in multivariate analyses that having a mastectomy was associated with greater problems in interest in sex; chemotherapy was associated with greater sexual dysfunction.[7] Other studies confirm that sexual quality of life is disrupted more among those receiving chemotherapy, those who have undergone total mastectomies, those whose cancers were detected at later stages, and those with more depressive symptoms near the time of diagnosis.[8] A large survey of women with breast cancer who were being treated with either adjuvant tamoxifen or adjuvant exemestane (an aromatase inhibitor) was conducted to evaluate the differences in menopausal symptoms associated with these two agents. After 1 year of use, exemestane was associated with fewer hot flashes and less vaginal discharge than tamoxifen but with more vaginal dryness, bone pain, and sleep disorders.[9]

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