Sexual health and body image in breast cancer survivors: a prospective, multicenter, 5-year longitudinal study

Introduction: Breast cancer survivors face lots of difficulties, such as psychological and sexual problems, even years after treatment. In this study, we aimed to evaluate sexual health and body image in breast cancer survivors (BCS) during a 5-year follow-up study. Methods: This prospective longitudinal study recruited 1250 female patients with breast cancer from five referral medical centers located in Tehran, Iran. All participants had completed the standard treatments within one month. The demographic and clinical information were obtained immediately after treatment completion. Data on body image and sexual function were collected using the Body Image Concern Inventory (BICI) and the Female Sexual Function Index (FSFI), respectively, at three time points: baseline (immediately), 1 year, and 5 years after treatment completion. The relationship between women's sexual function scores and body image dissatisfaction with various demographic factors was examined using linear regression. Results: Of 1,115 breast cancer survivors who participated in the study, 856 women (76.7%) completed the study by five years of follow-up. Body image distress score were reported 32.98±11.95 at immediately, 28.79±11.19 at 1 year, and 22.73±7.95 at 5 years after treatment completion and trend of total sexual function index changes during 5-year follow up (9.71±7.88, 11.67±8.14 and 10.14±7.76 at immediately, 1 year and 5 years after treatment completion, respectively), showed a significant improvement in body image distress and total sexual function during follow up period (p<0.001). A significant decline in desire was observed over 5 years (p<0.001). In addition, older age at diagnosis, higher baseline depression, and higher stage of disease were associated with more severe sexual dysfunction, while being married was associated with better sexual function. Body image dissatisfaction decreased with time since treatment and older age at diagnosis, while baseline depression was associated with increased long-term body image concerns. Conclusion: Given the decline in the desire subscale of FSFI, despite body image and sexual function improvement following years after treatment in BCS, and the role of depression immediately after treatment completion in body image concern and sexual dysfunction, the need for psychological counseling to reduce depression, as well as ongoing sexual counseling in short and long-term follow-up periods after breast cancer treatment, is evident.