Patterns of sexual health in patients with breast cancer in China: a latent class analysis



This study aimed to identify unobserved distinct latent classes/subgroups of breast cancer (BC) patients in China with respect to various sexual health measures and examine the association of the latent membership with individual characteristics.


In a cross-sectional study, 123 BC patients were analyzed. Their sexual health was measured using the Female Sexual Functioning Index (FSFI). Latent class analysis (LCA) was used to examine the patterns of sexual health in patients. Associations of the latent class membership with individual characteristics were examined using multinomial logistic regression.


Three a priori unknown distinct latent classes of patients were identified with respect to the 19 FSFI sexual health measures: 50 patients (41.6%) were classified in class 1 “No Impairment Group,” 49 patients (39.4%) in class 2 “Organic Sexual Dysfunction Group,” and 24 patients (19.1%) in class 3 “Poor Sexual Health Group.” Income and anxiety were positively, whereas disease duration was negatively associated with the likelihood of being in class 2 than in class 1, patients with recurrence of cancer were likely to be in classes 2 and 3. Patients classified in class 3 were more likely to have better prior body image and have more severe menopausal symptoms, whereas less likely to have better post body image and have better partner relationships.


The findings revealed the heterogeneity of sexual health among BC patients in China and may guide to identify the high-risk patients and enable early intervention.

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  1. 1.

    Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, Jemal A, Yu XQ, He J (2016) Cancer statistics in China, 2015. CA Cancer J Clin 66(2):115–132

    Article  Google Scholar 

  2. 2.

    Berterö C, Wilmoth MC (2007) Breast cancer diagnosis and its treatment affecting the self: a meta-synthesis. Cancer Nurs 30(3):194–202

    Article  Google Scholar 

  3. 3.

    Word Health Organisation (1995) The World Health Organization quality of life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med 41(10):1403–1409

    Article  Google Scholar 

  4. 4.

    Lee M, Kim YH, Jeon MJ (2015) Risk factors for negative impacts on sexual activity and function in younger breast cancer survivors. Psycho-Oncol 24(9):1097–1103.

    CAS  Article  Google Scholar 

  5. 5.

    Krychman M, Millheiser LS (2013) Sexual health issues in women with cancer. J Sex Med 10:5–15.

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Aerts L, Christiaens MR, Enzlin P, Neven P, Amant F (2014) Sexual functioning in women after mastectomy versus breast conserving therapy for early-stage breast cancer: a prospective controlled study. Breast 23(5):629–636.

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Barton DL, Ganz PA (2015) Symptoms: menopause, infertility, and sexual health. In: Ganz PA (ed) Improving outcomes for breast cancer survivors: perspectives on research challenges and opportunities, Advances in experimental medicine and biology, vol 862. Springer-Verlag Berlin, Berlin, pp 115–141.

    Google Scholar 

  8. 8.

    Barni S, Mondin R (1997) Sexual dysfunction in treated breast cancer patients. Ann Oncol 8(2):149–153

    CAS  Article  Google Scholar 

  9. 9.

    Schover LR, Yetman RJ, Tuason LJ, Meisler E, Esselstyn CB, Hermann RE, Grundfest-Broniatowski S, Dowden RV (1995) Partial mastectomy and breast reconstruction. A comparison of their effects on psychosocial adjustment, body image, and sexuality. Cancer 75(1):54–64

    CAS  Article  Google Scholar 

  10. 10.

    Safarinejad MR, Shafiei N, Safarinejad S (2013) Quality of life and sexual functioning in young women with early-stage breast cancer 1year after lumpectomy. Psycho-Oncol 22(6):1242–1248.

    Article  Google Scholar 

  11. 11.

    Ganz PA, Greendale GA, Petersen L, Kahn B, Bower JE (2003) Breast cancer in younger women: reproductive and late health effects of treatment. J Clin Oncol 21(22):4184–4193

    Article  Google Scholar 

  12. 12.

    Hawkins Y, Ussher J, Gilbert E, Perz J, Sandoval M, Sundquist K (2009) Changes in sexuality and intimacy after the diagnosis and treatment of cancer the experience of partners in a sexual relationship with a person with cancer. Cancer Nurs 32(4):271–280.

    Article  PubMed  Google Scholar 

  13. 13.

    Toriy AM, Wolpe RE, Pires SA, Sperandio FF (2015) Use of “FSFI” to assess the sexual function of women after gynaecological cancer treatment: systematic literature review. Acta Medica Mediterranea 31(3):697–704

    Google Scholar 

  14. 14.

    Taylor S, Harley C, Ziegler L, Brown J, Velikova G (2011) Interventions for sexual problems following treatment for breast cancer: a systematic review. Breast Cancer Res Treat 130(3):711–724.

    Article  PubMed  Google Scholar 

  15. 15.

    World Health Organization (2006) Defining sexual health: report of a technical consultation on sexual health, 28-31 January 2002, Geneva

  16. 16.

    Ganz PA, Desmond KA, Belin TR, Meyerowitz BE, Rowland JH (1999) Predictors of sexual health in women after a breast cancer diagnosis. J Clin Oncol 17(8):2371–2371

    CAS  Article  Google Scholar 

  17. 17.

    Rajaram N, Lim ZY, Song CV, Kaur R, Mohd Taib NA, Muhamad M, Ong WL, Schouwenburg M, See MH, Teo S-H, Saunders C, Yip CH (2019) Patient-reported outcome measures among breast cancer survivors: a cross-sectional comparison between Malaysia and high-income countries. Psycho-Oncol 28(1):147–153.

    Article  Google Scholar 

  18. 18.

    Rosen CB, Heiman J, Leiblum S, Meston C, Shabsigh R, Ferguson D, D'Agostino R (2000) The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Ther 26(2):191–208

    CAS  Article  Google Scholar 

  19. 19.

    Schneider HP, Heinemann LA, Rosemeier HP, Potthoff P, Potthoff P, Behre HM (2000) The Menopause Rating Scale (MRS): reliability of scores of menopausal complaints. Climacteric 3(1) (1369–7137 (Print)):59–64

    CAS  Article  Google Scholar 

  20. 20.

    Dalton EJ, Rasmussen VN, Classen CC, Grumann M, Palesh OG, Zarcone J, Kraemer HC, Kirshner JJ, Colman LK, Morrow GR, Spiegel D (2009) Sexual adjustment and body image scale (SABIS): a new measure for breast cancer patients. Breast J 15(3):287–290.

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Zigmond A, Snaith R (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370

    CAS  Article  Google Scholar 

  22. 22.

    Busby DM, Christensen C, Crane DR, Larson JH (1995) A revision of the dyadic adjstment scale for use with distressed and nondistressed couples-construct hierarchy and multidimensional scales. J Marital Fam Ther 21(3):289–308.

    Article  Google Scholar 

  23. 23.

    Spanier GB (1976) Measuring dyadic adjustment: new scales for assessing the quality of marriage and similar dyads. J Marriage Fam:15–28

  24. 24.

    Muthén BO (2002) Beyond SEM: general latent variable modeling. Behaviormetrika 29(1):81–117

    Article  Google Scholar 

  25. 25.

    Collins LM, Lanza ST (2010) Latent class and latent transition analysis : with applications in the social behavioral, and health sciences. Wiley, New York

    Google Scholar 

  26. 26.

    Muthén BO, Muthén L (2010) Mplus T echnical appendices. Los Angeles, CA

    Google Scholar 

  27. 27.

    Arbuckle JL (1996) Full information estimation in the presence of incomplete data. In: Advanced structural equation modeling: issues and techniques. Lawrence Erlbaum Associates, pp 243-278

  28. 28.

    Little RJ, Rubin DB (2002) Statistical analysis with missing data, 2nd edn. John Wiley & Sons, New York

    Book  Google Scholar 

  29. 29.

    Asparouhov T, Muthén B (2014) Auxiliary variables in mixture modeling: three-step approaches using M plus. Struct Equ Model Multidiscip J 21(3):329–341

    Article  Google Scholar 

  30. 30.

    Nylund KL, Asparouhov T, Muthén BO (2007) Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Struct Equ Model Multidiscip J 14(4):535–569

    Article  Google Scholar 

  31. 31.

    Park H, Yoon HG (2013) Menopausal symptoms, sexual function, depression, and quality of life in Korean patients with breast cancer receiving chemotherapy. Support Care Cancer 21(9):2499–2507.

    Article  PubMed  Google Scholar 

  32. 32.

    Berkey FJ (2010) Managing the adverse effects of radiation therapy. Am Fam Physician 82(4):381–388

    PubMed  Google Scholar 

  33. 33.

    Sarenmalm EK, Ohlen J, Jonsson T, Gaston-Johansson F (2007) Coping with recurrent breast cancer: predictors of distressing symptoms and health-related quality of life. J Pain Symptom Manag 34(1):24–39.

    Article  Google Scholar 

  34. 34.

    Adams PF, Dey AN, Vickerie JL (2007) Summary health statistics for the US population; National Health Interview Survey, 2005

  35. 35.

    Fu MR, Xu B, Liu Y, Haber J (2008) ‘Making the best of it’: Chinese women’s experiences of adjusting to breast cancer diagnosis and treatment. J Adv Nurs 63(2):155–165

    Article  Google Scholar 

  36. 36.

    Christie KM, Meyerowitz BE, Maly RC (2010) Depression and sexual adjustment following breast cancer in low-income Hispanic and non-Hispanic White women. Psycho-Oncol 19(10):1069–1077.

    Article  Google Scholar 

  37. 37.

    Boquiren VM, Esplen MJ, Wong JH, Toner B, Warner E, Malik N (2016) Sexual functioning in breast cancer survivors experiencing body image disturbance. Psycho-Oncol 25(1):66–76.

    Article  Google Scholar 

  38. 38.

    Fang S-Y, Lin Y-C, Chen T-C, Lin C-Y (2015) Impact of marital coping on the relationship between body image and sexuality among breast cancer survivors. Support Care Cancer 23(9):2551–2559.

    Article  PubMed  Google Scholar 

  39. 39.

    Kenyon M, Mayer DK, Owens AK (2014) Late and long-term effects of breast cancer treatment and surveillance management for the general practitioner. J Obstet Gynecol Neonatal Nurs 43(3):382–398

    Article  Google Scholar 

  40. 40.

    Bredart A, Dolbeault S, Savignoni A, Besancenet C, This P, Giami A, Michaels S, Flahault C, Falcou MC, Asselain B, Copel L (2011) Prevalence and associated factors of sexual problems after early-stage breast cancer treatment: results of a French exploratory survey. Psycho-Oncol 20(8):841–850.

    Article  Google Scholar 

  41. 41.

    Wang FL, Chen F, Huo XQ, Xu RB, Wu L, Wang JM, Lu C (2013) A neglected issue on sexual well-being following breast cancer diagnosis and treatment among Chinese women. PLoS One 8 (9). doi:

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The study was sponsored by the National Natural Science Foundation of China, 2019 (No. 71874032) and Scientific Research Foundation of Shanghai Municipal Commission of Health and Family Planning, 2016(No. 20164Y0135).

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Correspondence to Changrong Yuan.

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Yuan, X., Wang, J., Bender, C.M. et al. Patterns of sexual health in patients with breast cancer in China: a latent class analysis. Support Care Cancer 28, 5147–5156 (2020).

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  • Breast cancer
  • Sexual health
  • Female sexual dysfunction
  • Latent class analysis (LCA)