Annals of Surgical Oncology

, Volume 26, Issue 10, pp 3159–3165 | Cite as

Sexual Dysfunction in Survivorship; the Impact of Menopause and Endocrine Therapy

  • Reed KuehnEmail author
  • Jesse Casaubon
  • Christina Raker
  • David Edmonson
  • Ashley Stuckey
  • Jennifer Gass
Breast Oncology



Sexual dysfunction is common for breast cancer survivors. Premenopausal women with breast cancer are increasingly offered ovarian suppression and aromatase inhibitor (AI) therapy. We evaluated the association of menopausal status and treatment modalities on sexual dysfunction.


We conducted a cross-sectional anonymous Female Sexual Function Index (FSFI) survey of breast cancer survivors between 2000 and 2016. Analysis utilized Kruskal–Wallis test for FSFI scores, Chi square, or Fisher’s exact test for categorical data, and regression analysis for associations.


Of 585 respondents, 278 (47.5%) had complete FSFI scores. Of these, 24 (8.6%) were premenopausal and 80 (28.8%) were pre/perimenopausal at survey completion. Median FSFI scores for premenopausal (31.2, interquartile range [IQR] 26.8–33.6) and pre/perimenopausal (29.2, IQR 25.9–32.2) were similar, whereas postmenopausal women (25.9, IQR 21.0–30.3) were significantly lower (p = 0.0007 and p = 0.0002, respectively). Premenopausal women were less likely to meet criteria for sexual dysfunction (FSFI score ≤ 26.55) than postmenopausal women (21 versus 55%, p < 0.0001, univariate analysis [odds ratio (OR) 0.32, 95% confidence interval (CI) 0.18–0.56]). Adjusting for treatment modality did not impact the significance (OR 0.43, 95% [CI] 0.23–0.80) but revealed that AIs independently are associated with sexual dysfunction (OR 2.41, 95% CI 1.32–4.40). The interaction between menopausal status and AIs was not significant (p = 0.24).


Our study demonstrates that menopausal status is associated with sexual dysfunction in breast cancer patients and sexual dysfunction in premenopausal women is not impacted by treatment modality outside of aromatase inhibitor therapy. As more premenopausal patients are treated with ovarian suppression, these data may guide clinicians in counseling patients regarding sexual dysfunction expectations.



The authors have indicated they have no potential conflicts of interest to disclose.


  1. 1.
    National Cancer Institute. National Cancer Institute: Surveillance Epidemiology and End Results Program.Google Scholar
  2. 2.
    Park H, Yoon HG. Menopausal symptoms, sexual function, depression, and quality of life in Korean patients with breast cancer receiving chemotherapy. Support Care Cancer. 2013;21(9):2499–507. Scholar
  3. 3.
    Kowalczyk R, Nowosielski K, Cedrych I, et al. Factors affecting sexual function and body image of early-stage breast cancer survivors in Poland: a short-term observation. Clin Breast Cancer. 2019;19(1):e30–9. Scholar
  4. 4.
    Arraras JI, Illarramendi JJ, la Cruz de S, et al. Erratum: Quality of life in long-term premenopausal early-stage breast cancer survivors from Spain. Effects of surgery and time since surgery. J BUON. 2016;21(6):1573.Google Scholar
  5. 5.
    Francis PA, Pagani O, Fleming GF, et al. Tailoring adjuvant endocrine therapy for premenopausal breast cancer. N Engl J Med. 2018;379(2):122–37. Scholar
  6. 6.
    Francis PA, Regan MM, Fleming GF, et al. Adjuvant ovarian suppression in premenopausal breast cancer. N Engl J Med. 2015;372(5):436-46. Scholar
  7. 7.
    Pagani O, Regan MM, Francis PA. Are SOFT and TEXT results practice changing and how? Breast. 2016;27:122-5. Scholar
  8. 8.
    Burstein HJ, Lacchetti C, Anderson H, et al. Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: ASCO Clinical Practice Guideline Focused Update. J Clin Oncol. 2019;37(5):423-38. Scholar
  9. 9.
    Regan MM, Francis PA, Pagani O, et al. Absolute benefit of adjuvant endocrine therapies for premenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2-negative early breast cancer: TEXT and SOFT Trials. J Clin Oncol. 2016;34(19):2221-31. Scholar
  10. 10.
    Pagani O, Regan MM, Walley BA, et al. Adjuvant exemestane with ovarian suppression in premenopausal breast cancer. N Engl J Med. 2014;371(2):107-18. Scholar
  11. 11.
    Rojas KE, Matthews N, Raker C, et al. Body mass index (BMI), postoperative appearance satisfaction, and sexual function in breast cancer survivorship. J Cancer Surviv. 2018;12(1):127-33. Scholar
  12. 12.
    Gass JS, Onstad M, Pesek S, et al. Breast-specific sensuality and sexual function in cancer survivorship: does surgical modality matter? Ann Surg Oncol. 2017;24(11):3133-40. Scholar
  13. 13.
    Baser RE, Li Y, Carter J. Psychometric validation of the Female Sexual Function Index (FSFI) in cancer survivors. Cancer. 2012;118(18):4606-18. Scholar
  14. 14.
    Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther. 2005;31(1):1-20. Scholar
  15. 15.
    Rosen R, Brown C, Heiman J, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191-208. Scholar
  16. 16.
    Fakhri A, Pakpour AH, Burri A, Morshedi H, Zeidi IM. The Female Sexual Function Index: translation and validation of an Iranian version. J Sex Med. 2012;9(2):514-23. Scholar
  17. 17.
    Regan MM, Fleming GF, Walley B, Francis PA, Pagani O. Adjuvant systemic treatment of premenopausal women with hormone receptor-positive early breast cancer: lights and shadows. J Clin Oncol. 2019;37(11):862-6. Scholar
  18. 18.
    Koga C, Akiyoshi S, Ishida M, Nakamura Y, Ohno S, Tokunaga E. Chemotherapy-induced amenorrhea and the resumption of menstruation in premenopausal women with hormone receptor-positive early breast cancer. Breast Cancer. 2017;24(5):714-9. Scholar
  19. 19.
    Dohou J, Mouret-Reynier M-A, Kwiatkowski F, et al. A retrospective study on the onset of menopause after chemotherapy: analysis of data extracted from the Jean Perrin Comprehensive Cancer Center database concerning 345 young breast cancer patients diagnosed between 1994 and 2012. Oncology. 2017;92(5):255-63. Scholar
  20. 20.
    Yoo C, Yun MR, Ahn J-H, et al. Chemotherapy-induced amenorrhea, menopause-specific quality of life, and endocrine profiles in premenopausal women with breast cancer who received adjuvant anthracycline-based chemotherapy: a prospective cohort study. Cancer Chemother Pharmacol. 2013;72(3):565-75. Scholar
  21. 21.
    Sparano JA, Gray RJ, Makower DF, et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med. 2018;379(2):111-21. Scholar
  22. 22.
    Ribi K, Luo W, Bernhard J, et al. Adjuvant tamoxifen plus ovarian function suppression versus tamoxifen alone in premenopausal women with early breast cancer: patient-reported outcomes in the suppression of Ovarian Function Trial. J Clin Oncol. 2016;34(14):1601-10. Scholar
  23. 23.
    Ochsenkühn R, Hermelink K, Clayton AH, et al. Menopausal status in breast cancer patients with past chemotherapy determines long-term hypoactive sexual desire disorder. J Sex Med. 2011;8(5):1486-94. Scholar
  24. 24.
    Saha P, Regan MM, Pagani O, et al. Treatment efficacy, adherence, and quality of life among women younger than 35 years in the International Breast Cancer Study Group TEXT and SOFT Adjuvant Endocrine Therapy Trials. J Clin Oncol. 2017;35(27):3113-22. Scholar
  25. 25.
    Ganz PA, Cecchini RS, Julian TB, et al. Patient-reported outcomes with anastrozole versus tamoxifen for postmenopausal patients with ductal carcinoma in situ treated with lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trial. Lancet. 2016;387(10021):857-65. Scholar
  26. 26.
    Land SR, Wickerham DL, Costantino JP, et al. Patient-reported symptoms and quality of life during treatment with tamoxifen or raloxifene for breast cancer prevention: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA. 2006;295(23):2742-51. Scholar
  27. 27.
    Fobair P, Stewart SL, Chang S, D’Onofrio C, Banks PJ, Bloom JR. Body image and sexual problems in young women with breast cancer. Psychooncology. 2006;15(7):579-94. Scholar
  28. 28.
    Takahashi M, Ohno S, Inoue H, et al. Impact of breast cancer diagnosis and treatment on women’s sexuality: a survey of Japanese patients. Psychooncology. 2008;17(9):901-7. Scholar
  29. 29.
    Kwait RM, Pesek S, Onstad M, et al. Influential forces in breast cancer surgical decision making and the impact on body image and sexual function. Ann Surg Oncol. 2016;23(10):3403-411. Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Reed Kuehn
    • 1
    Email author
  • Jesse Casaubon
    • 1
  • Christina Raker
    • 2
  • David Edmonson
    • 1
    • 3
  • Ashley Stuckey
    • 1
    • 4
  • Jennifer Gass
    • 1
    • 3
  1. 1.Breast Health CenterWomen and Infants Hospital of Rhode IslandProvidenceUSA
  2. 2.Division of ResearchWomen and Infants Hospital of Rhode IslandProvidenceUSA
  3. 3.Department of SurgeryWomen and Infants Hospital of Rhode IslandProvidenceUSA
  4. 4.Gynecologic OncologyWomen and Infants Hospital of Rhode IslandProvidenceUSA

Personalised recommendations