Impact of Neoadjuvant Chemotherapy on the Quality of Sexual Life of Women with Breast Cancer

Impact of Neoadjuvant Chemotherapy on the Quality of Sexual Life of Women with Breast Cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Neoadjuvant Chemotherapy on the Quality of Sexual Life of Women with Breast Cancer Isabela Rodrigues Neves, Silvana Soares dos Santos, Solange Moraes Sanches, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6214592/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To evaluate the impact of neoadjuvant chemotherapy on the sexual quality of life of women with breast cancer. Method: Prospective cohort study, carried out between July 2022 and July 2023, with 149 women with non-metastatic breast cancer, candidates for neoadjuvant chemotherapy treatment at the A.C. Camargo Cancer Center. Data collection was performed at three moments: at the beginning of treatment (PM), during the change in therapeutic protocol (SM) and at the end of treatment, with the application of the BREAST-Q and EORTC-QLQ-BR23 instruments. Result: The impact of neoadjuvant chemotherapy can be observed, with a reduction in self-perception of sexual attractiveness without clothes (which decreased from 41.4% in PM, to 25.7% in SM and 23.2% in TM), in the feeling of femininity when dressed (72.5% in PM, 47.7% in SM and 43.4% in TM), and in satisfaction with sexual life (PM 38.5%, SM 20.2%, TM 18.0%). Such factors are implicated in the deterioration of sexual quality of life throughout neoadjuvant chemotherapy (p=0.000). Conclusion: A reduction in QOL was observed throughout treatment, with greater relevance between the beginning and half of treatment, as well as between the beginning and end of treatment. Quality of Life Breast Neoplasms Neoadjuvant Therapy Sexuality. Introduction Breast cancer is a leading cause of morbidity and mortality among women worldwide, representing a major public health challenge. According to data from the World Health Organization (WHO), the global incidence of breast cancer has increased in recent decades, becoming the most common neoplasm among women ( 1 ). In Brazil, this trend is equally worrying, with the National Cancer Institute (INCA) estimating that breast cancer will be responsible for more than 73 thousand new cases in the 2023–2025 triennium, consolidating itself as the most frequent form of the disease in the country, reflecting patterns that resemble the trends observed in developed countries ( 2 , 3 ). Treatment for certain subtypes of breast cancer often includes neoadjuvant chemotherapy, the goal of which is to render inoperable tumors operable, to reduce the intensity of breast and/or axillary surgery in operable tumors, and in some tumor subtypes to direct postoperative treatment and de-escalation or intensification of adjuvant treatment ( 4 , 5 , 6 ). However, it is essential to consider not only the clinical efficacy of this approach, but also the adverse effects and the impact on patients' quality of life, particularly with regard to their sexual life. Quality of sexual life encompasses the physical, emotional, mental and social well-being related to an individual's sexuality ( 7 ). This concept involves not only satisfaction with sexual activity, but also how sexuality influences daily life and interpersonal relationships. Understanding this intersection between cancer treatment and sexuality is crucial, as the impacts of chemotherapy on the sexuality of women with breast cancer are multifaceted and can affect treatment adherence, mental health, and profoundly influence the patient's emotional and relational well-being ( 8 ). Despite the growing relevance of the topic, research on quality of sexual life in women with breast cancer, specifically during neoadjuvant chemotherapy, is relatively scarce. Although there are studies on the effects of chemotherapy and sexual dysfunction in women with breast cancer in general, few focus specifically on the consequences for sexual life during neoadjuvant treatment. In this context, studies such as Ljungman et al. (2018) and other related studies provide relevant contributions on the effects of the disease and treatment on women's sexual lives, but do not directly address the neoadjuvant chemotherapy phase. Ljungman et al. (2018) investigated sexual dysfunction and reproductive concerns in women with breast cancer and found that, in 51% of the participants, the main reason for the absence of sexual relations with a partner was the feeling of unattractiveness ( 9 ). Another study carried out in the same year, with 181 women diagnosed with breast cancer, found that 68% of them reported sexual dysfunction, with 51% of the participants mentioning the feeling of being unattractive as one of the main reasons for sexual abstention ( 10 ). Similarly, a study of 1,965 women that assessed changes in sexual well-being and intimacy after breast cancer treatment revealed a substantial decrease in sexual well-being, especially in relation to feelings of lack of attraction and femininity ( 11 ). In summary, neoadjuvant chemotherapy, although effective in the treatment of breast cancer, has a significant impact on the quality of women's sexual lives. Therefore, it is essential to explore these issues, encouraging health professionals to integrate the discussion about sexuality into the care of patients with breast cancer. After all, adequate support for these issues can not only improve the quality of life of patients, but also promote a more complete and satisfactory recovery, through holistic care focused on the needs of women. Given this problem, the objective of this article is to evaluate you impacts of neoadjuvant chemotherapy on the quality of sexual life of women with breast cancer. Method This is a prospective cohort study conducted between July 2022 and July 2023, with the participation of 149 women diagnosed with non-metastatic breast cancer, candidates for neoadjuvant chemotherapy treatment. All participants were treated at the chemotherapy outpatient clinic of the AC Camargo Cancer Center and signed the Free and Informed Consent Form (FICF), approved by the Research Ethics Committee (CEP), under number 3077/21. Participants were selected through screening in administrative reports and appointments provided by clinical oncology nurses and the navigation service. Patients who developed metastases or showed disease progression during neoadjuvant chemotherapy treatment, those who did not complete more than 10% of the items on the data collection instruments, patients who did not understand Portuguese, and those who discontinued chemotherapy treatment were excluded from the study. During the study, eight participants were lost due to contact difficulties and 21 refused to participate, resulting in loss and refusal rates of 4.5% and 11.8%, respectively. collection was performed at three distinct time points throughout the treatment. The first point (PM) occurred at the beginning of neoadjuvant chemotherapy treatment. The second point (SM) was recorded according to the neoadjuvant chemotherapy protocol used. For patients receiving the regimen with anthracycline and taxanes for luminal tumors, the SM occurred at the transition from doxorubicin in combination with cyclophosphamide to paclitaxel. For patients who started treatment with paclitaxel (alone or combined with carboplatin and/or pembrolizumab), the second point was at the transition to the doxorubicin and cyclophosphamide protocol. In the case of the protocol with docetaxel, cyclophosphamide, trastuzumab and pertuzumab, used for HER2-overexpressing tumors, the second time point was performed between the third and fourth cycle of chemotherapy. The third moment (TM) occurred at the end of chemotherapy treatment, before surgery, for all patients, regardless of the protocol used. It is worth noting that, at this moment, six patients refused to participate in the study. Participants were assessed by completing a General Questionnaire, which included demographic and clinical data obtained from the electronic medical record, in addition to the BREAST-Q and EORTC-QLQ-BR23 instruments. The BREAST-Q has specific modules for breast cancer, including mastectomy, breast-conserving therapy, and breast reconstruction, in addition to modules for breast augmentation, breast reduction, and mastopexy. Each module consists of several scales, some of which are common to all breast cancer patients, such as the Sexual Well-Being (PREOP) and Psychosocial Well-Being (PREOP) scales. Both scales use a 5-point Likert scale, with the following options: ( 1 ) never, ( 2 ) rarely, ( 3 ) occasionally, ( 4 ) often, and ( 5 ) always. A higher score reflects better sexual and psychosocial well-being. The Portuguese versions of these scales were obtained through a request for academic use in the official portfolio ( http://qportfolio.org/breast-q/breast-cancer ). The EORTC-QLQ-BR23 instrument includes functional scales of body image and sexual function, whose responses follow a 4-point Likert scale: ( 1 ) no, ( 2 ) a little, ( 3 ) quite a bit, and ( 4 ) very much. Higher scores on the functional scales indicate better functioning and quality of life, while higher scores on the symptom scales indicate greater symptomatology and worse quality of life. The collected data was entered into a database built on the institutional Redcap® system. Redcap® is free software, on a user-friendly digital platform, specialized in capturing research data with a focus on clinical data. This approach will allow information to be shared between institutional research groups in accordance with data protection and security rules. To summarize the quantitative variables, summary measures of position and dispersion were considered, such as mean, median, standard deviation and minimum and maximum values, and absolute and relative frequencies (%) were used for the qualitative variables. To assess whether the questionnaires applied differed between the evaluated moments, the Friedman test was used. To assess the association between the patients' characteristics and the questionnaire scores, the Mann-Whitney or Kruskal-Walli's test was used. The significant level adopted will be 5%. Thus, results whose p-values are less than 0.05 are considered statistically significant. The IBM International Business Machine - Statistical software Package for the Social Sciences - SPSS version 29 was used in data analysis. Results of 149 participants were included in the study, with ages ranging from 25 to 72 years, with a median of 44 years, 102 (68.5%) were married, 67 (45.0%) declared themselves to be Catholic, and 23 (82.6%) of the participants had completed higher education. In terms of clinical characteristics, stage II was identified in 70 (47.0%) of the sample, with 89 (59.7%) of the cases being T2 and 84 (56.4%) N0. Table 1 of 6 Table 1. Description of sociodemographic characteristics in absolute and relative numbers (%). Sociodemographic Characteristics Sex N % Feminine 149 100.0 Age Up to 44 years old 33 22.1 45-59 years old 110 73.9 60 years or older 6 4.0 Marital status Single 32 21.5 Married / Stable union 102 68.5 Widow 2 1.3 Separated/Divorced 13 8.7 Religion N % Catholic 67 45.0 Evangelical 25 16.8 Spiritist 16 10.7 Other 41 27.5 Education Completed high school 20 13.4 Completed third degree 123 82.6 Other 6 4.0 Clinical Features N % Clinical Staging I 32 21.4 II 70 47.0 III 47 31,5 TNM – cT T2 89 59,7 T3 38 25,5 T4 14 9,4 Outros 8 5,4 TNM – cN N0 84 56,4 N1 45 30,2 N2 17 11,4 Outros 3 2,0 Total 149 100,0 Legend: cT others: 4 T1 and 1 T4a; cN others: 1 N2b and 2 N3 Regarding sexual well-being, a significant reduction was observed throughout the treatment. Initially, 55 (37.9%) of the participants reported feeling sexually attractive in their clothes, with this percentage reducing to 38 (25.5%) at the intermediate moment and to 26 (18.2%) at the end of the treatment. Regarding comfort during sexual intercourse, 54 (42.2%) of the participants stated that they felt comfortable at the beginning of chemotherapy, but this number decreased to 29 (22.3%) at the intermediate stage and 21 (17.2%) at the final stage. When asked about sexual confidence, 61 (42.1%) of the participants reported feeling sexually confident at the beginning of treatment. This percentage decreased to 42 (28.6%) at the intermediate stage and to 26 (19.0%) at the end of chemotherapy treatment. Regarding satisfaction with sexual life, 50 (38.5%) of the participants reported being satisfied with their sexual life at the first moment. At the intermediate moment, this percentage decreased to 26 (20.2%), and, at the end of chemotherapy, only 22 (18.0%) of the participants expressed satisfaction with their sexual life. Regarding the perception of sexual attractiveness without clothes, 60 (41.4%) of the participants stated that they felt sexually attractive at the beginning of chemotherapy. This number decreased to 38 (25.7%) at the intermediate stage and 33 (23.2%) at the end of treatment. See Table 2. Regarding the Psychosocial Well-being instrument, 86 (55.7%) of the participants stated that they felt self-confident at the initial moment. In the second moment 62 (41.6%) and in the third moment 53 (37.1%) of the participants made the same statement. See table 3. Regarding the feeling of femininity when dressed, 108 (72.5%) of the women reported feeling feminine at the beginning of chemotherapy. This percentage dropped to 71 (47.7%) in the second moment and 62 (43.4%) in the third moment. Regarding acceptance of one's own body, 96 (64.4%) of the participants indicated acceptance at the beginning of the treatment, a number that fell to 63 (42.3%) when the protocol changed. and 55 (38.5%) at the end of treatment. Among the participants, 77 (51.7%) reported feeling attractive at the beginning of treatment. This percentage decreased to 40 (26.8%) when the protocol was changed and 32 (22.4%) at the end of chemotherapy. Data is shown in Table 3. Of the 149 study participants, 141 (94.6%) responded to question 44 (sexual desire) and 140 (94.0%) responded to question 45 (sexual activity). Regarding sexual desire, 19 (13.5%) of the participants reported having experienced sexual desire at the beginning of treatment, 6 (4.1%) at the intermediate moment and 4 (2.8%) at the end of chemotherapy. Regarding sexual activity, 22 (15.7%) of the participants stated that they were very sexually active at the beginning, 4 (2.7%) very active at the intermediate moment and 3 (2.2%) very active at the end of the treatment. When asked about pleasure during sexual intercourse, 46 (43.8%) of the participants reported feeling a lot of pleasure at the beginning of the treatment, 28 (38.9%) a lot of pleasure in the middle stage and 23 (34.8%) a lot of pleasure at the end of the treatment. Data is shown in Table 4. In the EORTC-QLQ-BR23 instrument, when asked about hair loss, 3 (2.0%) of the participants reported a lot of hair loss at the initial moment, 101 (67.8%) at the second moment and 115 (80.4%) at the third moment. When asked about concerns about hair loss, 18 (75.0%) of the participants responded that they did not feel worried at the beginning of treatment, 46 (33.3%) at the intermediate stage and 59 (41.3%) at the end of chemotherapy. Regarding the feeling of less femininity because of the treatment or the disease, 7 (4.7%) of the women reported this perception at the beginning of the treatment. This number increased to 28 (18.8%) at the intermediate moment and remained high at the end of the treatment, with 28 (19.6%) of the participants indicating feeling less feminine. Regarding the perception of dissatisfaction with the body, 7 (4.7%) of the participants reported feeling less satisfied at the beginning of the treatment. This percentage increased to 20 (13.4%) when the protocol was changed and remained high, with 18 (12.6%) at the end of chemotherapy. See Table 5 Table 2 of 5 Table 2. Comparison of responses to the “Sexual well- being” questionnaire, PM, SM and TM moments, in absolute and relative numbers (%). Not once Few times Sometimes Most of the time All the time Questions/ Moment PM N (%) SM N (%) T M N (%) PM N (%) SM N (%) TM N (%) PM N (%) SM N (%) TM N (%) PM OF (%) BC OF (%) ™ OF (%) PM OF (%) BC OF (%) ™ OF (%) a. 7 (4.8%) 20 (13.4%) 22 (15.4%) 13 (9.0%) 29 (19.5%) 25 (17.5%) 37 (25.5%) 29 (19.5%) 41 (28.7%) 33 (22.8%) 33 (22.1%) 29 (20.3%) 55 (37.9%) 38 (25.5%) 26 (18,2%) b. 12 (9,4%) 32 (24,6%) 35 (28,7%) 10 (7,8%) 19 (14,6%) 24 (19,7%) 19 (14,8%) 21 (16,2%) 20 (16,4%) 33 (25,8%) 29 (22,3%) 22 (18,0%) 54 (42,2%) 29 (22,3%) 21 (17,2%) c. 13 (9,0%) 33 (22,4%) 40 (29,2%) 13 (9,0%) 22 (15,0%) 21 (15,3%) 21 (14,5%) 27 (18,4%) 24 (17,5%) 37 (25,5%) 23 (15,6%) 26 (19,0%) 61 (42,1%) 42 (28,6%) 26 (19,0%) d. 15 (11,5%) 30 (23,3%) 35 (28,7%) 13 (10,0%) 24 (18,6%) 27 (22,1%) 15 (11,5%) 23 (17,8%) 19 (15,6%) 37 (28,5%) 26 (20,2%) 19 (15,6%) 50 (38,5%) 26 (20,2%) 22 (18,0%) e. 12 (8,3%) 27 (18,2%) 30 (21.1%) 10 (6.9%) 23 (15.5%) 25 (17.6%) 26 (17.9%) 27 (18.2%) 24 (16.9%) 37 (25.5%) 33 (22.3%) 30 (21.1%) 60 (41.4%) 38 (25.7%) 33 (23.2%) Legend: PM: Initiation of neoadjuvant chemotherapy treatment; SM: Switching between the third and fourth cycle of chemotherapy; TM: End of neoadjuvant chemotherapy treatment. Legend: Between the first and second moments and between the first and third moments (p=0.000). a. Sexually attractive in your clothes? b. Comfortable (at ease) during sexual intercourse? c. Sexually confident? d. Satisfied with your sex life? e. Sexually attractive when naked? Table 3 of 5 Table 3. Comparison of responses to the “Psychosocial Well-Being” questionnaire, PM, SM and TM moments, in absolute numbers and relative (%). Not once Few times Sometimes Most of the time All the time Questions/ Moment PM N (%) SM N (%) TM OF (%) PM OF (%) BC OF (%) ™ OF (%) PM OF (%) BC OF (%) ™ OF (%) PM OF (%) BC OF (%) ™ OF (%) PM OF (%) BC OF (%) ™ OF (%) a. 1 (0,7%) 4 (2,7%) 11 (7,7%) 3 (2,0%) 9 (6,0%) 7 (4,9%) 19 (12,8%) 28 (18,8%) 30 (21,0%) 40 (26,8%) 46 (30,9%) 42 (29,4%) 86 (57,7%) 62 (41,6%) 53 (37,1%) b. 3 (2,0%) 6 (4,0%) 8 (5,6%) 1 (0,7%) 9 (6,0%) 10 (7%) 11 (7,4%) 18 (12,1%) 22 (15,4%) 26 (17,4%) 45 (30,2%) 41 (28,7%) 108 (72,5%) 71 (47,7%) 62 (43,4%) c. 3 (2,0%) 6 (4,0%) 9 (6,3%) 3 (2,0%) 15 (10,1%) 11 (7,7%) 15 (10,1%) 24 (16,1%) 28 (19,6%) 32 (21,5%) 41 (27,5%) 40 (28,0,0%) 96 (64,4%) 63 (42,3%) 55 (38,5%) d. 6 (4,0%) 22 (14,8%) 20 (14,0%) 10 (6,7%) 17 (11,4%) 22 (15,4%) 25 (16,8%) 38 (25,5%) 35 (24,5%) 31 (20,8%) 32 (21,5%) 34 (23,8%) 77 (51.7%) 40 (26.8%) 32 (22.4%) Legend: PM: Start of neoadjuvant chemotherapy treatment; SM: Switch or between the third and fourth cycle of chemotherapy; TM: End of neoadjuvant chemotherapy treatment. Between the first and second moments and between the first and third moments (p=0.000). a. Self-confident? b. Feminine when dressed? c. Accepting your own body? d. Attractive? Table 4 of 5 Table 4. Comparison of responses to the questionnaire “EORTC–QLQ-BR23 Sexual Function”, questions a, b, and c, PM, SM and TM moments, in absolute and relative numbers (%). Legend: PM: Start of neoadjuvant chemotherapy treatment; SM: Switch or between the third and fourth cycle of chemotherapy; TM: End of neoadjuvant chemotherapy treatment. Between the first and second moments and between the first and third moments (p=0.000). No A little Quite a lot Very Questions/ Moment PM N (%) SM N (%) TM N (%) PM N (%) SM N (%) TM N (%) PM N (%) SM N (%) TM N (%) PM N (%) SM N (%) TM N (%) a. 39 (27,7%) 68 (46,9%) 75 (53,2%) 39 (27,7%) 55 (37,9%) 49 (34,8%) 44 (31,2%) 16 (11,0%) 13 (9,2%) 19 (13,5%) 6 (4,1%) 4 (2,8%) b. 35 (25,0%) 73 (50,0%) 74 (53,2%) 42 (30,0%) 49 (33,6%) 47 (33,8%) 41 (29,3%) 20 (13,7%) 15 (10,8%) 22 (15,7%) 4 (2,7%) 3 ( 2,2%) c. 1 (1,0%) 2 (2,8%) 3 (4,5%) 18 (17,1%) 23 (31,9%) 26 (39,4%) 40 (38,1%) 19 (26,4%) 14 (21,2%) 46 (43,8%) 28 (38,9%) 23 (34,8%) a. To what extent do you feel sexual desire? b. To what extent have you been sexually active (with or without intercourse)? c. Only answer this question if you have been sexually active: To what extent did sexual intercourse give you pleasure? Table 5 of 5 Table 5. Comparison of responses to the “EORTC - QL Q- BR 23” questionnaire, Functional Body Image Scale, PM, SM and TM moments in absolute and relative numbers (%). No A little Quite a lot Very Questions/ Moment PM N (%) SM N (%) TM N (%) PM N (%) SM N (%) TM N (%) PM N (%) SM TM N (%) PM N (%) SM N (%) TM N (%) a. 125 (83,9%) 11 (7,4%) 5 (3,5%) 15 (10,1%) 14 (9,4%) 9 (6,3%) 6 (4%) 23 (15,4%) 14 (9,8%) 3 (2%) 101 (67,8%) 115 (80,4%) b. 18 (75,0%) 46 (33,3%) 59 (41,3%) 5 (20,8%) 26 (18,8%) 23 (16,1%) - 18 (13%) 18 (12,6%) 1 (4,2%) 48 (34,8%) 43 (30,1%) c. 115 (77,2%) 69 (46,3%) 63 (44,1%) 25 (16,8%) 35 (23,5%) 31 (21,7%) 2 (1,3%) 17 (11,4%) 21 (14,7%) 7 (4,7%) 28 (18,8%) 28 (19,6%) d. 106 (71,1%) 59 (39,6%) 56 (39,2%) 29 (19,5%) 51 (34,2%) 40 (28%) 7 (4,7%) 19 (12,8%) 29 (20,3%) 7 (4,7%) 20 (13,4%) 18 (12,6%) Legend: PM: Start of neoadjuvant chemotherapy treatment; SM: Switch or between the third and fourth cycle of chemotherapy; TM: End of neoadjuvant chemotherapy treatment. Between the first and second moments and between the first and third moments (p=0.000). a. Did any of your hair fall out? b. Only answer this question if you have experienced hair loss: Are you worried about hair loss? c. Did you feel less feminine because of your illness and treatment? e. Did you feel less satisfied with your body? Discussion Breast cancer is the most common malignant neoplasm among women worldwide, representing a significant public health challenge ( 1 ). In addition to the physical impact of the disease and its treatment, the emotional, psychological and social consequences are widely documented, affecting the quality of life of patients ( 7 ). Among these repercussions, sexuality is often compromised, either by diagnosis or by subsequent treatments, and does not always receive due attention in the therapeutic approach and clinical support ( 12 ). Sexuality is an essential dimension of human life, directly influencing identity, emotional well-being and quality of life ( 11 ). In this prospective cohort study of 149 women diagnosed with non-metastatic breast cancer who underwent neoadjuvant chemotherapy, we observed that, even before the start of treatment, just over a third of the participants (37%) reported feeling sexually attractive in their clothes, confident and comfortable during sexual intercourse. Although cancer diagnosis and treatment are recognized as factors that affect sexuality, it is essential to consider that pre-existing difficulties in sexual behaviors, perceptions and practices can be confounding and potentiating factors of these events. Previous studies indicate that the prevalence of sexual dysfunction in women without a diagnosis of breast cancer varies between 20% and 60%. ( 13 – 14 ) Female sexual health should not only be understood from a physical perspective but also considering its psychological and social implications. ( 7 ) The emotional impact of breast cancer, including feelings of fear, uncertainty, stress, anger, and depressive symptoms, can compromise the perception of sexuality from the beginning of treatment. A 2021 meta-analysis on the psychological impacts of breast cancer found that 34% of patients experience significant clinical symptoms of anxiety, with this being most prevalent between diagnosis and the start of treatment. ( 15 ) Cultural aspects and repression in the approach to sexuality may explain the low completion of specific questions in the Sexual Well-Being questionnaire. Since the beginning of the research, only 19.5% of the participants completed the Sexual Well-Being questionnaire in full. The question about comfort during sexual intercourse was omitted by 14.9% of the women, while the question about satisfaction with sexual life was left blank by 14.1%. Historically, the interest of health professionals in female sexuality has been limited to the prevention of sexually transmitted infections and birth control. ( 16 ) This lack of openness can generate discomfort and apprehension among patients, making communication with health professionals difficult. Studies indicate that most women avoid discussing sexual issues due to embarrassment or lack of support from professionals. ( 17 – 18 ) The impact of treatment on self-image cannot be overlooked either. ( 19 ) Chemotherapy treatment alters body perception, affecting patients’ self-image and self-confidence. Chemotherapy-induced alopecia, although not a fatal risk, is one of the most distressing side effects for women with breast cancer. ( 20 – 21 ) In our study, 80.4% of participants reported severe hair loss at the end of treatment, and 58.8% expressed concern about this change. In addition to hair loss, other physical changes, such as loss of eyelashes and eyebrows, weight loss, edema, excessive vomiting, and changes in skin and nail color, contributed to the deterioration of self-esteem and perception of one’s own sexuality. The impact of sexuality on relationships is also a relevant factor. ( 22 ) Changes in self-esteem and body image can affect the dynamics of the relationship, making communication and intimacy between couples difficult. Studies show that marital support is essential for the emotional adaptation of patients and can minimize the negative effects on sexuality ( 23 – 24 ). Marital counseling and couples therapy programs have been shown to be effective in reducing the impact of breast cancer on the sexual lives of patients and their partners. ( 25 – 26 ) In conclusion, despite the cultural and psychological barriers that hinder the discussion of sexuality in the oncological context, it is essential that health professionals adopt a proactive and sensitive approach to the topic. In addition to addressing patients' complaints, it is necessary to interpret nonverbal signals and offer comprehensive support during treatment, recognizing and addressing the physical and emotional changes that impact women's sexual health and well-being. Conclusion In this study, we evaluated the impacts of neoadjuvant chemotherapy treatment on women's quality of sexual life. The most significant differences were found between the beginning and half of treatment, as well as between the beginning and end of treatment, with statistically significant variations. It is important to highlight that, since the beginning of the treatment, many women already had low levels of sexual satisfaction, however, as the treatment progressed, an even more pronounced reduction was observed, especially in the aspects of attractiveness, self-confidence and femininity. Although there are other prospective cohort studies that provide valuable insights, most of them are based on smaller samples. Research involving more than one hundred participants within this topic is rare in scientific literature. In this context, the present study assumes special importance, since its large sample allows a more robust analysis of the impact of neoadjuvant chemotherapy on the sexual quality of life of women with breast cancer. The data from our study are fundamental to illuminate the intersection between cancer treatment and sexual health, highlighting the importance of more comprehensive and patient-centered care. The recognition that sexual health may already be impacted before the diagnosis of cancer and that there is an even more significant reduction with treatment can serve as a starting point for the development of clinical interventions that address the emotional, psychological and sexual needs of women during breast cancer treatment. We believe that future research will be able to provide a deeper understanding of the impacts perceived by participants, and that studies with interventions will represent an excellent opportunity to improve the quality of sexual life of women undergoing neoadjuvant chemotherapy, promoting more holistic and patient-centered care. Declarations Financing The authors declare that no funds, grants, or other support were received during the preparation of this manuscript Competing Interests The authors have no relevant financial or non-financial interests to declare Author contributions All authors contributed to the conception and design of the study. The preparation of the material, data collection and analysis were carried out by Isabela Rodrigues Neves de Oliveira. The first draft of the manuscript was made by Isabela Rodrigues Neves de Oliveira and all authors commented on previous versions of the manuscript. All authors have read and approved the final manuscript. Ethical Approval This study was carried out in accordance with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the A.C. Camargo Cancer Center on July 16, 2021 - Number: 307721. Consent to Participate Informed consent was obtained from all individual participants included in the study. References World Health Organization International Agency for Research on Cancer. The Global Cancer Observatory. 20 22 statistics. National Cancer Institute José Alencar Gomes da Silva (INCA). Rio de Janeiro (RJ), Brazil. Brazilian Breast Cancer Study Group (GBECAM). Rio de Janeiro (RJ), Brazil. International Agency for Research on Cancer. 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Maturitas. 2010;67(3):233–8. Fortin J, Leblanc M, Elgbeili G, Cordova MJ, Marin MF, Brunet A. The mental health impacts of receiving a breast cancer diagnosis: a meta-analysis. Br J Cancer. 2021;125(11):1582–1592. Alidost F, Pakzad R, Dolatian M, Abdi F. Sexual dysfunction among women of reproductive age: a systematic review and meta-analysis. Int J Reprod Biomed. 2021;19(5):421–432. Dubé JP, Dawson SJ, Rosen NO. Emotion regulation and sexual well-being among women: current status and future directions. Curr Sex Health Rep. 2020; 12:143–152. Fischer VJ, Andersson G, Billieux J, Vögele C. The relationship between emotion regulation and sexual function and satisfaction: a scoping review. Sex Med Rev. 2022;10(2):195–208 Pedersen B, Groenkjaer M, Falkmer U, Delmar C. Understanding the essential meaning of measured changes in weight and body composition among women during and after adjuvant treatment for breast cancer: a mixed-methods study. Cancer Nurs. 2017 Nov/Dec;40(6):433–444. Schapira L, Zheng Y, Gelber SI, Poorvu P, Ruddy KJ, Tamimi RM, et al. Trajectories of fear of cancer recurrence in young breast cancer survivors. Cancer. 2022;128(2):335–343. Koch L, Bertram H, Eberle A, Holleczek B, Schmid- Höpfner S, Waldmann A, et al. Fear of recurrence in long-term breast cancer survivors-still an issue. Results on prevalence, determinants, and the association with quality of life and depression from cancer survivorship–a multi-regional population-based study. Psychooncology. May 2014;23(5):547–54. Santos LN, Dias CA, Lacerda GL, Barreto WWP, Santos TR. Sexuality and breast cancer: reports from eight affected women. Psychol Hosp. (São Paulo). 2008; 6(2):2–19. Akpor, Oluwaseyi Abiodun; Kolawole, Eyitayo Roseline ; Olorunfemi, Olaolorunpo 1 ; Oduyemi, Rachael Olufunmilayo 2 . Breast Cancer and Body Image: The Roles of the Male Partner. APIK Journal of Internal Medicine 11(2): p 65–69, Apr – Jun 2023. | DOI: 10.4103/ajim.ajim_108_21 Brajkovic L, Sladic P, Kopilaš V. Sexual Quality of Life in Women with Breast Cancer. Health Psychol Res. 2021;9(1):24512. doi: 10.52965/001c.24512 . PMID: 34746481; PMCID: PMC8567769. Reese JB, Lepore SJ, Sorice KA, Zimmaro LA, Hasler J, Handorf E, Daly MB, Zaleta AK, Westbrook K, Porter LS. Efficacy of a couple-based intervention addressing sexual concerns for breast cancer survivors: Results of a randomized controlled trial. Cancer. 2025;131(1):e35685. doi: 10.1002/cncr.35685. Epub 2024 Dec 8. PMID: 39645589; PMCID: PMC11696781. Li M, Chan CWH, Chow KM, Xiao J, Choi KC. A systematic review and meta-analysis of couple-based intervention on sexuality and the quality of life of cancer patients and their partners. Support Care Cancer. 2020;28(4):1607–1630. doi: 10.1007/s00520-019-05215-z . Epub 2019 Dec 24. Erratum in: Support Care Cancer. 2020;28(10):5045. doi: 10.1007/s00520-020-05546-2. PMID: 31872299. Additional Declarations No competing interests reported. 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According to data from the World Health Organization (WHO), the global incidence of breast cancer has increased in recent decades, becoming the most common neoplasm among women (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Brazil, this trend is equally worrying, with the National Cancer Institute (INCA) estimating that breast cancer will be responsible for more than 73 thousand new cases in the 2023\u0026ndash;2025 triennium, consolidating itself as the most frequent form of the disease in the country, reflecting patterns that resemble the trends observed in developed countries (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTreatment for certain subtypes of breast cancer often includes neoadjuvant chemotherapy, the goal of which is to render inoperable tumors operable, to reduce the intensity of breast and/or axillary surgery in operable tumors, and in some tumor subtypes to direct postoperative treatment and de-escalation or intensification of adjuvant treatment (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHowever, it is essential to consider not only the clinical efficacy of this approach, but also the adverse effects and the impact on patients' quality of life, particularly with regard to their sexual life.\u003c/p\u003e \u003cp\u003eQuality of sexual life encompasses the physical, emotional, mental and social well-being related to an individual's sexuality (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). This concept involves not only satisfaction with sexual activity, but also how sexuality influences daily life and interpersonal relationships.\u003c/p\u003e \u003cp\u003eUnderstanding this intersection between cancer treatment and sexuality is crucial, as the impacts of chemotherapy on the sexuality of women with breast cancer are multifaceted and can affect treatment adherence, mental health, and profoundly influence the patient's emotional and relational well-being (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the growing relevance of the topic, research on quality of sexual life in women with breast cancer, specifically during neoadjuvant chemotherapy, is relatively scarce. Although there are studies on the effects of chemotherapy and sexual dysfunction in women with breast cancer in general, few focus specifically on the consequences for sexual life during neoadjuvant treatment.\u003c/p\u003e \u003cp\u003eIn this context, studies such as Ljungman et al. (2018) and other related studies provide relevant contributions on the effects of the disease and treatment on women's sexual lives, but do not directly address the neoadjuvant chemotherapy phase. Ljungman et al. (2018) investigated sexual dysfunction and reproductive concerns in women with breast cancer and found that, in 51% of the participants, the main reason for the absence of sexual relations with a partner was the feeling of unattractiveness (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Another study carried out in the same year, with 181 women diagnosed with breast cancer, found that 68% of them reported sexual dysfunction, with 51% of the participants mentioning the feeling of being unattractive as one of the main reasons for sexual abstention (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Similarly, a study of 1,965 women that assessed changes in sexual well-being and intimacy after breast cancer treatment revealed a substantial decrease in sexual well-being, especially in relation to feelings of lack of attraction and femininity (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn summary, neoadjuvant chemotherapy, although effective in the treatment of breast cancer, has a significant impact on the quality of women's sexual lives. Therefore, it is essential to explore these issues, encouraging health professionals to integrate the discussion about sexuality into the care of patients with breast cancer. After all, adequate support for these issues can not only improve the quality of life of patients, but also promote a more complete and satisfactory recovery, through holistic care focused on the needs of women.\u003c/p\u003e \u003cp\u003eGiven this problem, the objective of this article is to evaluate you impacts of neoadjuvant chemotherapy on the quality of sexual life of women with breast cancer.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e This is a prospective cohort study conducted between July 2022 and July 2023, with the participation of 149 women diagnosed with non-metastatic breast cancer, candidates for neoadjuvant chemotherapy treatment. All participants were treated at the chemotherapy outpatient clinic of the AC Camargo Cancer Center and signed the Free and Informed Consent Form (FICF), approved by the Research Ethics Committee (CEP), under number 3077/21. Participants were selected through screening in administrative reports and appointments provided by clinical oncology nurses and the navigation service.\u003c/p\u003e \u003cp\u003ePatients who developed metastases or showed disease progression during neoadjuvant chemotherapy treatment, those who did not complete more than 10% of the items on the data collection instruments, patients who did not understand Portuguese, and those who discontinued chemotherapy treatment were excluded from the study. During the study, eight participants were lost due to contact difficulties and 21 refused to participate, resulting in loss and refusal rates of 4.5% and 11.8%, respectively.\u003c/p\u003e \u003cp\u003ecollection was performed at three distinct time points throughout the treatment. The first point (PM) occurred at the beginning of neoadjuvant chemotherapy treatment. The second point (SM) was recorded according to the neoadjuvant chemotherapy protocol used. For patients receiving the regimen with anthracycline and taxanes for luminal tumors, the SM occurred at the transition from doxorubicin in combination with cyclophosphamide to paclitaxel. For patients who started treatment with paclitaxel (alone or combined with carboplatin and/or pembrolizumab), the second point was at the transition to the doxorubicin and cyclophosphamide protocol. In the case of the protocol with docetaxel, cyclophosphamide, trastuzumab and pertuzumab, used for HER2-overexpressing tumors, the second time point was performed between the third and fourth cycle of chemotherapy. The third moment (TM) occurred at the end of chemotherapy treatment, before surgery, for all patients, regardless of the protocol used. It is worth noting that, at this moment, six patients refused to participate in the study.\u003c/p\u003e \u003cp\u003eParticipants were assessed by completing a General Questionnaire, which included demographic and clinical data obtained from the electronic medical record, in addition to the BREAST-Q and EORTC-QLQ-BR23 instruments. The BREAST-Q has specific modules for breast cancer, including mastectomy, breast-conserving therapy, and breast reconstruction, in addition to modules for breast augmentation, breast reduction, and mastopexy. Each module consists of several scales, some of which are common to all breast cancer patients, such as the Sexual Well-Being (PREOP) and Psychosocial Well-Being (PREOP) scales. Both scales use a 5-point Likert scale, with the following options: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) never, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) rarely, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) occasionally, (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) often, and (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) always. A higher score reflects better sexual and psychosocial well-being. The Portuguese versions of these scales were obtained through a request for academic use in the official portfolio ( \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://qportfolio.org/breast-q/breast-cancer\u003c/span\u003e\u003cspan address=\"http://qportfolio.org/breast-q/breast-cancer\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e ).\u003c/p\u003e \u003cp\u003eThe EORTC-QLQ-BR23 instrument includes functional scales of body image and sexual function, whose responses follow a 4-point Likert scale: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) no, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) a little, (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) quite a bit, and (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) very much. Higher scores on the functional scales indicate better functioning and quality of life, while higher scores on the symptom scales indicate greater symptomatology and worse quality of life.\u003c/p\u003e \u003cp\u003eThe collected data was entered into a database built on the institutional Redcap\u0026reg; system. Redcap\u0026reg; is free software, on a user-friendly digital platform, specialized in capturing research data with a focus on clinical data. This approach will allow information to be shared between institutional research groups in accordance with data protection and security rules.\u003c/p\u003e \u003cp\u003eTo summarize the quantitative variables, summary measures of position and dispersion were considered, such as mean, median, standard deviation and minimum and maximum values, and absolute and relative frequencies (%) were used for the qualitative variables. To assess whether the questionnaires applied differed between the evaluated moments, the Friedman test was used. To assess the association between the patients' characteristics and the questionnaire scores, the Mann-Whitney or Kruskal-Walli's test was used.\u003c/p\u003e \u003cp\u003eThe significant level adopted will be 5%. Thus, results whose p-values are less than 0.05 are considered statistically significant. The IBM \u003cem\u003eInternational Business Machine - Statistical software Package for the Social Sciences -\u003c/em\u003e SPSS version 29 was used in data analysis.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eof 149 participants were included in the study, with ages ranging from 25 to 72 years, with a median of 44 years, 102 (68.5%) were married, 67 (45.0%) declared themselves to be Catholic, and 23 (82.6%) of the participants had completed higher education. In terms of clinical characteristics, stage II was identified in 70 (47.0%) of the sample, with 89 (59.7%) of the cases being T2 and 84 (56.4%) N0.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 of 6\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eDescription of sociodemographic characteristics in absolute and relative numbers (%).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 275px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSociodemographic Characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 275px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 275px;\"\u003e\n \u003cp\u003eFeminine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 275px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 275px;\"\u003e\n \u003cp\u003eUp to 44 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e22.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 275px;\"\u003e\n \u003cp\u003e45-59 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e73.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 275px;\"\u003e\n \u003cp\u003e60 years or older\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 275px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 275px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e21.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 275px;\"\u003e\n \u003cp\u003eMarried / Stable union\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e68.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 275px;\"\u003e\n \u003cp\u003eWidow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 275px;\"\u003e\n \u003cp\u003eSeparated/Divorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 275px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 275px;\"\u003e\n \u003cp\u003eCatholic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e45.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 275px;\"\u003e\n \u003cp\u003eEvangelical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e16.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 275px;\"\u003e\n \u003cp\u003eSpiritist\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e10.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 275px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e27.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 275px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 275px;\"\u003e\n \u003cp\u003eCompleted high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e13.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 275px;\"\u003e\n \u003cp\u003eCompleted third degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e82.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 275px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e4.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical Features\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical Staging\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e21.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e47.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e31,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTNM \u0026ndash; cT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003e\n \u003cp\u003eT2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e59,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003e\n \u003cp\u003eT3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e25,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003e\n \u003cp\u003eT4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e9,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003e\n \u003cp\u003eOutros\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e5,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTNM \u0026ndash; cN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003e\n \u003cp\u003eN0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e56,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003e\n \u003cp\u003eN1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e30,2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003e\n \u003cp\u003eN2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e11,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003e\n \u003cp\u003eOutros\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e2,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 336px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e100,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eLegend:\u0026nbsp;\u003c/strong\u003ecT others: 4 T1 and 1 T4a; cN others: 1 N2b and 2 N3\u003c/p\u003e\n\u003cp\u003eRegarding sexual well-being, a significant reduction was observed throughout the treatment. Initially, 55 (37.9%) of the participants reported feeling sexually attractive in their clothes, with this percentage reducing to 38 (25.5%) at the intermediate moment and to 26 (18.2%) at the end of the treatment.\u003c/p\u003e\n\u003cp\u003eRegarding comfort during sexual intercourse, 54 (42.2%) of the participants stated that they felt comfortable at the beginning of chemotherapy, but this number decreased to 29 (22.3%) at the intermediate stage and 21 (17.2%) at the final stage.\u003c/p\u003e\n\u003cp\u003eWhen asked about sexual confidence, 61 (42.1%) of the participants reported feeling sexually confident at the beginning of treatment. This percentage decreased to 42 (28.6%) at the intermediate stage and to 26 (19.0%) at the end of chemotherapy treatment.\u003c/p\u003e\n\u003cp\u003eRegarding satisfaction with sexual life, 50 (38.5%) of the participants reported being satisfied with their sexual life at the first moment. At the intermediate moment, this percentage decreased to 26 (20.2%), and, at the end of chemotherapy, only 22 (18.0%) of the participants expressed satisfaction with their sexual life.\u003c/p\u003e\n\u003cp\u003eRegarding the perception of sexual attractiveness without clothes, 60 (41.4%) of the participants stated that they felt sexually attractive at the beginning of chemotherapy. This number decreased to 38 (25.7%) at the intermediate stage and 33 (23.2%) at the end of treatment. See Table 2.\u003c/p\u003e\n\u003cp\u003eRegarding the Psychosocial Well-being instrument, 86 (55.7%) of the participants stated that they felt self-confident at the initial moment. In the second moment 62 (41.6%) and in the third moment 53 (37.1%) of the participants made the same statement. See table 3.\u003c/p\u003e\n\u003cp\u003eRegarding the feeling of femininity when dressed, 108 (72.5%) of the women reported feeling feminine at the beginning of chemotherapy. This percentage dropped to 71 (47.7%) in the second moment and 62 (43.4%) in the third moment.\u003c/p\u003e\n\u003cp\u003eRegarding acceptance of one\u0026apos;s own body, 96 (64.4%) of the participants indicated acceptance at the beginning of the treatment, a number that fell to 63 (42.3%) when the protocol changed. and 55 (38.5%) at the end of treatment.\u003c/p\u003e\n\u003cp\u003eAmong the participants, 77 (51.7%) reported feeling attractive at the beginning of treatment. This percentage decreased to 40 (26.8%) when the protocol was changed and 32 (22.4%) at the end of chemotherapy. Data is shown in Table 3.\u003c/p\u003e\n\u003cp\u003eOf the 149 study participants, 141 (94.6%) responded to question 44 (sexual desire) and 140 (94.0%) responded to question 45 (sexual activity). Regarding sexual desire, 19 (13.5%) of the participants reported having experienced sexual desire at the beginning of treatment, 6 (4.1%) at the intermediate moment and 4 (2.8%) at the end of chemotherapy.\u003c/p\u003e\n\u003cp\u003eRegarding sexual activity, 22 (15.7%) of the participants stated that they were very sexually active at the beginning, 4 (2.7%) very active at the intermediate moment and 3 (2.2%) very active at the end of the treatment.\u003c/p\u003e\n\u003cp\u003eWhen asked about pleasure during sexual intercourse, 46 (43.8%) of the participants reported feeling a lot of pleasure at the beginning of the treatment, 28 (38.9%) a lot of pleasure in the middle stage and 23 (34.8%) a lot of pleasure at the end of the treatment. Data is shown in Table 4.\u003c/p\u003e\n\u003cp\u003eIn the EORTC-QLQ-BR23 instrument, when asked about hair loss, 3 (2.0%) of the participants reported a lot of hair loss at the initial moment, 101 (67.8%) at the second moment and 115 (80.4%) at the third moment.\u003c/p\u003e\n\u003cp\u003eWhen asked about concerns about hair loss, 18 (75.0%) of the participants responded that they did not feel worried at the beginning of treatment, 46 (33.3%) at the intermediate stage and 59 (41.3%) at the end of chemotherapy.\u003c/p\u003e\n\u003cp\u003eRegarding the feeling of less femininity because of the treatment or the disease, 7 (4.7%) of the women reported this perception at the beginning of the treatment. This number increased to 28 (18.8%) at the intermediate moment and remained high at the end of the treatment, with 28 (19.6%) of the participants indicating feeling less feminine.\u003c/p\u003e\n\u003cp\u003eRegarding the perception of dissatisfaction with the body, 7 (4.7%) of the participants reported feeling less satisfied at the beginning of the treatment. This percentage increased to 20 (13.4%) when the protocol was changed and remained high, with 18 (12.6%) at the end of chemotherapy. See Table 5\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2 of 5\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Comparison of responses to the \u003cu\u003e\u0026ldquo;Sexual well-\u003c/u\u003ebeing\u0026rdquo; questionnaire, PM, SM and TM moments, in absolute and relative numbers (%).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"994\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 174px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot once\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFew times\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSometimes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 185px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMost of the time\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll the time\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestions/\u0026nbsp;\u003cbr\u003e\u0026nbsp;Moment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003ePM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eSM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003eT M\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003ePM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003eSM\u003c/p\u003e\n \u003cp\u003eN (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003eTM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003ePM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003eSM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003eTM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003ePM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOF (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003eBC\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOF (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026trade;\u003c/p\u003e\n \u003cp\u003eOF (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003ePM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOF (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003eBC\u003c/p\u003e\n \u003cp\u003eOF (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026trade;\u003c/p\u003e\n \u003cp\u003eOF (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ea.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e7 (4.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e20 (13.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e22 (15.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e13 (9.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e29 (19.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e25 (17.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e37 (25.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e29 (19.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e41 (28.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e33 (22.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e33 (22.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e29 (20.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e55 (37.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e38 (25.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;26 (18,2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eb.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;12 (9,4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;32 (24,6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;35 (28,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;10 (7,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;19 (14,6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;24 (19,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;19 (14,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;21 (16,2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;20 (16,4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;33 (25,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;29 (22,3%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;22 (18,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;54 (42,2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;29 (22,3%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;21 (17,2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ec.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;13 (9,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;33 (22,4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;40 (29,2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;13 (9,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;22 (15,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;21 (15,3%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;21 (14,5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;27 (18,4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;24 (17,5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;37 (25,5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;23 (15,6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;26 (19,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;61 (42,1%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;42 (28,6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;26 (19,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ed.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;15 (11,5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;30 (23,3%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;35 (28,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;13 (10,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;24 (18,6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;27 (22,1%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;15 (11,5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;23 (17,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;19 (15,6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;37 (28,5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;26 (20,2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;19 (15,6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e\u0026nbsp;50 (38,5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;26 (20,2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;22 (18,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ee.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e\u0026nbsp;12 (8,3%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;27 (18,2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e30 (21.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e10 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e23 (15.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e25 (17.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e26 (17.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e27 (18.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003e24 (16.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e37 (25.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e33 (22.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 57px;\"\u003e\n \u003cp\u003e30 (21.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003e60 (41.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e38 (25.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e33 (23.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eLegend:\u003c/strong\u003e PM: Initiation of neoadjuvant chemotherapy treatment; SM: Switching between the third and fourth cycle of chemotherapy; TM: End of neoadjuvant chemotherapy treatment. \u003cstrong\u003eLegend:\u003c/strong\u003e Between the first and second moments and between the first and third moments (p=0.000).\u003c/p\u003e\n\u003cp\u003ea. Sexually attractive in your clothes?\u003c/p\u003e\n\u003cp\u003eb. Comfortable (at ease) during sexual intercourse?\u003c/p\u003e\n\u003cp\u003ec. Sexually confident?\u003c/p\u003e\n\u003cp\u003ed. Satisfied with your sex life?\u003c/p\u003e\n\u003cp\u003ee. Sexually attractive when naked?\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3 of 5\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eComparison of responses to the \u0026ldquo;Psychosocial Well-Being\u0026rdquo; questionnaire, PM, SM and TM moments, in absolute numbers and relative (%).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"1022\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 188px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot once\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFew times\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 194px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSometimes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 196px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMost of the time\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAll the time\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestions/\u0026nbsp;\u003cbr\u003e\u0026nbsp;Moment\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003ePM\u003c/p\u003e\n \u003cp\u003eN (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003eSM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eTM\u003c/p\u003e\n \u003cp\u003eOF (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003ePM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOF (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003eBC\u003c/p\u003e\n \u003cp\u003eOF (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026trade;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOF (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003ePM\u003c/p\u003e\n \u003cp\u003eOF (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003eBC\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOF (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026trade;\u003c/p\u003e\n \u003cp\u003eOF (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003ePM\u003c/p\u003e\n \u003cp\u003eOF (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003eBC\u003c/p\u003e\n \u003cp\u003eOF (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026trade;\u003c/p\u003e\n \u003cp\u003eOF (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003ePM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOF (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003eBC\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOF (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026trade;\u003c/p\u003e\n \u003cp\u003eOF (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ea.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;1\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(0,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;4\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(2,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;11\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(7,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;3\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(2,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;9\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(6,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;7\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(4,9%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;19 (12,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;28\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(18,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;30 (21,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;40 (26,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;46 (30,9%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;42 (29,4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;86 (57,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;62 (41,6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;53 (37,1%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eb.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;3\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(2,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;6\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(4,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;8\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(5,6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;1\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(0,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;9\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(6,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;10\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;11\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(7,4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;18\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(12,1%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;22 (15,4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;26 (17,4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;45 (30,2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;41 (28,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;108 (72,5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;71 (47,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;62 (43,4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ec.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;3\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(2,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;6\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(4,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;9\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(6,3%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;3\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(2,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;15 (10,1%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;11\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(7,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;15 (10,1%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;24\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(16,1%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;28 (19,6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;32 (21,5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;41 (27,5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;40 (28,0,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;96 (64,4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;63 (42,3%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;55 (38,5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ed.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;6\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(4,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e22 (14,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;20\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(14,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;10 (6,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;17 (11,4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;22 (15,4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;25 (16,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;38\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(25,5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;35 (24,5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;31 (20,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;32 (21,5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;34 (23,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 60px;\"\u003e\n \u003cp\u003e77 (51.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e40 (26.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e32 (22.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 64px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eLegend:\u0026nbsp;\u003c/strong\u003ePM: Start of neoadjuvant chemotherapy treatment; SM:\u0026nbsp;Switch or between the third and fourth cycle of\u0026nbsp;chemotherapy; TM: End of neoadjuvant chemotherapy treatment.\u0026nbsp;Between the first and second moments and between the first and third moments (p=0.000).\u003c/p\u003e\n\u003cp\u003ea. Self-confident?\u003c/p\u003e\n\u003cp\u003eb. Feminine when dressed?\u003c/p\u003e\n\u003cp\u003ec. Accepting your own body?\u003c/p\u003e\n\u003cp\u003ed. Attractive?\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4 of 5\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eComparison of responses to the questionnaire \u003cu\u003e\u0026ldquo;EORTC\u0026ndash;QLQ-BR23 Sexual\u0026nbsp;\u003c/u\u003eFunction\u0026rdquo;, questions a, b, and c, PM, SM and TM moments, in absolute and relative numbers (%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLegend:\u0026nbsp;\u003c/strong\u003ePM: Start of neoadjuvant chemotherapy treatment; SM: Switch or between the third and fourth cycle of chemotherapy; TM: End of neoadjuvant chemotherapy treatment. \u0026nbsp;Between the first and second moments and between the first and third moments (p=0.000).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"954\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 232px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 231px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eA little\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuite a lot\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 197px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestions/\u0026nbsp;\u003cbr\u003e\u0026nbsp;Moment\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003ePM\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003eSM\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003eTM\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003ePM\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003eSM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003eTM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003ePM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003eSM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003eTM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 61px;\"\u003e\n \u003cp\u003ePM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003eSM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003eTM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ea.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;39\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(27,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;68\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(46,9%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;75\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(53,2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;39\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(27,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;55\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(37,9%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;49\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(34,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;44\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(31,2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;16\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(11,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;13\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(9,2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;19\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(13,5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;6\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(4,1%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;4\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(2,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eb.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;35\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(25,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;73\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(50,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;74\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(53,2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;42\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(30,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;49\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(33,6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;47\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(33,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;41\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(29,3%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;20\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(13,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;15\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(10,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;22\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(15,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;4\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(2,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;3 (\u003c/p\u003e\n \u003cp\u003e2,2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ec.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;1\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(1,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;2\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(2,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;3\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(4,5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;18\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(17,1%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;23\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(31,9%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;26\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(39,4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;40\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(38,1%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;19\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(26,4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;14\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(21,2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;46\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(43,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\n \u003cp\u003e\u0026nbsp;28\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(38,9%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;23\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(34,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 60px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 1px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ea. To what extent do you feel sexual desire?\u003c/p\u003e\n\u003cp\u003eb. To what extent have you been sexually active (with or without intercourse)?\u003c/p\u003e\n\u003cp\u003ec. Only answer this question if you have been sexually active: To what extent did sexual intercourse give you pleasure?\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5 of 5\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u0026nbsp;\u003c/strong\u003eComparison of responses to the \u003cu\u003e\u0026ldquo;EORTC - QL Q- BR 23\u0026rdquo; questionnaire, Functional Body\u0026nbsp;\u003c/u\u003eImage Scale, PM, SM and TM moments in absolute and relative numbers (%).\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"929\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 234px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 214px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eA little\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 198px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuite a lot\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestions/\u0026nbsp;\u003cbr\u003e\u0026nbsp;Moment\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003ePM\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003eSM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eTM\u003c/p\u003e\n \u003cp\u003eN (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003ePM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003eSM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003eTM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003ePM\u003c/p\u003e\n \u003cp\u003eN (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eSM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eTM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003ePM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003eSM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eTM\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ea.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;125 (83,9%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;11\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(7,4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;5\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(3,5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;15\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(10,1%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;14\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(9,4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;9\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(6,3%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;6\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;23\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(15,4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;14\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(9,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;3\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;101 (67,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;115 (80,4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eb.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;18\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(75,0%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;46\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(33,3%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;59\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(41,3%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;5\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(20,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;26\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(18,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;23\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(16,1%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;-\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;18\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(13%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;18\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(12,6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;1\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(4,2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;48\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(34,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;43\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(30,1%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ec.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;115 (77,2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;69\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(46,3%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;63\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(44,1%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;25\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(16,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;35\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(23,5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;31\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(21,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;2\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(1,3%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;17\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(11,4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;21\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(14,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;7\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(4,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;28\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(18,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;28\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(19,6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ed.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;106 (71,1%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;59\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(39,6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;56\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(39,2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;29\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(19,5%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;51\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(34,2%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;40\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(28%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;7\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(4,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;19\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(12,8%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;29\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(20,3%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;7\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(4,7%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;20\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(13,4%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;18\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(12,6%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 3px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eLegend:\u0026nbsp;\u003c/strong\u003ePM: Start of neoadjuvant chemotherapy treatment; SM: Switch or between the third and fourth cycle of chemotherapy; TM: End of neoadjuvant chemotherapy treatment. Between the first and second moments and between the first and third moments (p=0.000).\u003c/p\u003e\n\u003cp\u003ea. Did any of your hair fall out?\u003c/p\u003e\n\u003cp\u003eb. Only answer this question if you have experienced hair loss: Are you worried about hair loss?\u003c/p\u003e\n\u003cp\u003ec. Did you feel less feminine because of your illness and treatment?\u003c/p\u003e\n\u003cp\u003ee. Did you feel less satisfied with your body?\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eBreast cancer is the most common malignant neoplasm among women worldwide, representing a significant public health challenge (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In addition to the physical impact of the disease and its treatment, the emotional, psychological and social consequences are widely documented, affecting the quality of life of patients (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Among these repercussions, sexuality is often compromised, either by diagnosis or by subsequent treatments, and does not always receive due attention in the therapeutic approach and clinical support (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Sexuality is an essential dimension of human life, directly influencing identity, emotional well-being and quality of life (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this prospective cohort study of 149 women diagnosed with non-metastatic breast cancer who underwent neoadjuvant chemotherapy, we observed that, even before the start of treatment, just over a third of the participants (37%) reported feeling sexually attractive in their clothes, confident and comfortable during sexual intercourse. Although cancer diagnosis and treatment are recognized as factors that affect sexuality, it is essential to consider that pre-existing difficulties in sexual behaviors, perceptions and practices can be confounding and potentiating factors of these events. Previous studies indicate that the prevalence of sexual dysfunction in women without a diagnosis of breast cancer varies between 20% and 60%. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eFemale sexual health should not only be understood from a physical perspective but also considering its psychological and social implications. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) The emotional impact of breast cancer, including feelings of fear, uncertainty, stress, anger, and depressive symptoms, can compromise the perception of sexuality from the beginning of treatment. A 2021 meta-analysis on the psychological impacts of breast cancer found that 34% of patients experience significant clinical symptoms of anxiety, with this being most prevalent between diagnosis and the start of treatment. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eCultural aspects and repression in the approach to sexuality may explain the low completion of specific questions in the Sexual Well-Being questionnaire. Since the beginning of the research, only 19.5% of the participants completed the Sexual Well-Being questionnaire in full. The question about comfort during sexual intercourse was omitted by 14.9% of the women, while the question about satisfaction with sexual life was left blank by 14.1%. Historically, the interest of health professionals in female sexuality has been limited to the prevention of sexually transmitted infections and birth control. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) This lack of openness can generate discomfort and apprehension among patients, making communication with health professionals difficult. Studies indicate that most women avoid discussing sexual issues due to embarrassment or lack of support from professionals. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe impact of treatment on self-image cannot be overlooked either. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) Chemotherapy treatment alters body perception, affecting patients\u0026rsquo; self-image and self-confidence. Chemotherapy-induced alopecia, although not a fatal risk, is one of the most distressing side effects for women with breast cancer. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) In our study, 80.4% of participants reported severe hair loss at the end of treatment, and 58.8% expressed concern about this change. In addition to hair loss, other physical changes, such as loss of eyelashes and eyebrows, weight loss, edema, excessive vomiting, and changes in skin and nail color, contributed to the deterioration of self-esteem and perception of one\u0026rsquo;s own sexuality.\u003c/p\u003e \u003cp\u003eThe impact of sexuality on relationships is also a relevant factor. (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) Changes in self-esteem and body image can affect the dynamics of the relationship, making communication and intimacy between couples difficult. Studies show that marital support is essential for the emotional adaptation of patients and can minimize the negative effects on sexuality (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Marital counseling and couples therapy programs have been shown to be effective in reducing the impact of breast cancer on the sexual lives of patients and their partners. (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn conclusion, despite the cultural and psychological barriers that hinder the discussion of sexuality in the oncological context, it is essential that health professionals adopt a proactive and sensitive approach to the topic. In addition to addressing patients' complaints, it is necessary to interpret nonverbal signals and offer comprehensive support during treatment, recognizing and addressing the physical and emotional changes that impact women's sexual health and well-being.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn this study, we evaluated the impacts of neoadjuvant chemotherapy treatment on women's quality of sexual life. The most significant differences were found between the beginning and half of treatment, as well as between the beginning and end of treatment, with statistically significant variations. It is important to highlight that, since the beginning of the treatment, many women already had low levels of sexual satisfaction, however, as the treatment progressed, an even more pronounced reduction was observed, especially in the aspects of attractiveness, self-confidence and femininity.\u003c/p\u003e \u003cp\u003eAlthough there are other prospective cohort studies that provide valuable insights, most of them are based on smaller samples. Research involving more than one hundred participants within this topic is rare in scientific literature. In this context, the present study assumes special importance, since its large sample allows a more robust analysis of the impact of neoadjuvant chemotherapy on the sexual quality of life of women with breast cancer. The data from our study are fundamental to illuminate the intersection between cancer treatment and sexual health, highlighting the importance of more comprehensive and patient-centered care. The recognition that sexual health may already be impacted before the diagnosis of cancer and that there is an even more significant reduction with treatment can serve as a starting point for the development of clinical interventions that address the emotional, psychological and sexual needs of women during breast cancer treatment.\u003c/p\u003e \u003cp\u003eWe believe that future research will be able to provide a deeper understanding of the impacts perceived by participants, and that studies with interventions will represent an excellent opportunity to improve the quality of sexual life of women undergoing neoadjuvant chemotherapy, promoting more holistic and patient-centered care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFinancing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to declare\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the conception and design of the study. The preparation of the material, data collection and analysis were carried out by Isabela Rodrigues Neves de Oliveira. The first draft of the manuscript was made by Isabela Rodrigues Neves de Oliveira and all authors commented on previous versions of the manuscript. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was carried out in accordance with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the A.C. Camargo Cancer Center on July 16, 2021 - Number: 307721.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization International Agency for Research on Cancer. The Global Cancer Observatory. 20 22 statistics.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational Cancer Institute Jos\u0026eacute; Alencar Gomes da Silva (INCA). Rio de Janeiro (RJ), Brazil. Brazilian Breast Cancer Study Group (GBECAM). Rio de Janeiro (RJ), Brazil.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInternational Agency for Research on Cancer. Geneva: World Health Organization. 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PMID: 31872299.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Quality of Life, Breast Neoplasms, Neoadjuvant Therapy, Sexuality.","lastPublishedDoi":"10.21203/rs.3.rs-6214592/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6214592/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eObjective: To evaluate the impact of neoadjuvant chemotherapy on the sexual quality of life of women with breast cancer.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMethod: Prospective cohort study, carried out between July 2022 and July 2023, with 149 women with non-metastatic breast cancer, candidates for neoadjuvant chemotherapy treatment at the A.C. Camargo Cancer Center. Data collection was performed at three moments: at the beginning of treatment (PM), during the change in therapeutic protocol (SM) and at the end of treatment, with the application of the BREAST-Q and EORTC-QLQ-BR23 instruments.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResult: The impact of neoadjuvant chemotherapy can be observed, with a reduction in self-perception of sexual attractiveness without clothes (which decreased from 41.4% in PM, to 25.7% in SM and 23.2% in TM), in the feeling of femininity when dressed (72.5% in PM, 47.7% in SM and 43.4% in TM), and in satisfaction with sexual life (PM 38.5%, SM 20.2%, TM 18.0%). Such factors are implicated in the deterioration of sexual quality of life throughout neoadjuvant chemotherapy (p=0.000).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: A reduction in QOL was observed throughout treatment, with greater relevance between the beginning and half of treatment, as well as between the beginning and end of treatment.\u003c/p\u003e","manuscriptTitle":"Impact of Neoadjuvant Chemotherapy on the Quality of Sexual Life of Women with Breast Cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-07 14:18:36","doi":"10.21203/rs.3.rs-6214592/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"10545c35-ebe0-4e7e-a6a1-fa56a2dd4ad4","owner":[],"postedDate":"May 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-29T00:38:23+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-07 14:18:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6214592","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6214592","identity":"rs-6214592","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}