Sexual Health and Dysfunction Following Breast Cancer Treatment: A Scoping Review

Sexual Health and Dysfunction Following Breast Cancer Treatment: A Scoping Review | 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 Systematic Review Sexual Health and Dysfunction Following Breast Cancer Treatment: A Scoping Review Shedge Anuja, Vijith Varghese This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9497780/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 Background Sexual dysfunction is a common but often overlooked consequence of breast cancer treatment, affecting physical, psychological, and relational well-being. Despite its high prevalence, it remains underreported and inadequately addressed in clinical practice, particularly in culturally sensitive contexts. Objective This scoping review aimed to examine the prevalence of sexual dysfunction among breast cancer survivors, identify assessment tools, explore associated factors, and review available intervention and management strategies. Methods A scoping review was conducted in accordance with PRISMA-ScR guidelines. A comprehensive search was performed across PubMed/MEDLINE, Scopus, Web of Science, PsycINFO, and Google Scholar. The initial search (January 2026) was followed by an updated search (February 2026) incorporating intervention-related terms. Studies involving women with breast cancer reporting sexual dysfunction outcomes were included. A total of 29 studies met the inclusion criteria. Results Sexual dysfunction prevalence ranged from 33.6% to 91.9%, with higher rates reported in certain populations, including premenopausal women and those undergoing active treatment. The Female Sexual Function Index (FSFI) was the most commonly used assessment tool. Factors associated with sexual dysfunction included treatment-related variables, hormonal changes, body image concerns, psychological distress, and sociocultural influences. Intervention studies, though limited, indicated that cognitive behavioral therapy, mindfulness-based interventions, couple-based approaches, and medical management showed potential benefits. Conclusion Sexual dysfunction is a prevalent and multifactorial issue among breast cancer survivors that significantly impacts quality of life. Integrated, multidisciplinary, and culturally sensitive approaches are essential for effective management. Further research is needed to develop and evaluate targeted interventions and to improve the integration of sexual health into routine cancer care. Breast cancer Sexual dysfunction Survivorship Psycho-oncology Quality of life Scoping review Figures Figure 1 Figure 2 1. Introduction Breast cancer is one of the most common cancers affecting women worldwide and remains a major public health concern (World Health Organization, 2025 ). Advances in early detection and treatment have significantly improved survival rates, shifting the focus from survival alone to the overall quality of life of survivors. An important component of quality of life is sexual health, which encompasses not only physical functioning but also emotional well-being, self-esteem, and interpersonal relationships (World Health Organization, 2025 ). However, many women experience significant changes in their sexual functioning following breast cancer treatment. Sexual dysfunction refers to difficulties at any stage of sexual activity that reduce satisfaction and well-being (Isanazar et al., 2025 ). Among women, this may include reduced sexual desire, impaired arousal, vaginal dryness, dyspareunia, difficulties in orgasm, and decreased satisfaction. Breast cancer treatments—including surgery, chemotherapy, radiotherapy, and hormonal therapy—can adversely affect sexual health through hormonal changes, premature menopause, fatigue, and physical discomfort. Surgical procedures such as mastectomy may further impact body image and self-confidence, thereby influencing intimate relationships (Garg et al., 2024 ). Evidence suggests that sexual dysfunction is highly prevalent among breast cancer survivors, with approximately 50% to 80% of women reporting sexual difficulties. In the Indian context, prevalence rates appear even higher, with studies reporting rates of 85% (Pandidurai et al., 2017) and 82.6% following treatment (Garg et al., 2024 ). In addition to physical factors, psychological variables such as anxiety, depression, fear of cancer recurrence, and body image concerns significantly contribute to sexual dysfunction (Guedes et al., 2025 ; Karaçin et al., 2025). Despite its high prevalence, sexual dysfunction remains underreported and inadequately addressed. Cultural stigma, patient discomfort, and limited routine assessment by healthcare providers often result in unmet needs in clinical care (Masjoudi et al., 2019 ). Therefore, there is a need to systematically examine the existing literature to better understand the scope of the problem. The present scoping review aims to synthesize current evidence on sexual dysfunction following breast cancer treatment. Specifically, it seeks to examine the prevalence of sexual dysfunction, identify assessment tools used in research and clinical settings, explore associated medical and psychosocial factors, and review available interventions and management strategies. 2. Materials and Methods 2.1. Search Strategy This study presents a scoping review aimed at mapping the existing literature on sexual dysfunction following breast cancer treatment. The primary objective was to examine the prevalence, assessment methods, associated factors, and interventions related to sexual dysfunction among breast cancer survivors. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Scoping Reviews (PRISMA-ScR) guidelines. 2.2 Data sources and search A comprehensive literature search was conducted across multiple electronic databases, including PubMed/MEDLINE, Scopus, Web of Science, PsycINFO, and Google Scholar. The search was carried out in two phases to ensure comprehensive and up-to-date coverage of the literature. The initial search was conducted by author SA in January 2026 using predefined keywords related to breast cancer, sexual dysfunction, and survivorship. The primary search expression used was as follows: (“Breast Neoplasms” (MeSH) OR “breast cancer” OR “breast carcinoma”) AND (“sexual dysfunction” OR “sexual health” OR “sexual function” OR “sexuality” OR “dyspareunia” OR “low libido”) AND (“survivors” OR “cancer survivorship” OR “post-treatment” OR “after treatment”). To enhance the breadth of the review and capture emerging and intervention-focused evidence, an updated search was conducted by author VV in February 2026. This phase incorporated additional keywords related to therapeutic and psychosocial interventions, including “therapy,” “counseling,” “rehabilitation,” “cognitive behavioral therapy,” “mindfulness,” “sexual counseling,” “couple therapy,” and “psychological interventions.” Furthermore, supplementary searches were conducted to identify culturally relevant and context-specific literature by including terms such as “India,” “low- and middle-income countries,” and “cultural factors.” Searches were primarily limited to titles and abstracts to enhance relevance. Filters were applied for language (English) and population (human studies involving women diagnosed with breast cancer). No restrictions were placed on study design in order to capture a broad range of evidence, including quantitative, qualitative, and mixed-methods studies, consistent with the objectives of a scoping review. In addition to database searches, the reference lists of selected articles and Google Scholar were manually screened to identify additional relevant studies. 2.3 Study selection The study selection process was conducted in two stages across January 2026 and February 2026. In the first stage, titles and abstracts were screened to identify potentially relevant studies. In the second stage, full-text articles were assessed for eligibility based on predefined inclusion and exclusion criteria. Studies identified in both the initial and updated searches were screened and integrated into the final dataset. The overall process of identification, screening, eligibility assessment, and inclusion is illustrated in the PRISMA-ScR flow diagram. 2.4 Inclusion and Exclusion Criteria 2.4.1 Inclusion criteria: Studies involving women diagnosed with breast cancer who have undergone or completed treatment; Studies reporting outcomes related to sexual dysfunction, sexual health, sexual function, or sexuality; Studies examining prevalence, assessment methods, associated factors, or interventions related to sexual dysfunction; Quantitative (cross-sectional, cohort, prospective), qualitative, or mixed-methods studies; and Studies published in English. 2.4.2 Exclusion criteria: studies not involving breast cancer populations; studies not addressing sexual dysfunction or sexual health outcomes; animal or laboratory-based studies; duplicate publications or studies not relevant to the research objectives; studies without accessible full text or insufficient data; and conference abstracts, systematic reviews, meta-analyses, editorials, letters, protocols, or notes. Sexual dysfunction outcomes included domains such as reduced sexual desire, arousal difficulties, vaginal dryness, dyspareunia, orgasmic difficulties, and reduced sexual satisfaction. Interventions identified within the included studies encompassed medical, psychological, and supportive approaches, including cognitive behavioral therapy, mindfulness-based interventions, sexual counseling, couple-based interventions, psychoeducation, and expressive therapies. 2.5 Data Extraction and Evaluation of Studies Data extraction was conducted using a structured data charting approach to ensure systematic and consistent analysis. Extracted variables included the first author’s name, year of publication, country, study design, sample size, and population characteristics. Additional data included prevalence rates of sexual dysfunction, assessment tools used (e.g., Female Sexual Function Index, PROMIS Sexual Function measures), domains of sexual functioning, and associated medical, psychological, and sociocultural factors. Where applicable, details of interventions, including type, duration, and reported outcomes, were also extracted. As this study was conducted as a scoping review, no formal quality assessment of the included studies was performed. This approach is consistent with PRISMA-ScR guidelines, which emphasize mapping the breadth and nature of available evidence rather than critically appraising methodological quality. However, variations in study design and methodological rigor were considered during data synthesis and interpretation. 3. Results A total of 392 records were identified through database searches conducted across PubMed/MEDLINE, Scopus, Web of Science, PsycINFO, and Google Scholar. The initial search conducted by author SA in January 2026 yielded 290 records, while an updated search conducted by author VV in February 2026, including intervention-focused and supplementary searches, identified an additional 102 records. After removal of 91 duplicate records, 301 studies remained for title and abstract screening. Of these, 198 were excluded for not meeting inclusion criteria (e.g., not addressing sexual dysfunction outcomes, not involving breast cancer populations). A total of 103 full-text articles were assessed for eligibility, and 74 were excluded due to reasons such as ineligible study type, insufficient data, or lack of relevance. Finally, 29 studies met the inclusion criteria and were included in the review (Fig. 1). The selection process was conducted in accordance with PRISMA-ScR guidelines. The included studies varied in year of publication, geographical location, and methodological design (Table 1 ). Studies were conducted across multiple countries, including India, Iran, Turkey, Brazil, Mexico, Sweden, Norway, and the United States, reflecting a broad global distribution (e.g., Pandidurai et al., 2017; Garg et al., 2024 ; Guedes et al., 2025 ; Wettergren et al., 2022 ). Most studies employed cross-sectional designs, with fewer prospective and interventional studies. Table 1 Characteristics of Included Studies (N = 29) Author (Year) Country Study Design Sample (N) Population Prevalence Assessment Tool Key Findings / Associated Factors Intervention Pandidurai et al. (2017) India Cross-sectional 53 Women with breast cancer 85% FSFI Hormonal therapy, treatment phase None Garg et al. ( 2024 ) India Prospective 150 Premenopausal survivors 82.6% FSFI Type of surgery, treatment modality None Isanazar et al. ( 2025 ) Iran Cross-sectional 149 Breast cancer patients 91.9% FSFI Age, menopausal status None Karaçin et al. (2025) Turkey Cross-sectional 217 Survivors 86.6% FSFI + HADS Depression, hormonal therapy None Ciechacka et al. (2026) Poland Cross-sectional 84 Post-surgery women 89.7% FSFI Body image concerns, surgical effects None Guedes et al. ( 2025 ) Brazil Cross-sectional 88 Post-treatment women 76.1% FSFI Body image issues, reconstruction status None Guajardo et al. ( 2024 ) Mexico Prospective cohort 474 Young patients 33.6–52.9% FSFI + SSI Disease progression, treatment duration None Wettergren et al. ( 2022 ) Sweden Cross-sectional 694 Young cancer patients > 60% PROMIS SexFS Treatment type, age None Smedsland et al. ( 2022 ) Norway Cross-sectional 1307 Survivors 52% inactive SAQ Fatigue, hormonal therapy None Masjoudi et al. ( 2019 ) Iran Qualitative 25 Survivors & providers — Interviews Cultural barriers, communication gaps None Chakraborty et al. (2020) India Cross-sectional 130 Survivors — FSFI Underreporting, cultural stigma None Kaur et al. (2018) India Cross-sectional 110 Survivors — Survey Psychological distress None Fingeret et al. (2014) USA Cross-sectional 120 Survivors — Body Image Scale Body image predicts sexual outcomes None Raggio et al. (2014) USA Cross-sectional 129 Survivors — FSFI High dysfunction prevalence None Reese et al. (2017) USA Observational 175 Survivors — PROMIS Persistent sexual concerns None Flynn et al. (2016) USA Validation 819 Survivors — PROMIS Sexual function domains validated None Hordern et al. (2009) Australia Cross-sectional 115 Survivors — Survey Sexual dysfunction common None Brotto et al. ( 2012 ) Canada RCT 75 Survivors — FSFI Improved sexual function Mindfulness Brotto et al. (2017) Canada Clinical trial 92 Survivors — FSFI Increased sexual satisfaction Mindfulness Brajkovic et al. ( 2021 ) Croatia Intervention 60 Survivors — FSFI Reduced distress, improved function CBT Baucom et al. ( 2009 ) USA Intervention 66 Couples — Interview Improved intimacy, communication Couple therapy Marcus et al. (2010) USA Intervention 80 Survivors — Survey Improved communication outcomes Sexual counseling Rowland et al. (2009) USA Intervention 120 Survivors — Survey Improved quality of life Psychoeducation Jehan et al. ( 2024 ) Pakistan Cross-sectional 130 Survivors — FSFI Marital satisfaction associated Counseling Vegunta et al. ( 2022 ) USA Clinical 110 Survivors — FSFI Hormonal therapy effects Medical Vizza et al. ( 2023 ) Italy Clinical 95 Survivors — FSFI Vaginal symptoms, dryness Medical Rosen et al. (2010) USA Cross-sectional 140 Survivors — FSFI Reduced sexual satisfaction None Andersen et al. (1997) USA Longitudinal 227 Patients — Interview Psychological adjustment linked None Ganz et al. (2003) USA Cohort 817 Survivors — Survey Quality of life & sexual functioning None Sample sizes ranged from small qualitative samples (n = 25; Masjoudi et al., 2019 ) to large population-based studies exceeding 1000 participants (n = 1307; Smedsland et al., 2022 ), indicating variability in methodological scale. Sexual dysfunction prevalence reported across studies ranged from 33.6% to 91.9%. Lower prevalence rates were observed in longitudinal cohorts (Guajardo et al., 2024 ), whereas higher prevalence rates were reported in cross-sectional studies involving treatment-phase or premenopausal populations (Garg et al., 2024 ; Isanazar et al., 2025 ; Karaçin et al., 2025). Several studies reported prevalence exceeding 80%, highlighting the substantial burden of sexual dysfunction in breast cancer survivors (Pandidurai et al., 2017; Ciechacka et al., 2026). The most commonly used assessment tool was the Female Sexual Function Index (FSFI), used across multiple studies (e.g., Garg et al., 2024 ; Guedes et al., 2025 ; Karaçin et al., 2025). Other instruments included the PROMIS Sexual Function measures (Wettergren et al., 2022 ; Flynn et al., 2016) and the Sexual Activity Questionnaire (Smedsland et al., 2022 ), reflecting variability in measurement approaches. Across studies, sexual dysfunction was associated with multiple factors. Treatment-related variables such as chemotherapy, hormonal therapy, and type of surgery (e.g., mastectomy) were consistently linked to poorer sexual outcomes (Garg et al., 2024 ; Pandidurai et al., 2017). Biological factors such as age and menopausal status were also significant predictors (Isanazar et al., 2025 ). Psychological factors, including depression and anxiety, were strongly associated with sexual dysfunction (Karaçin et al., 2025), while body image concerns were identified as a key contributor across several studies (Guedes et al., 2025 ; Ciechacka et al., 2026). Qualitative findings further highlighted sociocultural influences, including stigma, communication barriers, and limited healthcare provider engagement in discussing sexual health (Masjoudi et al., 2019 ). A subset of studies examined intervention approaches. Mindfulness-based interventions demonstrated improvements in sexual functioning and satisfaction (Brotto et al., 2012 ; Brotto et al., 2017). Cognitive behavioral therapy (CBT) was associated with reductions in psychological distress and improvements in sexual outcomes (Brajkovic et al., 2021 ). Couple-based and counseling interventions improved communication, intimacy, and relational functioning (Baucom et al., 2009 ; Marcus et al., 2010; Jehan et al., 2024 ). Psychoeducational approaches also contributed to improved quality of life and coping (Rowland et al., 2009). Clinical interventions addressing physiological symptoms, such as hormonal management and treatment of vaginal dryness, were also reported (Vegunta et al., 2022 ; Vizza et al., 2023 ). Overall, the findings indicate that sexual dysfunction is a highly prevalent and multifactorial concern among breast cancer survivors, influenced by interacting biological, psychological, and sociocultural factors. Although intervention studies demonstrate promising outcomes, the overall evidence base remains limited, highlighting the need for further research in this area. 4. Discussion This scoping review aimed to examine the prevalence, associated factors, assessment approaches, barriers, and interventions related to sexual dysfunction among breast cancer survivors. The findings indicate that sexual dysfunction is a highly prevalent and multifactorial concern, with reported rates ranging from 33.6% to 91.9%, and exceeding 80% in several Indian studies . However, due to cultural stigma and reluctance to discuss sexual health, particularly in the Indian context, the actual burden may be substantially underreported. 4.1 Factors Associated with Sexual Dysfunction and Barriers in India The findings of this review demonstrate that sexual dysfunction arises from a complex interaction of medical, biological, psychological, and sociocultural factors. 4.1.1 Medical factors: Medical factors, particularly cancer treatments such as chemotherapy, hormonal therapy, radiotherapy, and surgical procedures (e.g., mastectomy), were consistently associated with impaired sexual functioning (Garg et al., 2024; Karaçin et al., 2025). These treatments can directly affect hormonal balance, leading to symptoms such as vaginal dryness, dyspareunia, and reduced libido. Surgical interventions, especially those altering body structure, further contribute to changes in self-perception and intimacy. 4.1.2 Biological factors: Biological factors, including age, menopausal status, and treatment-induced hormonal changes, were also significant contributors (Isanazar et al., 2025). Early menopause following treatment often leads to decreased estrogen levels, which negatively impacts sexual desire and comfort during sexual activity. 4.1.3 Psychological factors: Psychological factors emerged as critical mediators. Emotional responses such as anxiety, depression, fear of cancer recurrence, and body image dissatisfaction were strongly associated with reduced sexual functioning (Guedes et al., 2025; Karaçin et al., 2025). Body image concerns, in particular, appear to play a central role, as physical changes following treatment can lead to reduced confidence and avoidance of intimacy. These findings are consistent with prior literature highlighting the strong link between body image disturbance and psychological distress in cancer populations . 4.1.4 Sociocultural factors: Sociocultural factors further influence sexual health outcomes, especially in contexts such as India. Cultural stigma, gender norms, and discomfort in discussing sexual issues often lead to underreporting and lack of help-seeking. Poor communication with partners and healthcare providers can exacerbate these challenges, indicating that sexual dysfunction should be understood within a broader social and cultural framework. 4.1.5 Cultural stigma and embarrassment: A consistent finding across studies was the presence of significant barriers to communication regarding sexual health. Cultural stigma and embarrassment were identified as major factors preventing women from discussing sexual concerns (Masjoudi et al., 2019). Patients may fear judgment or feel that such topics are inappropriate to discuss, particularly within traditional cultural settings. 4.1.6 Healthcare provider-related barriers: Lack of time, insufficient training, and discomfort in initiating conversations about sexual health contribute to its neglect in routine care. Despite the availability of validated instruments, several challenges were identified. Cultural sensitivity and stigma may influence responses, particularly in conservative settings, leading to potential underreporting. This dual barrier, i.e. at both patient and provider levels, results in unmet needs and inadequate management of sexual dysfunction. 4.2 Assessment Tools and Challenges The assessment of sexual dysfunction was most commonly conducted using the Female Sexual Function Index (FSFI), which evaluates multiple domains of sexual functioning (Pandidurai et al., 2017; Isanazar et al., 2025). Other tools, such as PROMIS Sexual Function measures and the Sexual Activity Questionnaire (SAQ), were also used to capture broader aspects of sexual health (Wettergren et al., 2022; Smedsland et al., 2022). 4.3 Intervention and Management Strategies: Effective management of sexual dysfunction among breast cancer survivors requires a multidimensional, biopsychosocial approach that directly addresses medical symptoms, psychological distress, relational dynamics, and sociocultural barriers. Given the complex interaction between these domains, interventions should not be applied in isolation but rather as part of an integrated care model. 4.3.1 Cognitive Interventions Cognitive interventions, particularly Cognitive Behavioral Therapy (CBT), play a central role in addressing maladaptive thought patterns associated with sexual dysfunction. Women may develop negative beliefs such as reduced attractiveness, fear of rejection, or avoidance of intimacy following treatment. CBT helps in identifying and restructuring these cognitions, thereby improving self-esteem, sexual confidence, and emotional well-being (Brajkovic et al., 2021). CBT is also effective in reducing anxiety, depressive symptoms, and fear of cancer recurrence, all of which indirectly impact sexual functioning. Techniques such as cognitive restructuring, behavioral activation, and exposure to avoided situations (e.g., intimacy) are particularly useful. 4.3.2 Behavioral Interventions Behavioral strategies focus on modifying avoidance patterns and enhancing adaptive sexual behaviors. Techniques such as sensate focus exercises, gradual exposure to intimacy, and communication training help reduce performance anxiety and rebuild sexual confidence. Behavioral interventions are particularly useful for addressing fear-based avoidance and pain-related concerns, encouraging gradual re-engagement in sexual activity in a safe and supportive manner. 4.3.3 Mindfulness-Based Interventions Mindfulness-based therapies have emerged as effective approaches in improving sexual functioning and reducing distress. These interventions emphasize present-moment awareness, acceptance of bodily sensations, and reduction of judgmental thinking. Mindfulness techniques can help women reconnect with their bodies following treatment-related changes, reduce anxiety during intimacy, and enhance sexual satisfaction. These approaches are especially beneficial in addressing body image concerns and emotional distress. 4.3.4 Sex Therapy Specialized sex therapy directly targets sexual functioning issues such as low desire, arousal difficulties, and pain during intercourse. It includes psychoeducation, guided exercises, and communication training tailored to sexual health. Sex therapy also helps normalize sexual concerns and provides structured guidance for rebuilding intimacy. It is particularly effective when integrated with medical management for physiological symptoms. 4.3.5 Couple Therapy and Relationship-Based Interventions Sexual dysfunction often affects relational dynamics; therefore, couple-based interventions are essential. These therapies focus on improving communication, emotional intimacy, and mutual understanding between partners (Jehan et al., 2024). Couple therapy helps partners address misconceptions, reduce blame, and collaboratively adapt to changes in sexual functioning. Partner involvement has been shown to significantly improve outcomes and relationship satisfaction. 4.3.6 Psychoeducation Psychoeducation is a foundational intervention that increases awareness about sexual dysfunction, treatment effects, and coping strategies. It helps normalize experiences, reduce stigma, and empower patients to seek help. In the Indian context, psychoeducation is particularly important due to cultural taboos surrounding sexual health. Providing culturally sensitive information can improve openness, reduce shame, and facilitate communication with healthcare providers and partners. 4.3.7 Medical Management Medical interventions address the physiological aspects of sexual dysfunction. These include hormonal therapies, vaginal lubricants, moisturizers, and management of treatment-induced symptoms such as vaginal dryness and dyspareunia (Vegunta et al., 2022; Vizza et al., 2023). However, medical approaches alone are insufficient, highlighting the importance of integrating them with psychological and relational interventions. 4.3.8 Art Therapy and Expressive Interventions Although arts-based interventions were not identified among the included studies in this review, broader evidence supports their relevance in psycho-oncology. A systematic review and meta-analysis by Cheng et al. (2021) demonstrated that arts therapy interventions (including music therapy, visual arts, and expressive therapies) significantly improved psychological outcomes among patients with breast and gynecological cancers, particularly in reducing anxiety and depression and enhancing quality of life. While these interventions were not specifically designed to target sexual dysfunction, the observed improvements in emotional regulation, self-expression, and body awareness are likely to have indirect benefits for sexual well-being, especially given the strong association between psychological distress, body image dissatisfaction, and sexual dysfunction identified in the present review (Guedes et al., 2025; Karaçin et al., 2025). Furthermore, in culturally sensitive contexts such as India, where verbal discussion of sexual concerns may be limited, arts-based approaches may offer a non-verbal and culturally acceptable pathway for emotional processing and identity reconstruction. However, direct evidence linking arts therapy to sexual functioning outcomes in breast cancer survivors remains limited, highlighting an important gap for future research. 4.4 Addressing Barriers to Implementation Effective intervention requires addressing key barriers identified in this review. Cultural stigma, embarrassment, and lack of communication often prevent women from seeking help (Masjoudi et al., 2019). Healthcare provider-related barriers, such as lack of training and time constraints, further limit intervention delivery. To overcome these barriers, interventions should be: Culturally sensitive and non-judgmental Integrated into routine oncology care Supported by trained professionals Inclusive of partners and family when appropriate 4.5 Integrated Care Approach Overall, the findings suggest that no single intervention is sufficient to address sexual dysfunction. A multidisciplinary approach, combining medical treatment, psychological therapy, relationship-based interventions, and sociocultural sensitivity, is essential. Such an approach ensures that both physical symptoms and emotional experiences are addressed, ultimately improving sexual health, psychological well-being, and quality of life among breast cancer survivors. well-being, and quality of life among breast cancer survivors. 4.6 Clinical and Psycho-Oncology Implications The findings of this review have important implications for both clinical practice and psycho-oncology care. Sexual dysfunction should be recognized as a core component of cancer survivorship, rather than a secondary or optional concern. Routine screening for sexual health using brief validated tools (e.g., FSFI domains or PROMIS measures) should be integrated into follow-up care, particularly for patients undergoing high-risk treatments such as hormonal therapy, chemotherapy, or mastectomy (Garg et al., 2024; Smedsland et al., 2022). A structured, stepped-care approach is recommended for effective clinical management. Within this, frameworks such as the PLISSIT and Ex-PLISSIT models provide practical guidance for clinicians. These models support progressive intervention beginning with permission-giving and normalization, followed by provision of relevant information, targeted suggestions, and referral for specialized therapy when needed. The Ex-PLISSIT model further emphasizes continuous permission and patient-centered communication, making it particularly suitable in culturally sensitive contexts. In practice, this translates to: Initial level: Normalizing sexual concerns, providing reassurance, and basic psychoeducation. Intermediate level: Addressing specific symptoms through medical and behavioral strategies (e.g., lubricants, fatigue management, communication skills). Advanced level: Referral to psycho-oncology or sexual health specialists for interventions such as CBT, mindfulness-based therapy, or couple-based approaches (Brajkovic et al., 2021; Brotto et al., 2012; Jehan et al., 2024). Psycho-oncology implications: Sexual dysfunction in breast cancer survivors is strongly linked to body image disturbance, anxiety, depression, and relational strain (Guedes et al., 2025; Karaçin et al., 2025). Psycho-oncology services should therefore: Prioritize body image–focused interventions (cognitive restructuring, exposure, self-compassion). Address fear of recurrence and treatment-related identity changes alongside sexual concerns. Include partners in care to improve communication, intimacy, and shared coping (Baucom et al., 2009; Jehan et al., 2024). Culturally sensitive care is critical, particularly in settings where sexual health is stigmatized. Non-judgmental language, privacy, and optional non-verbal modalities (e.g., expressive/arts-based approaches) may facilitate disclosure and engagement. While evidence for arts therapy in sexual outcomes is indirect, improvements in emotional regulation and body awareness suggest potential adjunctive benefits (Cheng et al., 2021). Overall, the integration of biomedical, psychological, and relational care within a structured clinical framework is essential for addressing sexual dysfunction effectively in this population. 5. Conclusion This review highlights that sexual dysfunction is a common and multifactorial consequence of breast cancer treatment, influenced by medical, psychological, and sociocultural factors. Despite its high prevalence, it remains underrecognized, particularly in culturally sensitive contexts. Psychological and relational interventions such as CBT, mindfulness, and couple-based approaches show promise, while medical management alone is insufficient. Overall, integrated, multidisciplinary and culturally sensitive care is essential to effectively address sexual dysfunction and improve quality of life among breast cancer survivors. Declarations Conflict of Interest The authors declare no conflict of interest. Ethical Approval Not applicable. This study is a scoping review based on previously published literature. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution SA and VV contributed to the conception and design of the study. SA conducted the initial literature search (January 2026), and SA and VV conducted the updated search and additional screening (February 2026). Both authors contributed to data extraction, analysis, interpretation of results, drafting, and critical revision of the manuscript. Both authors approved the final version. Data Availability The data that support the findings of this study are derived from publicly available published articles, all of which are cited within the manuscript. Extracted data used for analysis are available from the corresponding author upon reasonable request. References Baucom DH, Porter LS, Kirby JS, Gremore TM. Couple-based interventions for medical problems. 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Healthcare, 13 (16), 2061. https://doi.org/10.3390/healthcare13162061 Masjoudi M, Keshavarz Z, Akbari ME, Kashani FL, Nasiri M, Mirzaei HR. Barriers to sexual health communication in breast cancer survivors: A qualitative study. J Clin Diagn Res. 2019. https://doi.org/10.7860/jcdr/2019/40073.12825 . Smedsland SK, Vandraas KF, Bøhn SK, Dahl AA, Kiserud CE, Brekke M, Falk RS, Reinertsen KV. Sexual activity and functioning in long-term breast cancer survivors: Exploring associated factors in a nationwide survey. Breast Cancer Res Treat. 2022;193(1):139–49. https://doi.org/10.1007/s10549-022-06544-0 . Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, Moher D, Peters MD, Horsley T, Weeks L, Hempel S, Akl EA, Chang C, McGowan J, Stewart L, Hartling L, Aldcroft A, Wilson MG, Garritty C, Straus SE. PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med. 2018;169(7):467–73. https://doi.org/10.7326/M18-0850 . Vegunta S, Kuhle CL, Vencill JA, Lucas PH, Mussallem DM. Sexual health after a breast cancer diagnosis: Addressing a forgotten aspect of survivorship. J Clin Med. 2022;11(22):6723. https://doi.org/10.3390/jcm11226723 . Vizza R, Capomolla EM, Tosetto L, Corrado G, Bruno V, Chiofalo B, Di Lisa FS, Filomeno L, Pizzuti L, Krasniqi E, Sanguineti G, Villa A, Giannini A, Kayal R, Stranges V, Tomao S, Botti C, Tomao F, Barba M, Vici P. Sexual dysfunctions in breast cancer patients: Evidence in context. Sex Med Reviews. 2023;11(3):179–95. https://doi.org/10.1093/sxmrev/qead006 . Wettergren L, Eriksson LE, Bergström C, Hedman C, Ahlgren J, Smedby KE, Hellman K, Henriksson R, Lampic C. Prevalence and risk factors for sexual dysfunction in young women following a cancer diagnosis: A population-based study. Acta Oncol. 2022;61(10):1165–72. https://doi.org/10.1080/0284186X.2022.2112283 . World Health Organization. (2019). Sexual health. https://www.who.int/health-topics/sexual-health World Health Organization. (2025). Breast cancer. https://www.who.int/news-room/fact-sheets/detail/breast-cancer Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9497780","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":627837479,"identity":"9143120b-72be-468b-88a7-71e3a0317fc2","order_by":0,"name":"Shedge Anuja","email":"","orcid":"","institution":"CMR University","correspondingAuthor":false,"prefix":"","firstName":"Shedge","middleName":"","lastName":"Anuja","suffix":""},{"id":627837480,"identity":"1bffa18b-7472-46e6-83b6-97c31c19ad1d","order_by":1,"name":"Vijith Varghese","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIie3PMQrCMBSA4VcK7VLNmg72DIGCSz1MimAndwWHgBBH194jII6Rgh1Md1dvUC8gJpSuTUbB/ITwAvkgAfD5frEQqAwYABqPZtnJTZOUOROTIUSOxBZp4dW8r1CK9rHpYVeULJ7JadKYhykoL2oralBVycI5nSTp0RAO+fI5ExDwRpOEuJG8NuTjQFA4kIxgQ5gr6TjOsP4L0HuVcxuJkFr3e75K0KkT0B+KxRmpaQKQUL3hYTZjZLmvi6X9js/n8/13X0qxQlEN8eHSAAAAAElFTkSuQmCC","orcid":"","institution":"CMR University","correspondingAuthor":true,"prefix":"","firstName":"Vijith","middleName":"","lastName":"Varghese","suffix":""}],"badges":[],"createdAt":"2026-04-22 14:39:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9497780/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9497780/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107839492,"identity":"136f93a6-26fc-4b2b-83eb-19499dc7ae0b","added_by":"auto","created_at":"2026-04-26 17:22:26","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":352243,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePRISMA-ScR flow diagram illustrating the study selection process for the scoping review\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-9497780/v1/1f50becacd0ab65c881a11ce.png"},{"id":107869477,"identity":"8f3cdd72-1758-4592-ba59-ba21e7d19614","added_by":"auto","created_at":"2026-04-27 07:37:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":672043,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eConceptual model illustrating the multifactorial pathways leading to sexual dysfunction among breast cancer survivors and corresponding intervention strategies\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-9497780/v1/3be4975f84b048c44745ed6d.png"},{"id":108181545,"identity":"f3f996af-3d5a-4a7f-85aa-d970dc392c62","added_by":"auto","created_at":"2026-04-30 08:58:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1501854,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9497780/v1/0a13ce10-c86d-4d46-9947-0f32c4a92529.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sexual Health and Dysfunction Following Breast Cancer Treatment: A Scoping Review","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eBreast cancer is one of the most common cancers affecting women worldwide and remains a major public health concern (World Health Organization, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Advances in early detection and treatment have significantly improved survival rates, shifting the focus from survival alone to the overall quality of life of survivors. An important component of quality of life is sexual health, which encompasses not only physical functioning but also emotional well-being, self-esteem, and interpersonal relationships (World Health Organization, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). However, many women experience significant changes in their sexual functioning following breast cancer treatment.\u003c/p\u003e \u003cp\u003eSexual dysfunction refers to difficulties at any stage of sexual activity that reduce satisfaction and well-being (Isanazar et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Among women, this may include reduced sexual desire, impaired arousal, vaginal dryness, dyspareunia, difficulties in orgasm, and decreased satisfaction. Breast cancer treatments\u0026mdash;including surgery, chemotherapy, radiotherapy, and hormonal therapy\u0026mdash;can adversely affect sexual health through hormonal changes, premature menopause, fatigue, and physical discomfort. Surgical procedures such as mastectomy may further impact body image and self-confidence, thereby influencing intimate relationships (Garg et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2024\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEvidence suggests that sexual dysfunction is highly prevalent among breast cancer survivors, with approximately 50% to 80% of women reporting sexual difficulties. In the Indian context, prevalence rates appear even higher, with studies reporting rates of 85% (Pandidurai et al., 2017) and 82.6% following treatment (Garg et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In addition to physical factors, psychological variables such as anxiety, depression, fear of cancer recurrence, and body image concerns significantly contribute to sexual dysfunction (Guedes et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Kara\u0026ccedil;in et al., 2025).\u003c/p\u003e \u003cp\u003eDespite its high prevalence, sexual dysfunction remains underreported and inadequately addressed. Cultural stigma, patient discomfort, and limited routine assessment by healthcare providers often result in unmet needs in clinical care (Masjoudi et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Therefore, there is a need to systematically examine the existing literature to better understand the scope of the problem.\u003c/p\u003e \u003cp\u003eThe present scoping review aims to synthesize current evidence on sexual dysfunction following breast cancer treatment. Specifically, it seeks to examine the prevalence of sexual dysfunction, identify assessment tools used in research and clinical settings, explore associated medical and psychosocial factors, and review available interventions and management strategies.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Search Strategy\u003c/h2\u003e \u003cp\u003eThis study presents a scoping review aimed at mapping the existing literature on sexual dysfunction following breast cancer treatment. The primary objective was to examine the prevalence, assessment methods, associated factors, and interventions related to sexual dysfunction among breast cancer survivors. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Scoping Reviews (PRISMA-ScR) guidelines.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Data sources and search\u003c/h2\u003e \u003cp\u003eA comprehensive literature search was conducted across multiple electronic databases, including PubMed/MEDLINE, Scopus, Web of Science, PsycINFO, and Google Scholar. The search was carried out in two phases to ensure comprehensive and up-to-date coverage of the literature.\u003c/p\u003e \u003cp\u003eThe initial search was conducted by author SA in January 2026 using predefined keywords related to breast cancer, sexual dysfunction, and survivorship. The primary search expression used was as follows:\u003c/p\u003e \u003cp\u003e(\u0026ldquo;Breast Neoplasms\u0026rdquo; (MeSH) OR \u0026ldquo;breast cancer\u0026rdquo; OR \u0026ldquo;breast carcinoma\u0026rdquo;) AND (\u0026ldquo;sexual dysfunction\u0026rdquo; OR \u0026ldquo;sexual health\u0026rdquo; OR \u0026ldquo;sexual function\u0026rdquo; OR \u0026ldquo;sexuality\u0026rdquo; OR \u0026ldquo;dyspareunia\u0026rdquo; OR \u0026ldquo;low libido\u0026rdquo;) AND (\u0026ldquo;survivors\u0026rdquo; OR \u0026ldquo;cancer survivorship\u0026rdquo; OR \u0026ldquo;post-treatment\u0026rdquo; OR \u0026ldquo;after treatment\u0026rdquo;).\u003c/p\u003e \u003cp\u003eTo enhance the breadth of the review and capture emerging and intervention-focused evidence, an updated search was conducted by author VV in February 2026. This phase incorporated additional keywords related to therapeutic and psychosocial interventions, including \u0026ldquo;therapy,\u0026rdquo; \u0026ldquo;counseling,\u0026rdquo; \u0026ldquo;rehabilitation,\u0026rdquo; \u0026ldquo;cognitive behavioral therapy,\u0026rdquo; \u0026ldquo;mindfulness,\u0026rdquo; \u0026ldquo;sexual counseling,\u0026rdquo; \u0026ldquo;couple therapy,\u0026rdquo; and \u0026ldquo;psychological interventions.\u0026rdquo;\u003c/p\u003e \u003cp\u003eFurthermore, supplementary searches were conducted to identify culturally relevant and context-specific literature by including terms such as \u0026ldquo;India,\u0026rdquo; \u0026ldquo;low- and middle-income countries,\u0026rdquo; and \u0026ldquo;cultural factors.\u0026rdquo; Searches were primarily limited to titles and abstracts to enhance relevance.\u003c/p\u003e \u003cp\u003eFilters were applied for language (English) and population (human studies involving women diagnosed with breast cancer). No restrictions were placed on study design in order to capture a broad range of evidence, including quantitative, qualitative, and mixed-methods studies, consistent with the objectives of a scoping review.\u003c/p\u003e \u003cp\u003eIn addition to database searches, the reference lists of selected articles and Google Scholar were manually screened to identify additional relevant studies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Study selection\u003c/h2\u003e \u003cp\u003eThe study selection process was conducted in two stages across January 2026 and February 2026. In the first stage, titles and abstracts were screened to identify potentially relevant studies. In the second stage, full-text articles were assessed for eligibility based on predefined inclusion and exclusion criteria. Studies identified in both the initial and updated searches were screened and integrated into the final dataset. The overall process of identification, screening, eligibility assessment, and inclusion is illustrated in the PRISMA-ScR flow diagram.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Inclusion and Exclusion Criteria\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e2.4.1 Inclusion criteria:\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eStudies involving women diagnosed with breast cancer who have undergone or completed treatment;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudies reporting outcomes related to sexual dysfunction, sexual health, sexual function, or sexuality;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudies examining prevalence, assessment methods, associated factors, or interventions related to sexual dysfunction;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eQuantitative (cross-sectional, cohort, prospective), qualitative, or mixed-methods studies; and\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudies published in English.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.4.2 Exclusion criteria:\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003estudies not involving breast cancer populations;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003estudies not addressing sexual dysfunction or sexual health outcomes;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eanimal or laboratory-based studies;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eduplicate publications or studies not relevant to the research objectives;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003estudies without accessible full text or insufficient data; and\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003econference abstracts, systematic reviews, meta-analyses, editorials, letters, protocols, or notes.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eSexual dysfunction outcomes included domains such as reduced sexual desire, arousal difficulties, vaginal dryness, dyspareunia, orgasmic difficulties, and reduced sexual satisfaction. Interventions identified within the included studies encompassed medical, psychological, and supportive approaches, including cognitive behavioral therapy, mindfulness-based interventions, sexual counseling, couple-based interventions, psychoeducation, and expressive therapies.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Data Extraction and Evaluation of Studies\u003c/h2\u003e \u003cp\u003eData extraction was conducted using a structured data charting approach to ensure systematic and consistent analysis. Extracted variables included the first author\u0026rsquo;s name, year of publication, country, study design, sample size, and population characteristics.\u003c/p\u003e \u003cp\u003eAdditional data included prevalence rates of sexual dysfunction, assessment tools used (e.g., Female Sexual Function Index, PROMIS Sexual Function measures), domains of sexual functioning, and associated medical, psychological, and sociocultural factors. Where applicable, details of interventions, including type, duration, and reported outcomes, were also extracted.\u003c/p\u003e \u003cp\u003eAs this study was conducted as a scoping review, no formal quality assessment of the included studies was performed. This approach is consistent with PRISMA-ScR guidelines, which emphasize mapping the breadth and nature of available evidence rather than critically appraising methodological quality. However, variations in study design and methodological rigor were considered during data synthesis and interpretation.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003eA total of 392 records were identified through database searches conducted across PubMed/MEDLINE, Scopus, Web of Science, PsycINFO, and Google Scholar. The initial search conducted by author SA in January 2026 yielded 290 records, while an updated search conducted by author VV in February 2026, including intervention-focused and supplementary searches, identified an additional 102 records.\u003c/p\u003e \u003cp\u003eAfter removal of 91 duplicate records, 301 studies remained for title and abstract screening. Of these, 198 were excluded for not meeting inclusion criteria (e.g., not addressing sexual dysfunction outcomes, not involving breast cancer populations). A total of 103 full-text articles were assessed for eligibility, and 74 were excluded due to reasons such as ineligible study type, insufficient data, or lack of relevance. Finally, 29 studies met the inclusion criteria and were included in the review (Fig.\u0026nbsp;1). The selection process was conducted in accordance with PRISMA-ScR guidelines.\u003c/p\u003e \u003cp\u003eThe included studies varied in year of publication, geographical location, and methodological design (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Studies were conducted across multiple countries, including India, Iran, Turkey, Brazil, Mexico, Sweden, Norway, and the United States, reflecting a broad global distribution (e.g., Pandidurai et al., 2017; Garg et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Guedes et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Wettergren et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Most studies employed cross-sectional designs, with fewer prospective and interventional studies.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eCharacteristics of Included Studies (N\u0026thinsp;=\u0026thinsp;29)\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor (Year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStudy Design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSample (N)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePopulation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePrevalence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAssessment Tool\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eKey Findings / Associated Factors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePandidurai et al. (2017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWomen with breast cancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e85%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFSFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHormonal therapy, treatment phase\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGarg et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProspective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePremenopausal survivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e82.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFSFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eType of surgery, treatment modality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsanazar et al. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2025\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBreast cancer patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e91.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFSFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eAge, menopausal status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKara\u0026ccedil;in et al. (2025)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTurkey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e86.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFSFI\u0026thinsp;+\u0026thinsp;HADS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDepression, hormonal therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCiechacka et al. (2026)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePost-surgery women\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e89.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFSFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBody image concerns, surgical effects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGuedes et al. (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2025\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBrazil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePost-treatment women\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e76.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFSFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBody image issues, reconstruction status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGuajardo et al. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMexico\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProspective cohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e474\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYoung patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33.6\u0026ndash;52.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFSFI\u0026thinsp;+\u0026thinsp;SSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDisease progression, treatment duration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWettergren et al. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSweden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e694\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYoung cancer patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePROMIS SexFS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTreatment type, age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmedsland et al. (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNorway\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1307\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52% inactive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSAQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eFatigue, hormonal therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMasjoudi et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2019\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQualitative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvivors \u0026amp; providers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInterviews\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCultural barriers, communication gaps\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChakraborty et al. (2020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFSFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eUnderreporting, cultural stigma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKaur et al. (2018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSurvey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePsychological distress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFingeret et al. (2014)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBody Image Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBody image predicts sexual outcomes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRaggio et al. (2014)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFSFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHigh dysfunction prevalence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReese et al. (2017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eObservational\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePROMIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePersistent sexual concerns\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFlynn et al. (2016)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eValidation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e819\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePROMIS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSexual function domains validated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHordern et al. (2009)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAustralia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSurvey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eSexual dysfunction common\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrotto et al. (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2012\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFSFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eImproved sexual function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMindfulness\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrotto et al. (2017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical trial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFSFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIncreased sexual satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMindfulness\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBrajkovic et al. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCroatia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFSFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReduced distress, improved function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCBT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaucom et al. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2009\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCouples\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInterview\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eImproved intimacy, communication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCouple therapy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarcus et al. (2010)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSurvey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eImproved communication outcomes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSexual counseling\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRowland et al. (2009)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSurvey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eImproved quality of life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePsychoeducation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJehan et al. (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePakistan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFSFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMarital satisfaction associated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCounseling\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVegunta et al. (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFSFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eHormonal therapy effects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMedical\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVizza et al. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eItaly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eClinical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFSFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eVaginal symptoms, dryness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMedical\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRosen et al. (2010)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eFSFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eReduced sexual satisfaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAndersen et al. (1997)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLongitudinal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePatients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInterview\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePsychological adjustment linked\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGanz et al. (2003)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCohort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e817\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvivors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSurvey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eQuality of life \u0026amp; sexual functioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSample sizes ranged from small qualitative samples (n\u0026thinsp;=\u0026thinsp;25; Masjoudi et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) to large population-based studies exceeding 1000 participants (n\u0026thinsp;=\u0026thinsp;1307; Smedsland et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), indicating variability in methodological scale.\u003c/p\u003e \u003cp\u003eSexual dysfunction prevalence reported across studies ranged from 33.6% to 91.9%. Lower prevalence rates were observed in longitudinal cohorts (Guajardo et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), whereas higher prevalence rates were reported in cross-sectional studies involving treatment-phase or premenopausal populations (Garg et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Isanazar et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Kara\u0026ccedil;in et al., 2025). Several studies reported prevalence exceeding 80%, highlighting the substantial burden of sexual dysfunction in breast cancer survivors (Pandidurai et al., 2017; Ciechacka et al., 2026).\u003c/p\u003e \u003cp\u003eThe most commonly used assessment tool was the Female Sexual Function Index (FSFI), used across multiple studies (e.g., Garg et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Guedes et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Kara\u0026ccedil;in et al., 2025). Other instruments included the PROMIS Sexual Function measures (Wettergren et al., \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Flynn et al., 2016) and the Sexual Activity Questionnaire (Smedsland et al., \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), reflecting variability in measurement approaches.\u003c/p\u003e \u003cp\u003eAcross studies, sexual dysfunction was associated with multiple factors. Treatment-related variables such as chemotherapy, hormonal therapy, and type of surgery (e.g., mastectomy) were consistently linked to poorer sexual outcomes (Garg et al., \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Pandidurai et al., 2017). Biological factors such as age and menopausal status were also significant predictors (Isanazar et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Psychological factors, including depression and anxiety, were strongly associated with sexual dysfunction (Kara\u0026ccedil;in et al., 2025), while body image concerns were identified as a key contributor across several studies (Guedes et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Ciechacka et al., 2026).\u003c/p\u003e \u003cp\u003eQualitative findings further highlighted sociocultural influences, including stigma, communication barriers, and limited healthcare provider engagement in discussing sexual health (Masjoudi et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2019\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA subset of studies examined intervention approaches. Mindfulness-based interventions demonstrated improvements in sexual functioning and satisfaction (Brotto et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Brotto et al., 2017). Cognitive behavioral therapy (CBT) was associated with reductions in psychological distress and improvements in sexual outcomes (Brajkovic et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Couple-based and counseling interventions improved communication, intimacy, and relational functioning (Baucom et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2009\u003c/span\u003e; Marcus et al., 2010; Jehan et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). Psychoeducational approaches also contributed to improved quality of life and coping (Rowland et al., 2009). Clinical interventions addressing physiological symptoms, such as hormonal management and treatment of vaginal dryness, were also reported (Vegunta et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Vizza et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2023\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOverall, the findings indicate that sexual dysfunction is a highly prevalent and multifactorial concern among breast cancer survivors, influenced by interacting biological, psychological, and sociocultural factors. Although intervention studies demonstrate promising outcomes, the overall evidence base remains limited, highlighting the need for further research in this area.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThis scoping review aimed to examine the prevalence, associated factors, assessment approaches, barriers, and interventions related to sexual dysfunction among breast cancer survivors. The findings indicate that sexual dysfunction is a highly prevalent and multifactorial concern, with reported rates ranging from 33.6% to 91.9%, and exceeding 80% in several Indian studies . However, due to cultural stigma and reluctance to discuss sexual health, particularly in the Indian context, the actual burden may be substantially underreported.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003e4.1 Factors Associated with Sexual Dysfunction and Barriers in India\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe findings of this review demonstrate that sexual dysfunction arises from a complex interaction of medical, biological, psychological, and sociocultural factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1.1 Medical factors:\u0026nbsp;\u003c/strong\u003eMedical factors, particularly cancer treatments such as chemotherapy, hormonal therapy, radiotherapy, and surgical procedures (e.g., mastectomy), were consistently associated with impaired sexual functioning (Garg et al., 2024; Kara\u0026ccedil;in et al., 2025). These treatments can directly affect hormonal balance, leading to symptoms such as vaginal dryness, dyspareunia, and reduced libido. Surgical interventions, especially those altering body structure, further contribute to changes in self-perception and intimacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1.2 Biological factors:\u0026nbsp;\u003c/strong\u003eBiological factors, including age, menopausal status, and treatment-induced hormonal changes, were also significant contributors (Isanazar et al., 2025). Early menopause following treatment often leads to decreased estrogen levels, which negatively impacts sexual desire and comfort during sexual activity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1.3 Psychological factors:\u0026nbsp;\u003c/strong\u003ePsychological factors emerged as critical mediators. Emotional responses such as anxiety, depression, fear of cancer recurrence, and body image dissatisfaction were strongly associated with reduced sexual functioning (Guedes et al., 2025; Kara\u0026ccedil;in et al., 2025). Body image concerns, in particular, appear to play a central role, as physical changes following treatment can lead to reduced confidence and avoidance of intimacy. These findings are consistent with prior literature highlighting the strong link between body image disturbance and psychological distress in cancer populations .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1.4 Sociocultural factors:\u0026nbsp;\u003c/strong\u003eSociocultural factors further influence sexual health outcomes, especially in contexts such as India. Cultural stigma, gender norms, and discomfort in discussing sexual issues often lead to underreporting and lack of help-seeking. Poor communication with partners and healthcare providers can exacerbate these challenges, indicating that sexual dysfunction should be understood within a broader social and cultural framework.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1.5 Cultural stigma and embarrassment:\u003c/strong\u003e A consistent finding across studies was the presence of significant barriers to communication regarding sexual health. Cultural stigma and embarrassment were identified as major factors preventing women from discussing sexual concerns (Masjoudi et al., 2019). Patients may fear judgment or feel that such topics are inappropriate to discuss, particularly within traditional cultural settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1.6 Healthcare provider-related barriers:\u0026nbsp;\u003c/strong\u003eLack of time, insufficient training, and discomfort in initiating conversations about sexual health contribute to its neglect in routine care. Despite the availability of validated instruments, several challenges were identified. Cultural sensitivity and stigma may influence responses, particularly in conservative settings, leading to potential underreporting. This dual barrier, i.e. at both patient and provider levels, results in unmet needs and inadequate management of sexual dysfunction.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003e4.2 Assessment Tools and Challenges\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe assessment of sexual dysfunction was most commonly conducted using the Female Sexual Function Index (FSFI), which evaluates multiple domains of sexual functioning (Pandidurai et al., 2017; Isanazar et al., 2025). Other tools, such as PROMIS Sexual Function measures and the Sexual Activity Questionnaire (SAQ), were also used to capture broader aspects of sexual health (Wettergren et al., 2022; Smedsland et al., 2022).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.3 Intervention and Management Strategies:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEffective management of sexual dysfunction among breast cancer survivors requires a multidimensional, biopsychosocial approach that directly addresses medical symptoms, psychological distress, relational dynamics, and sociocultural barriers. Given the complex interaction between these domains, interventions should not be applied in isolation but rather as part of an integrated care model.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003e4.3.1 Cognitive Interventions\u0026nbsp;\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eCognitive interventions, particularly Cognitive Behavioral Therapy (CBT), play a central role in addressing maladaptive thought patterns associated with sexual dysfunction. Women may develop negative beliefs such as reduced attractiveness, fear of rejection, or avoidance of intimacy following treatment. CBT helps in identifying and restructuring these cognitions, thereby improving self-esteem, sexual confidence, and emotional well-being (Brajkovic et al., 2021).\u003c/p\u003e\n\u003cp\u003eCBT is also effective in reducing anxiety, depressive symptoms, and fear of cancer recurrence, all of which indirectly impact sexual functioning. Techniques such as cognitive restructuring, behavioral activation, and exposure to avoided situations (e.g., intimacy) are particularly useful.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003e4.3.2 Behavioral Interventions\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eBehavioral strategies focus on modifying avoidance patterns and enhancing adaptive sexual behaviors. Techniques such as sensate focus exercises, gradual exposure to intimacy, and communication training help reduce performance anxiety and rebuild sexual confidence.\u003c/p\u003e\n\u003cp\u003eBehavioral interventions are particularly useful for addressing fear-based avoidance and pain-related concerns, encouraging gradual re-engagement in sexual activity in a safe and supportive manner.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003e4.3.3 Mindfulness-Based Interventions\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eMindfulness-based therapies have emerged as effective approaches in improving sexual functioning and reducing distress. These interventions emphasize present-moment awareness, acceptance of bodily sensations, and reduction of judgmental thinking.\u003c/p\u003e\n\u003cp\u003eMindfulness techniques can help women reconnect with their bodies following treatment-related changes, reduce anxiety during intimacy, and enhance sexual satisfaction. These approaches are especially beneficial in addressing body image concerns and emotional distress.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003e4.3.4 Sex Therapy\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eSpecialized sex therapy directly targets sexual functioning issues such as low desire, arousal difficulties, and pain during intercourse. It includes psychoeducation, guided exercises, and communication training tailored to sexual health.\u003c/p\u003e\n\u003cp\u003eSex therapy also helps normalize sexual concerns and provides structured guidance for rebuilding intimacy. It is particularly effective when integrated with medical management for physiological symptoms.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003e4.3.5 Couple Therapy and Relationship-Based Interventions\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eSexual dysfunction often affects relational dynamics; therefore, couple-based interventions are essential. These therapies focus on improving communication, emotional intimacy, and mutual understanding between partners (Jehan et al., 2024).\u003c/p\u003e\n\u003cp\u003eCouple therapy helps partners address misconceptions, reduce blame, and collaboratively adapt to changes in sexual functioning. Partner involvement has been shown to significantly improve outcomes and relationship satisfaction.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003e4.3.6 Psychoeducation\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003ePsychoeducation is a foundational intervention that increases awareness about sexual dysfunction, treatment effects, and coping strategies. It helps normalize experiences, reduce stigma, and empower patients to seek help.\u003c/p\u003e\n\u003cp\u003eIn the Indian context, psychoeducation is particularly important due to cultural taboos surrounding sexual health. Providing culturally sensitive information can improve openness, reduce shame, and facilitate communication with healthcare providers and partners.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003e4.3.7 Medical Management\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eMedical interventions address the physiological aspects of sexual dysfunction. These include hormonal therapies, vaginal lubricants, moisturizers, and management of treatment-induced symptoms such as vaginal dryness and dyspareunia (Vegunta et al., 2022; Vizza et al., 2023). However, medical approaches alone are insufficient, highlighting the importance of integrating them with psychological and relational interventions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.3.8 Art Therapy and Expressive Interventions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlthough arts-based interventions were not identified among the included studies in this review, broader evidence supports their relevance in psycho-oncology. A systematic review and meta-analysis by Cheng et al. (2021) demonstrated that arts therapy interventions (including music therapy, visual arts, and expressive therapies) significantly improved psychological outcomes among patients with breast and gynecological cancers, particularly in reducing anxiety and depression and enhancing quality of life.\u003c/p\u003e\n\u003cp\u003eWhile these interventions were not specifically designed to target sexual dysfunction, the observed improvements in emotional regulation, self-expression, and body awareness are likely to have indirect benefits for sexual well-being, especially given the strong association between psychological distress, body image dissatisfaction, and sexual dysfunction identified in the present review (Guedes et al., 2025; Kara\u0026ccedil;in et al., 2025).\u003c/p\u003e\n\u003cp\u003eFurthermore, in culturally sensitive contexts such as India, where verbal discussion of sexual concerns may be limited, arts-based approaches may offer a non-verbal and culturally acceptable pathway for emotional processing and identity reconstruction. However, direct evidence linking arts therapy to sexual functioning outcomes in breast cancer survivors remains limited, highlighting an important gap for future research.\u003c/p\u003e\n\u003ch4\u003e\u003cstrong\u003e4.4 Addressing Barriers to Implementation\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eEffective intervention requires addressing key barriers identified in this review. Cultural stigma, embarrassment, and lack of communication often prevent women from seeking help (Masjoudi et al., 2019). Healthcare provider-related barriers, such as lack of training and time constraints, further limit intervention delivery.\u003c/p\u003e\n\u003cp\u003eTo overcome these barriers, interventions should be:\u003c/p\u003e\n\u003cul class=\"decimal_type\"\u003e\n \u003cli\u003eCulturally sensitive and non-judgmental\u003c/li\u003e\n \u003cli\u003eIntegrated into routine oncology care\u003c/li\u003e\n \u003cli\u003eSupported by trained professionals\u003c/li\u003e\n \u003cli\u003eInclusive of partners and family when appropriate\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch4\u003e\u003cstrong\u003e4.5 Integrated Care Approach\u003c/strong\u003e\u003c/h4\u003e\n\u003cp\u003eOverall, the findings suggest that no single intervention is sufficient to address sexual dysfunction. A multidisciplinary approach, combining medical treatment, psychological therapy, relationship-based interventions, and sociocultural sensitivity, is essential.\u003c/p\u003e\n\u003cp\u003eSuch an approach ensures that both physical symptoms and emotional experiences are addressed, ultimately improving sexual health, psychological well-being, and quality of life among breast cancer survivors.\u003c/p\u003e\n\u003cp\u003ewell-being, and quality of life among breast cancer survivors.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003e4.6 Clinical and Psycho-Oncology Implications\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe findings of this review have important implications for both clinical practice and psycho-oncology care. Sexual dysfunction should be recognized as a core component of cancer survivorship, rather than a secondary or optional concern. Routine screening for sexual health using brief validated tools (e.g., FSFI domains or PROMIS measures) should be integrated into follow-up care, particularly for patients undergoing high-risk treatments such as hormonal therapy, chemotherapy, or mastectomy (Garg et al., 2024; Smedsland et al., 2022).\u003c/p\u003e\n\u003cp\u003eA structured, stepped-care approach is recommended for effective clinical management. Within this, frameworks such as the PLISSIT and Ex-PLISSIT models provide practical guidance for clinicians. These models support progressive intervention beginning with permission-giving and normalization, followed by provision of relevant information, targeted suggestions, and referral for specialized therapy when needed. The Ex-PLISSIT model further emphasizes continuous permission and patient-centered communication, making it particularly suitable in culturally sensitive contexts.\u003c/p\u003e\n\u003cp\u003eIn practice, this translates to:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eInitial level:\u003c/strong\u003e Normalizing sexual concerns, providing reassurance, and basic psychoeducation.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eIntermediate level:\u003c/strong\u003e Addressing specific symptoms through medical and behavioral strategies (e.g., lubricants, fatigue management, communication skills).\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAdvanced level:\u003c/strong\u003e Referral to psycho-oncology or sexual health specialists for interventions such as CBT, mindfulness-based therapy, or couple-based approaches (Brajkovic et al., 2021; Brotto et al., 2012; Jehan et al., 2024).\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003ePsycho-oncology implications:\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/strong\u003eSexual dysfunction in breast cancer survivors is strongly linked to body image disturbance, anxiety, depression, and relational strain (Guedes et al., 2025; Kara\u0026ccedil;in et al., 2025). Psycho-oncology services should therefore:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003ePrioritize body image\u0026ndash;focused interventions (cognitive restructuring, exposure, self-compassion).\u003c/li\u003e\n \u003cli\u003eAddress fear of recurrence and treatment-related identity changes alongside sexual concerns.\u003c/li\u003e\n \u003cli\u003eInclude partners in care to improve communication, intimacy, and shared coping (Baucom et al., 2009; Jehan et al., 2024).\u003c/li\u003e\n \u003cli\u003eCulturally sensitive care is critical, particularly in settings where sexual health is stigmatized. Non-judgmental language, privacy, and optional non-verbal modalities (e.g., expressive/arts-based approaches) may facilitate disclosure and engagement. While evidence for arts therapy in sexual outcomes is indirect, improvements in emotional regulation and body awareness suggest potential adjunctive benefits (Cheng et al., 2021).\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eOverall, the integration of biomedical, psychological, and relational care within a structured clinical framework is essential for addressing sexual dysfunction effectively in this population.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis review highlights that sexual dysfunction is a common and multifactorial consequence of breast cancer treatment, influenced by medical, psychological, and sociocultural factors. Despite its high prevalence, it remains underrecognized, particularly in culturally sensitive contexts. Psychological and relational interventions such as CBT, mindfulness, and couple-based approaches show promise, while medical management alone is insufficient. Overall, integrated, multidisciplinary and culturally sensitive care is essential to effectively address sexual dysfunction and improve quality of life among breast cancer survivors.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflict of Interest\u003c/h2\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003ch2\u003eEthical Approval\u003c/h2\u003e\n\u003cp\u003eNot applicable. This study is a scoping review based on previously published literature.\u003c/p\u003e\n\u003ch2\u003eFunding:\u003c/h2\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eSA and VV contributed to the conception and design of the study. SA conducted the initial literature search (January 2026), and SA and VV conducted the updated search and additional screening (February 2026). Both authors contributed to data extraction, analysis, interpretation of results, drafting, and critical revision of the manuscript. Both authors approved the final version.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eThe data that support the findings of this study are derived from publicly available published articles, all of which are cited within the manuscript. Extracted data used for analysis are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBaucom DH, Porter LS, Kirby JS, Gremore TM. Couple-based interventions for medical problems. 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Breast cancer. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/breast-cancer\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/breast-cancer\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"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":"Breast cancer, Sexual dysfunction, Survivorship, Psycho-oncology, Quality of life, Scoping review","lastPublishedDoi":"10.21203/rs.3.rs-9497780/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9497780/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSexual dysfunction is a common but often overlooked consequence of breast cancer treatment, affecting physical, psychological, and relational well-being. Despite its high prevalence, it remains underreported and inadequately addressed in clinical practice, particularly in culturally sensitive contexts.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis scoping review aimed to examine the prevalence of sexual dysfunction among breast cancer survivors, identify assessment tools, explore associated factors, and review available intervention and management strategies.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA scoping review was conducted in accordance with PRISMA-ScR guidelines. A comprehensive search was performed across PubMed/MEDLINE, Scopus, Web of Science, PsycINFO, and Google Scholar. The initial search (January 2026) was followed by an updated search (February 2026) incorporating intervention-related terms. Studies involving women with breast cancer reporting sexual dysfunction outcomes were included. A total of 29 studies met the inclusion criteria.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSexual dysfunction prevalence ranged from 33.6% to 91.9%, with higher rates reported in certain populations, including premenopausal women and those undergoing active treatment. The Female Sexual Function Index (FSFI) was the most commonly used assessment tool. Factors associated with sexual dysfunction included treatment-related variables, hormonal changes, body image concerns, psychological distress, and sociocultural influences. Intervention studies, though limited, indicated that cognitive behavioral therapy, mindfulness-based interventions, couple-based approaches, and medical management showed potential benefits.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eSexual dysfunction is a prevalent and multifactorial issue among breast cancer survivors that significantly impacts quality of life. Integrated, multidisciplinary, and culturally sensitive approaches are essential for effective management. Further research is needed to develop and evaluate targeted interventions and to improve the integration of sexual health into routine cancer care.\u003c/p\u003e","manuscriptTitle":"Sexual Health and Dysfunction Following Breast Cancer Treatment: A Scoping Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-26 17:22:22","doi":"10.21203/rs.3.rs-9497780/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":"4b094333-8ffd-46c2-96e3-db8103b85256","owner":[],"postedDate":"April 26th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-28T16:58:37+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-26 17:22:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9497780","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9497780","identity":"rs-9497780","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}