Sexual health of breast cancer survivors and their partners

Sexual health of breast cancer survivors and their partners | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Sexual health of breast cancer survivors and their partners Anna Sophia Flechtenmacher, Lina Judit Schiestl, Susanne Singer, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7842806/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 22 Jan, 2026 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted 13 You are reading this latest preprint version Abstract Purpose To examine sexual health in breast cancer survivors and their partners. Methods Breast cancer patients and their partners completed self-report-questionnaires covering personal characteristics, a question on satisfaction with partner sexuality before versus after diagnosis (based on the Sexual Medicine Questionnaire for Chronic Diseases (SFCE)), the EORTC (European Organisation for Research and Treatment of Cancer) Sexual Health Questionnaire (EORTC QLQ-SH22) together with the EORTC Quality of Life Core Questionnaire (EORTC QLQ-C30), and a questionnaire assessing sexual health care. Descriptive statistics were used to summarize demographic and clinical data. For group comparisons, dyadic dependencies were accounted for, applying paired t-tests when normality (Shapiro-Wilk test) was met and Wilcoxon signed-rank test otherwise. Results A total of 128 participants (64 patients, 64 partners) were enrolled. Sexual satisfaction did not differ between patients (M = 55, SD = 20.9) and partners (M = 56.7, SD = 20) (t-test, p = 0.46). A positive correlation was found between patients’ and partners’ sexual satisfaction (r = 0.62, p < 0.0001). Satisfaction with partner sexuality was lower after diagnosis (p < 0.001, r = 0.54) – with both patients and partners being less satisfied after the diagnosis (M = 2.58, SD = 0.95) than before (M = 3.14, SD = 0.74). Overall, 75% of the study participants reported not having received information about sexual health issues related to breast cancer, while 64% expressed a desire for more information. Conclusion The findings of this study highlight the importance of considering couple dynamics in breast cancer care. Patients and partners have unmet needs concerning sexual health in the context of breast cancer. Addressing sexuality and sexual health may improve quality of life and psychosocial adjustment. Future research should include larger, more diverse samples and focus on assessing sexuality and sexual health as multidimensional constructs in line with WHO (World Health Organization) definitions. EORTC QLQ-C30 EORTC QLQ-SH22 patient-reported outcomes quality of life sexuality Figures Figure 1 Figure 2 Figure 3 What does this study add to the clinical work This study demonstrates that breast cancer diagnosis and treatment impact partnered sexual satisfaction and highlights the interdependence between patients’ and partners’ sexual satisfaction. It underlines the need to address sexuality and relationship dynamics in breast cancer care, as many patients and partners report unmet informational needs. Introduction With approximately 2,3 million new cases annually worldwide, breast cancer is the most common malignancy among women ( 1 ). As survival rates increase due to advances in diagnostics and treatment, quality of life has become an increasingly important focus in both clinical care and research ( 2 ). Sexuality and sexual health are integral aspects of quality of life. They have been defined by the World Health Organization (WHO) as multidimensional constructs influenced by biological, psychological, social, and cultural factors ( 3 ). Breast cancer diagnosis and treatment can profoundly affect patient’s sexuality and sexual health. Prevalence estimates for sexual dysfunction among breast cancer patients range from 30% to 100% ( 4 , 5 ). For most women the female breast is symbolically and functionally highly significant ( 6 ). Alterations due to cancer treatment can challenge a woman's sense of femininity and lead to reduced self-esteem, feelings of unattractiveness, shame, and sexual withdrawal ( 7 ). Surgical treatment may lead to asymmetry, fibrosis, scarring, lymphedema, sensory loss, and pain in the breast area ( 8 – 10 ). Radiotherapy may moderately affect sexual function due to fatigue, sleep disturbances, and pain ( 11 , 12 ). Chemotherapy is a key risk factor for sexual dysfunction, particularly regarding arousal, lubrication, orgasm, and pain during intercourse ( 2 , 13 ). The toxicity of chemotherapy can lead to mucosal damage, alopecia, nausea, fatigue, and ovarian insufficiency potentially resulting in chemotherapy-induced menopause, amongst others ( 14 , 15 ). Endocrine therapies are associated with various adverse effects which can affect patients’ sexual well-being, e.g. hot flashes, reduced sexual desire, weight gain, musculoskeletal pain, depression, cognitive impairment, and fatigue ( 16 , 17 ). In premenopausal women, these effects may be even more pronounced due to abrupt estrogen suppression ( 18 ). Despite its significance, sexuality and sexual health in the context of breast cancer often remain unaddressed in clinical practice partly due to being a taboo topic ( 19 , 20 ). Communication barriers may also include healthcare providers’ lack of time and felt incompetence in talking about it and offering support ( 21 ). Partners are often excluded from discussions about the impact of breast cancer on sexuality ( 22 , 23 ). However, research indicates that the impact of breast cancer diagnosis and treatment extends beyond the patient, affecting intimate relationships and partners, who often struggle with emotional and communicative challenges ( 24 – 27 ). Changes in intimacy, sexual activity, and relationship dynamics in the context of breast cancer have been documented in previous studies ( 27 – 29 ). Transitioning from the roles of patient and caregiver back to sexual partners can be difficult, and communication about sexuality is frequently avoided due to fear, insecurity, or lack of communication skills ( 29 , 30 ). Persistent communication barriers may negatively affect relationship quality ( 27 ). However, open communication, mutual support, and shared coping can strengthen relationships, foster emotional closeness, and improve psychological well-being ( 25 , 31 , 32 ). While some couples experience strain, others report strengthened bonds through mutual support ( 25 , 28 , 29 ). Despite the recognized importance of sexual health, many breast cancer patients and their partners report insufficient guidance from healthcare professionals ( 33 , 34 ). This study aimed to assess problems with sexuality and sexual health among breast cancer survivors and their partners in Germany. The focus was on the following three key aspects: sexual satisfaction, perceived changes in partner sexuality before vs. after breast cancer diagnosis, and unmet needs for information on sexuality and sexual health in the context of breast cancer. Methods Study design and procedures A cross-sectional study was initiated by the Clinic for Obstetrics and Women’s health of the University Medical Center Mainz, Germany. Two groups were enrolled: Women who had undergone surgery for primary breast cancer between January 2017 and June 2022, aged between 18 and 80 years at the time of data collection (Group 1) and their partners (Group 2). Patients without a partner at the time of the survey were excluded. Invitations were sent via post to all eligible patients (N = 1008). Study materials were sent via post to all interested patients and their partners who fulfilled the inclusion criteria (N = 190). The individuals were asked to return the completed questionnaires and signed consent forms in stamped return envelopes. Data collection was conducted from February 2023 to September 2023. Reminder letters were sent once in July 2023. Instruments Questionnaire sets were created for the two Groups, with the following structure: a questionnaire documenting medical history and sociodemographic characteristics; a question on satisfaction with partner sexuality (before and after diagnosis) from the "Sexual Medicine Questionnaire for Chronic Diseases" (SFCE) by Ahlers et al. ( 35 , 36 ), adjusted for the current study. Sexual satisfaction was assessed using the “Sexual Satisfaction” scale of the European Organisation for Research and Treatment of Cancer (EORTC) Sexual Health Questionnaire (EORTC QLQ-SH22) ( 37 ), with higher scores indicating greater satisfaction. Quality of life was assessed using the EORTC Quality of Life Core Questionnaire (EORTC QLQ-C30) ( 38 ). Questions about the care situation were taken from the “Sexual Medicine Questionnaire for Chronic Diseases” (SFCE) by Ahlers et al. ( 35 , 36 ). Statistical analysis Statistical analyses were conducted using R statistical software (version 4.3.2). Frequencies, percentages, means, standard deviations (SD), and quartiles were used to describe the characteristics of the participants. Given the dyadic nature of the relationships studied, patients and partners were treated as dependent samples in group comparisons. Accordingly, inferential statistical methods for dependent samples were applied. Prior to each comparison, the assumption of normally distributed differences required for paired t-tests was assessed using the Shapiro-Wilk test. If the assumption was met, paired t-tests were used; if not, the non-parametric Wilcoxon signed-rank test was applied. To examine the association between the sexual satisfaction of breast cancer patients and that of their partners, the Pearson correlation coefficient was computed. Ethical consideration The study was approved by the Ethics Committee of the State Medical Association of Rhineland-Palatinate on October 13, 2022 (Protocol No. 2022–16713_1). The legal basis for data processing in this study was the informed consent of participants in accordance with Article 6( 1 ) of the General Data Protection Regulation (GDPR). Use of Large Language Models The manuscript was proofread by ChatGPT-5 (OpenAI; USA) to increase readability. Following the utilization of these tools, the authors examined and revised the content as required, assuming complete responsibility for the publication's material. Results Data was collected from 128 individuals, comprising 64 breast cancer patients (Group 1) and 64 partners (Group 2). The response rate to the invitation letters was 9%. Of those who received the study materials, 67% completed and returned them. Demographic characteristics The mean age of the total sample was 60.1 years (SD = 11.3). Breast cancer patients were 58.4 years old on average (SD = 11.1, min 36, max 77), their partners 61.8 years (SD = 11.4, min 30, max 81). 98% of breast cancer patients identified as female, 98% of partners identified as male. None of the participants identified as non-binary. That said, only one homosexual couple answered to the study invitation but could not be included due to unmet study inclusion criteria. A total of 53% of participants held a university entrance qualification ( 39 ). About 92% reported being financially well or very well off; 56% identified with a religious community, however 91% reported that religious values had no or only minor influence on their daily lives, sexuality, or relationships. Family planning was reported as completed by 95% of participants (Table 1 ). Table 1 Demographics of the sample Total Sample Breast Cancer Patients Partners Individuals N (%) 128 (100) 64 ( 50 ) 64 ( 50 ) Gender Identification N (%) Female 63 (49.2) 63 (98.4) 63 (98.4) Male 63 (49.2) 0 (0) 0 (0) No answer 2 (1.6) 1 (1.6) 1 (1.6) Age in Years Mean (SD) 60.1 (11.3) 58.4 (11.1) 61.8 (11.4) Median (1st Quartile, 3rd Quartile) 61 (51, 69) 59 (50.5, 67.5) 64 (54, 70.5) Highest Level of Education N (%) Primary/Secondary School 19 (14.8) 7 (10.9) 12 (18.8) Intermediate/Secondary School/10th Grade 23 (18.0) 17 (26.6) 6 (9.4) University of Applied Sciences 15 (11.7) 6 (9.4) 9 (14.1) High/ Upper Secondary School 68 (53.1) 33 (51.6) 35 (54.7) Other/No Answer 3 (2.3) 1 (1.6) 2 (3.1) Financial Situation N (%) (How well do you manage with the money available to you each money?) Very poor 1 (0.8) 1 (1.6) 0 (0) Poor 7 (5.47) 4 (6.3) 3 (4.7) Good 66 (51.6) 30 (46.9) 36 (56.3) Very good 52 (40.6) 28 (43.7) 23 (35.9) No answer 3 (2.3) 1 (1.6) 2 (3.1) How strongly do religious beliefs influence your daily life, especially your sexuality and partnership? N (%) Not at all 94 (73.4) 45 (70.3) 49 (76.6) Slightly 22 (17.2) 11 (17.2) 11 (17.2) Strongly 8 (6.3) 5 (7.8) 3 (4.7) Very strongly 1 (0.8) 1 (1.6) 0 (0) No answer 2 (1.6) 1 (1.6) 1 (1.6) Family Planning completed N(%) Yes 122 (95.3) 61 (95.3) 61 (95.3) No 5 (3.9) 2 (3.1) 3 (4.7) No answer 1 (0.8) 1.6) 0 (0) Postmenopausal Yes - 55 (85.9) - No - 6 (9.4) - Table 2 Breast cancer specific medical history TNM Staging Breast Cancer Patients, N = 64 Dignity N (%) Invasive 54 (84.4) Ductal Carcinoma in Situ (DCIS) 10 (15.6) T-Stadium N (%) Tis 10 (15.6) T1 36 (56.3) T2 17 (26.6) T3 1 (1.6) N-Stadium N (%) NX 9 (14.1) N0 41 (64.1) N1 11 (17.2) N2 2 (3.1) N3 1 (1.6) M0-Stadium N (%) M0 64 (100) Table 3 Quality of Life Breast Cancer Patients N = 64 Partners N = 64 Mean (SD) Mean (SD) Importance of Sexual Activity * 59.1 (27.3) 64.0 (28.5) Communication with Professionals * 14.8 (24.5) 5 (14.8) Confidence Erection * - 66.7 (33.3) Sexual Satisfaction * 55.0 (20.9) 56.7 (12.0) Decreased Libido # 57.9 (34.9) 28.5 (26.2) Incontinence # 17.5 (29.2) 9.1 (19.2) Fatigue # 48.7 (34.3) 24.7 (26.9) Treatment # 49.2 (35.7) 25.8 (37.4) Partnership (insecurity about ability to satisfy partner) # 32.2 (33.9) 29.4 (32.8) Body Image (female) # 17.5 (28.0) - Vaginal Dryness # 55.2 (36.4) - Sexual Pain # 29.4 (29.6) 10.0 (15.3) Global Health/Quality of Life * 67.1 (18.9) 73.9 (14.3) Notes: * denotes function scales, with high scores representing good quality of life. # denotes symptom scales, with high scores representing poor quality of life. Breast cancer specific medical history None of the patients reported recurrence or distant metastases after the diagnosis. The majority (84%) had invasive tumors at the time of diagnosis, while 15% were diagnosed with ductal carcinoma in situ. All participants were within five years post-primary treatment. Breast-conserving surgery was performed in 82% of cases, while 17% underwent mastectomy. Quality of life Breast cancer patients reported a mean Global Health/Quality life score of 67.1 (SD = 18.9). Their partners showed slightly higher scores, with a mean of 73.9 (SD = 14.3) (Table 4 ). Table 4 Comparison of Sexual Satisfaction Between Patients and Partners Total Sample N = 120 Breast Cancer Patients N = 60 Partners N = 60 Mean difference (95% CI) p-Value Sexual Satisfaction 1.7 (-6.3 to 2.9) 0.46 Median (Q1, Q3) 58.33 (41.67, 70.83) 54.17 (41.25, 70.83) 58.33 (44.79, 70.83) Mean (SD) 55.81 (20.38) 54.95 (20.93) 56.67 (19.95) Range 0.00, 100.00 8.33, 91.67 6.67, 100.00 CI = Confidence Interval Paired t-test Table 5 Change in Satisfaction with Partnered Sexuality Before and After Diagnosis N = 228 Before Diagnosis, N = 114 After Diagnosis, N = 114 Mean difference (95% KI) p-value Satisfaction with partner sexuality 0.56 (0.40 to 0.72) < 0.001 Median (Q1, Q2) 3.00 (2.00, 3.00) 3.00 (3.00, 4.00) 3.00 (2.00, 3.00) Mean (SD) 2.86 (0.89) 3.14 (0.74) 2.58 (0.95) Range 0.00, 4.00 0.00, 4.00 0.00, 4.00 CI = Confidence Interval Wilcoxon signed rank test with continuity correction Sexual Satisfaction Breast cancer patients reported a mean sexual satisfaction score of 55 (SD = 20.9), partners of 56.7 (SD = 20), with no differences between patients and partners (p 0.46) (Table 4 ). A moderate-to-strong positive correlation was observed between patients’ and partners’ sexual satisfaction (Pearson’s r = 0.62, p < 0.0001, R 2 = 0.38, power = 99.9%) (Fig. 4). Satisfaction with partner sexuality before vs. after breast cancer diagnosis Satisfaction with partner sexuality was lower after the diagnosis (M = 2.58, SD = 0.95) compared to the remembered satisfaction before (M = 3.14, SD = 0.74) (p < 0.001, r = 0.54). There was no evidence for differences in the change in satisfaction with partner sexuality before vs. after diagnosis between the two study groups (p = 0.63; Fig. 3 ). Healthcare provision concerning sexuality following breast cancer About 75% of participants reported not having received information on potential sexual problems related to breast cancer (patients: 73%, partners: 77%). A majority (64%) expressed a desire for more information on sexuality in the context of breast cancer (patients: 69%, partners 59%), preferably provided by medical or mental health care professionals (Table 6 ). Table 6 Information received on sexuality-related concerns in the context of breast cancer Total Sample, N = 128 Breast Cancer Patients, N = 64 Partners, N = 64 Have you received information about possible sexual problems related to breast cancer? N (%) Yes 26 (20.3) 14 (21.9) 12 (18.8) No 96 (75) 47 (73.4) 49 (76.6) Missing 6 (4.7) 3 (4.7) 3 (4.7) How satisfied where you with the amount of the information received? N (%) Not at all 45 (35.2) 23 (35.9) 22 (34.4) A little 36 (28.1) 20 (31.3) 16 ( 25 ) Quite a bit 29 (22.7) 13 (20.3) 16 ( 25 ) Very much 4 (3.1) 1 (1.6) 3 (4.7) Missing 14 (10.9) 7 (10.9) 7 (10.9) Would you like to receive more information about sexuality in the context of breast cancer in the future? N (%) Yes 82 (64.1) 44 (68.8) 38 (59.4) No 40 (31.3) 17 (26.6) 23 (35.9) Missing 6 (4.7) 3 (4.7) 3 (4.7) If yes, who would you prefer to receive this information from? N (% ) Physicians 77 (60.2) 41 (64.1) 36 (56.3) Psychologists 43 (33.6) 27 (24.1) 16 ( 25 ) Pharmacists 2 (1.6) 2 (3.1) 0 (0) Nurses 4 (3.1) 3 (4.7) 1 (1.6) Other professional caregivers 3 (2.3) 3 (4.7) 0 (0) Others 3 (2.3) 2 (3.1) 1 (1.6) No answer 41 (32.0) 18 (28.1) 23 (35.9) Discussion This study explored sexuality and sexual health in breast cancer patients and their partners, focusing on three key aspects: sexual satisfaction, perceived changes in partner sexuality before versus after breast cancer diagnosis, and unmet informational needs. The study sample consisted of heterosexual, cisgender individuals with a high level of education and satisfactory financial resources. The sample is unrepresentative of same-sex couples or non-binary individuals. Although the study was open to same-sex couples, only one responded– and had to be excluded due to not meeting study inclusion criteria. Sexual und gender minority populations remain underrepresented in literature and often experience distress, as well as potential stigma and discrimination ( 40 ). Many questionnaires are built around heteronormative assumptions, which can contribute to feelings of exclusion and lower response rates. For most participants, religious beliefs had little impact on sexuality or partnership; however prior research suggests a significant influence of cultural and religious factors on sexual adjustment in breast cancer patients ( 41 ). Thus, the findings may not be generalizable to populations with different cultural or religious backgrounds. Most participants had completed family planning. Given that fertility concerns can significantly affect the quality of life and satisfaction of breast cancer patients ( 42 ), the results may not apply to couples who still have unmet desire for children. Previous studies focused mainly on sexual functioning, not sexual satisfaction. A universally accepted definition or concept for measuring "sexual satisfaction" does currently not exist. Some authors assessed sexual satisfaction using a single question ( 43 – 45 ). Others utilized multi-item instruments which encompass various dimensions of sexuality ( 46 ). In this study, both methodological approaches were applied. Unidimensional assessment revealed a significantly lower satisfaction with partner sexuality after compared to before diagnosis - indicating a significant negative impact of breast cancer. Breast cancer patients and their partners were equally less satisfied with partner sexuality after versus before diagnosis. However, multidimensional assessment showed that sexual satisfaction of breast cancer patients and their partners was comparable to general population norms ( 47 ). Given the physical and emotional burdens associated with breast cancer, lower levels of sexual satisfaction compared to a general population might have been expected. In previous research, some authors found reduced sexual satisfaction among breast cancer patients compared to “healthy” control groups ( 45 ), while others, especially when using more complex instruments, even reported higher sexual satisfaction levels ( 48 ). This discrepancy in literature as well as the findings of the present study may reflect a renegotiation of sexuality in the context of breast cancer. In this regard, the findings are in line with previous research suggesting a renegotiation of relationship dynamics, sexuality, and intimacy after breast cancer ( 27 , 28 ). Although breast cancer has a significant effect on sexuality and sexual health, when using a multidimensional approach to measure sexual satisfaction deficits in specific sexual domains may be offset by gains in intimacy or other relational aspects. There was a moderate-to-strong positive correlation between the sexual satisfaction of breast cancer patients and that of their partners, suggesting dyadic interdependence. This supports the hypothesis that sexual satisfaction within couples is mutually influenced—a dynamic also described by other authors ( 32 , 49 , 50 ). Importantly, 75% of participants reported not having received information about sexuality in the context of breast cancer, and 64% expressed a desire for more information on this topic. This underlines a persistent unmet need for information on sexual health in breast cancer care, consistent with previous research ( 34 ). Tailored, accessible information – delivered at various stages of the cancer journey – could help bridge this gap. In conclusion, this study highlights the importance of addressing the perspectives of both patients and their partners. Partners and relationship dynamics should be considered in breast cancer care, especially in relation to sexuality and sexual health. Strengths and limitations Our study offers several strengths. It applied a multimodal approach to sexuality and sexual health, addressing physiological, psychosocial, and emotional aspects based on WHO definitions. The use of validated instruments enhances reliability and validity. Our study assessed sexuality and sexual health in breast cancer patients and their “healthy” partners using elements of the EORTC QLQ-SH22. The questionnaire used in our study is applicable to both heterosexual and same-sex couples. Although ultimately no same-sex couple was represented in the study sample, the use of inclusive tools sets an important precedent for future research. Our study sample is relatively homogeneous in terms of cancer type, stage, and timing (five years post-primary treatment), enhancing internal validity. Limitations include potential response bias, as self-reported data may reflect socially desirable answers, especially on sensitive topics. It remains unclear whether partners completed the survey independently, which could influence responses. The single-center design limits generalizability to other settings. While consistent with international findings indicating unmet informational needs regarding sexuality in the context of breast cancer, the sample lacks diversity in gender identity, sexual orientation, and socioeconomic status. It does not represent individuals with advanced disease, minority identities, or those with fertility considerations. The cross-sectional design prevents assessment of temporal changes in sexual satisfaction, and the absence of baseline data limits retrospective accuracy. Finally, the use of some non-validated items reduces comparability and data reliability. Conclusion This study showed a significant impact of breast cancer on the satisfaction with partner sexuality - both patients and their partners were significantly less satisfied after the diagnosis than before. This goes for a unidimensional measurement of sexual satisfaction. When sexual satisfaction was assessed multidimensionally, the results demonstrated minimal deviation from those reported in previous studies of the general population. This could possibly reflect a renegotiation of sexuality in the context of breast cancer. We could show a moderate to strong positive correlation between the sexual satisfaction of breast cancer patients and that of their partners. This highlights the importance of considering couple dynamics in breast cancer care and involving partners in the process. Most study participants reported having received insufficient information regarding potential sexual health problems, indicating a high need for information. Addressing sexuality and sexual health may help to improve quality of life and psychosocial adjustment of breast cancer patients and their partners. Future research should focus on larger and more diverse samples (including the perspectives of sexual minorities). Sexuality and sexual health should be examined as multidimensional concepts in accordance with WHO definitions. Declarations Acknowledgments Parts of the presented results are part of the doctoral thesis of Anna Sophia Flechtenmacher. Author Contribution Information AS Flechtenmacher: Protocol/project development, data collection, data analysis, manuscript writing/editing, final review of the manuscript S Singer: Protocol/project development, manuscript editing, final review of the manuscript LJ Schiestl: Manuscript editing, final review of the manuscript A Hasenburg: Project development, manuscript editing, final review of the manuscript Conflicts of interest Anna Sophia Flechtenmacher: None Lina Judit Schiestl: None Susanne Singer reports honoraria for reviewing scientific papers from Lilly, outside the submitted work. Annette Hasenburg reports honoraria and expenses from AstraZeneca, GSK, Lilly Deutschland, MedConcept GmbH, Med update GmbH, Pfizer, MSD, Streamedup!GmbH as well as work as a consultant for AstraZeneca, MSD and GSK. None were related to the submitted work. Availability of data The data of this study are available from the first author upon reasonable request. Funding This work received no funding. Ethics approval This study was approved by the local ethics board. Approval number 2022-16713_1. Consent to participate Patients were given time to consider the study and ask any questions before consenting and participating. All participants provided written informed consent. Consent for publication Not applicable References Ferlay J, Colombet M, Soerjomataram I, Parkin DM, Piñeros M, Znaor A, et al. Cancer statistics for the year 2020: An overview. International Journal of Cancer. 2021;149(4):778-89. Gilbert E, Ussher JM, Perz J. Sexuality after breast cancer: a review. Maturitas. 2010;66(4):397-407. WHO. Sexual health and its linkages to reproductive health: an operational approach. 2017:2-10. Esmat Hosseini S, Ilkhani M, Rohani C, Nikbakht Nasrabadi A, Ghanei Gheshlagh R, Moini A. Prevalence of sexual dysfunction in women with cancer: A systematic review and meta-analysis. Int J Reprod Biomed. 2022;20(1):1-12. Bober SL, Varela VS. Sexuality in adult cancer survivors: challenges and intervention. J Clin Oncol. 2012;30(30):3712-9. Dorfmüller M. Die Bedeutung der Brust für das weibliche Körperbild. 1997:169-72. Rodrigues ECG, Neris RR, Nascimento LC, de Oliveira-Cardoso É A, Dos Santos MA. Body image experience of women with breast cancer: A meta-synthesis. Scand J Caring Sci. 2023;37(1):20-36. Andersen KG, Duriaud HM, Kehlet H, Aasvang EK. The Relationship Between Sensory Loss and Persistent Pain 1 Year After Breast Cancer Surgery. J Pain. 2017;18(9):1129-38. Kootstra JJ, Dijkstra PU, Rietman H, de Vries J, Baas P, Geertzen JH, et al. A longitudinal study of shoulder and arm morbidity in breast cancer survivors 7 years after sentinel lymph node biopsy or axillary lymph node dissection. Breast Cancer Res Treat. 2013;139(1):125-34. Hidding JT, Beurskens CH, van der Wees PJ, van Laarhoven HW, Nijhuis-van der Sanden MW. Treatment related impairments in arm and shoulder in patients with breast cancer: a systematic review. PLoS One. 2014;9(5):e96748. Arraras JI, Manterola A, Asin G, Illarramendi JJ, Cruz Sde L, Ibañez B, et al. Quality of life in elderly patients with localized breast cancer treated with radiotherapy. A prospective study. Breast. 2016;26:46-53. Sharma N, Purkayastha A. Impact of Radiotherapy on Psychological, Financial, and Sexual Aspects in Postmastectomy Carcinoma Breast Patients: A Prospective Study and Management. Asia Pac J Oncol Nurs. 2017;4(1):69-76. Ganz PA, Rowland JH, Desmond K, Meyerowitz BE, Wyatt GE. Life after breast cancer: understanding women's health-related quality of life and sexual functioning. J Clin Oncol. 1998;16(2):501-14. Ilyas AB, Bahaj RK, Shaikh AA, Khawandanah BS, Al-Foheidi M, Omer TY. Breast Cancer Patients' Perceptions of Their Experience With Chemotherapy-Induced Nausea and Vomiting and Its Impact on Quality of Life in Jeddah, Saudi Arabia. Cureus. 2020;12(12):e12038. Di Nardo P, Lisanti C, Garutti M, Buriolla S, Alberti M, Mazzeo R, et al. Chemotherapy in patients with early breast cancer: clinical overview and management of long-term side effects. Expert Opin Drug Saf. 2022;21(11):1341-55. Amir E, Seruga B, Niraula S, Carlsson L, Ocaña A. Toxicity of Adjuvant Endocrine Therapy in Postmenopausal Breast Cancer Patients: A Systematic Review and Meta-analysis. JNCI: Journal of the National Cancer Institute. 2011;103(17):1299-309. Zhu Y, Cohen SM, Rosenzweig MQ, Bender CM. Symptom Map of Endocrine Therapy for Breast Cancer: A Scoping Review. Cancer Nurs. 2019;42(5):E19-e30. Franzoi MA, Agostinetto E, Perachino M, Del Mastro L, de Azambuja E, Vaz-Luis I, et al. Evidence-based approaches for the management of side-effects of adjuvant endocrine therapy in patients with breast cancer. Lancet Oncol. 2021;22(7):e303-e13. Marsh S, Borges VF, Coons HL, Afghahi A. Sexual health after a breast cancer diagnosis in young women: clinical implications for patients and providers. Breast Cancer Res Treat. 2020;184(3):655-63. Traumer L, Jacobsen MH, Laursen BS. Patients' experiences of sexuality as a taboo subject in the Danish healthcare system: a qualitative interview study. Scand J Caring Sci. 2019;33(1):57-66. Jonsdottir JI, Zoëga S, Saevarsdottir T, Sverrisdottir A, Thorsdottir T, Einarsson GV, et al. Changes in attitudes, practices and barriers among oncology health care professionals regarding sexual health care: Outcomes from a 2-year educational intervention at a University Hospital. Eur J Oncol Nurs. 2016;21:24-30. Shaffer KM, Kennedy E, Glazer JV, Clayton AH, Cohn W, Reese JB, et al. Including partners in discussions of sexual side effects from breast cancer: a qualitative study of survivors, partners, and providers. Support Care Cancer. 2022;30(6):4935-44. Mangiardi-Veltin M, Hequet D, Segura-Djezzar C, Rouzier R, Bonneau C. Sexuality after breast cancer, how to provide a global and contemporary approach. Bull Cancer. 2023;110(1):113-28. Northouse LL, Cracchiolo-Caraway A, Appel CP. Psychologic consequences of breast cancer on partner and family. Seminars in Oncology Nursing. 1991;7(3):216-23. Moreira H, Canavarro MC. Psychosocial adjustment and marital intimacy among partners of patients with breast cancer: a comparison study with partners of healthy women. J Psychosoc Oncol. 2013;31(3):282-304. Christophe V, Duprez C, Congard A, Fournier E, Lesur A, Antoine P, et al. Evaluate the subjective experience of the disease and its treatment in the partners of young women with non-metastatic breast cancer. Eur J Cancer Care (Engl). 2016;25(5):734-43. Keesing S, Rosenwax L, McNamara B. A dyadic approach to understanding the impact of breast cancer on relationships between partners during early survivorship. BMC Womens Health. 2016;16(1):57. Loaring JM, Larkin M, Shaw R, Flowers P. Renegotiating sexual intimacy in the context of altered embodiment: the experiences of women with breast cancer and their male partners following mastectomy and reconstruction. Health Psychol. 2015;34(4):426-36. Gorman JR, Smith E, Drizin JH, Lyons KS, Harvey SM. Navigating sexual health in cancer survivorship: a dyadic perspective. Support Care Cancer. 2020;28(11):5429-39. Canzona MR, Fisher CL, Ledford CJW. Perpetuating the cycle of silence: the intersection of uncertainty and sexual health communication among couples after breast cancer treatment. Support Care Cancer. 2019;27(2):659-68. Belcher AJ, Laurenceau JP, Graber EC, Cohen LH, Dasch KB, Siegel SD. Daily support in couples coping with early stage breast cancer: maintaining intimacy during adversity. Health Psychol. 2011;30(6):665-73. Rottmann N, Gilså Hansen D, dePont Christensen R, Hagedoorn M, Frisch M, Nicolaisen A, et al. Satisfaction with sex life in sexually active heterosexual couples dealing with breast cancer: a nationwide longitudinal study. Acta Oncol. 2017;56(2):212-9. Flynn KE, Reese JB, Jeffery DD, Abernethy AP, Lin L, Shelby RA, et al. Patient experiences with communication about sex during and after treatment for cancer. Psychooncology. 2012;21(6):594-601. Albers LF, Van Ek GF, Krouwel EM, Oosterkamp-Borgelink CM, Liefers GJ, Den Ouden MEM, et al. Sexual Health Needs: How Do Breast Cancer Patients and Their Partners Want Information? J Sex Marital Ther. 2020;46(3):205-26. Ahlers CJ, Schaefer GA, Beier KM. Erhebungsinstrumente in der klinischen Sexualforschung und der sexualmedizinischen Praxis – Ein Überblick über die Fragebogenentwicklung in Sexualwissenschaft und Sexualmedizin. Sexuologie. 2004;11:74-97. Ahlers CJ, Neutze J, Mundt I, Hupp E, Konrad A, Beier KM, et al. Erhebungsinstrumente in der klinischen Sexualforschung und der sexualmedizinischen Praxis--Teil II. Sexuologie. 2008;15(3):82. Greimel E, Nagele E, Lanceley A, Oberguggenberger AS, Nordin A, Kuljanic K, et al. Psychometric validation of the European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire Sexual Health (EORTC QLQ-SH22). Eur J Cancer. 2021;154:235-45. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365-76. (Destatis) SB. Bildungsstand: Statistisches Bundesamt (Destatis); 2024 [Available from: https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Bildung-Forschung-Kultur/Bildungsstand/_inhalt.html. Kano M, Jaffe SA, Rieder S, Kosich M, Guest DD, Burgess E, et al. Improving Sexual and Gender Minority Cancer Care: Patient and Caregiver Perspectives From a Multi-Methods Pilot Study. Front Oncol. 2022;12:833195. Woloski-Wruble AC, Dekeyzer Ganz F, Jiang Y, Qiang WM, Kadmon I. Israeli and Chinese partners of women with breast cancer: a cross-cultural view of marital issues. Psychooncology. 2012;21(3):324-31. Jäkel K, Richter D, Leuteritz K, Sender A, Hinz A. Sexuality, fertility, family planning, family life, and partnership in young breast cancer patients: a longitudinal study. Front Psychol. 2023;14:1127359. Désfalvi J, Lakatos C, Csuka SI, Sallay V, Filep O, Dank M, et al. [Attachment style, relationship and sexual satisfaction: comparing breast cancer patients and healthy women]. Orv Hetil. 2020;161(13):510-8. Martins R, Otero P, Torres Á J, Vázquez FL. Quality of Life and Sexual Satisfaction in Women with Breast Cancer Undergoing a Surgical Treatment and in Their Male Partners. J Clin Med. 2022;11(23). Montañés-Muro P, Martínez-Tomé M, García-Manzano G. Psychosocial Care Needs of Women with Breast Cancer: Body Image, Self-Esteem, Optimism, and Sexual Performance and Satisfaction. Health Soc Work. 2023;48(2):115-23. Fouladi N, Feizi I, Nadermohammadi M, Mehrara E, Adldoosti R, Alimohammadi S. The Predictors of Sexual Satisfaction among Iranian Women with Breast Cancer. Asian Pac J Cancer Prev. 2021;22(2):391-6. Åsberg RE, Nilsen M, Hjermstad MJ, Reinertsen KV, Karlsen J, Giskeødegård GF, et al. Norwegian general population normative data for the European Organization for Research and Treatment of Cancer questionnaires: the Quality of Life Questionnaire-Core 30, the Sexual Health Questionnaire QLQ-SHQ22 and the sexual domains of the QLQ-BR23/BR45. Eur J Cancer. 2023;190:112943. Finck C, Barradas S, Agudelo D. CUANDO EL CÁNCER DE SENO NO SIGNIFICA INSATISFACCIÓN SEXUAL. UN ESTUDIO COMPARATIVO ENTRE PACIENTES Y UN GRUPO DE MUJERES SANAS EN COLOMBIA. Psicooncologia. 2012;9:41-64. Fisher WA, Donahue KL, Long JS, Heiman JR, Rosen RC, Sand MS. Individual and Partner Correlates of Sexual Satisfaction and Relationship Happiness in Midlife Couples: Dyadic Analysis of the International Survey of Relationships. Archives of Sexual Behavior. 2015;44(6):1609-20. Hummel SB, van Lankveld J, Oldenburg HSA, Hahn DEE, Kieffer JM, Gerritsma MA, et al. Sexual Functioning and Relationship Satisfaction of Partners of Breast Cancer Survivors Who Receive Internet-Based Sex Therapy. J Sex Marital Ther. 2019;45(2):91-102. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 22 Jan, 2026 Read the published version in Archives of Gynecology and Obstetrics → Version 1 posted Editorial decision: Revision requested 02 Nov, 2025 Reviewers agreed at journal 29 Oct, 2025 Reviews received at journal 28 Oct, 2025 Reviewers agreed at journal 26 Oct, 2025 Reviews received at journal 25 Oct, 2025 Reviews received at journal 25 Oct, 2025 Reviewers agreed at journal 25 Oct, 2025 Reviewers agreed at journal 24 Oct, 2025 Reviewers agreed at journal 24 Oct, 2025 Reviewers invited by journal 22 Oct, 2025 Editor assigned by journal 13 Oct, 2025 Submission checks completed at journal 13 Oct, 2025 First submitted to journal 12 Oct, 2025 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. 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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-7842806","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":538778783,"identity":"7059d9e4-2129-4606-915c-e2672b082caf","order_by":0,"name":"Anna Sophia Flechtenmacher","email":"data:image/png;base64,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","orcid":"","institution":"University Medical Center Mannheim","correspondingAuthor":true,"prefix":"","firstName":"Anna","middleName":"Sophia","lastName":"Flechtenmacher","suffix":""},{"id":538778784,"identity":"cd6a13f8-4291-498b-9e63-f2ab27aa3009","order_by":1,"name":"Lina Judit Schiestl","email":"","orcid":"","institution":"Department of Obstetrics and Gynecology, University Medical Center, Johannes 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1","display":"","copyAsset":false,"role":"figure","size":107461,"visible":true,"origin":"","legend":"\u003cp\u003eSexual Satisfaction in Breast Cancer Patients and their Partners\u003c/p\u003e\n\u003cp\u003eEORTC: European Organisation for Research and Treatment of Cancer\u003c/p\u003e\n\u003cp\u003eQLQ: Quality of Life Questionnaire\u003c/p\u003e\n\u003cp\u003eSH-22: Sexual Health Questionnaire\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7842806/v1/3989712913547fb5574fb628.png"},{"id":95010723,"identity":"85f7f725-55ff-4d48-89ba-105f6da5c182","added_by":"auto","created_at":"2025-11-03 10:18:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":45543,"visible":true,"origin":"","legend":"\u003cp\u003eAssociation of Sexual Satisfaction in breast cancer patients and their partners\u003c/p\u003e\n\u003cp\u003eEORTC: European Organisation for Research and Treatment of Cancer\u003c/p\u003e\n\u003cp\u003eQLQ: Quality of Life Questionnaire\u003c/p\u003e\n\u003cp\u003eSH-22: Sexual Health Questionnaire\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7842806/v1/da8f7e73e99dc9ae3e230fcf.png"},{"id":95010725,"identity":"dd4fee8f-045d-49e5-a541-5a918c933091","added_by":"auto","created_at":"2025-11-03 10:18:44","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":32042,"visible":true,"origin":"","legend":"\u003cp\u003eSatisfaction with partner sexuality pre- and post-diagnosis\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7842806/v1/6f0f9d555edef91127e87bd8.png"},{"id":101151772,"identity":"906a905a-3fe9-4ce4-b6e5-1c2f2816e304","added_by":"auto","created_at":"2026-01-26 16:05:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1103616,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7842806/v1/ef94be8a-d081-4302-a1f2-6ca3e002c2c3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Sexual health of breast cancer survivors and their partners","fulltext":[{"header":"What does this study add to the clinical work ","content":"\u003cp\u003eThis study demonstrates that breast cancer diagnosis and treatment impact partnered sexual satisfaction and highlights the interdependence between patients’ and partners’ sexual satisfaction. It underlines the need to address sexuality and relationship dynamics in breast cancer care, as many patients and partners report unmet informational needs.\u0026nbsp;\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eWith approximately 2,3\u0026nbsp;million new cases annually worldwide, breast cancer is the most common malignancy among women (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). As survival rates increase due to advances in diagnostics and treatment, quality of life has become an increasingly important focus in both clinical care and research (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eSexuality and sexual health are integral aspects of quality of life. They have been defined by the World Health Organization (WHO) as multidimensional constructs influenced by biological, psychological, social, and cultural factors (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Breast cancer diagnosis and treatment can profoundly affect patient\u0026rsquo;s sexuality and sexual health. Prevalence estimates for sexual dysfunction among breast cancer patients range from 30% to 100% (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). For most women the female breast is symbolically and functionally highly significant (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Alterations due to cancer treatment can challenge a woman's sense of femininity and lead to reduced self-esteem, feelings of unattractiveness, shame, and sexual withdrawal (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Surgical treatment may lead to asymmetry, fibrosis, scarring, lymphedema, sensory loss, and pain in the breast area (\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Radiotherapy may moderately affect sexual function due to fatigue, sleep disturbances, and pain (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Chemotherapy is a key risk factor for sexual dysfunction, particularly regarding arousal, lubrication, orgasm, and pain during intercourse (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The toxicity of chemotherapy can lead to mucosal damage, alopecia, nausea, fatigue, and ovarian insufficiency potentially resulting in chemotherapy-induced menopause, amongst others (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Endocrine therapies are associated with various adverse effects which can affect patients\u0026rsquo; sexual well-being, e.g. hot flashes, reduced sexual desire, weight gain, musculoskeletal pain, depression, cognitive impairment, and fatigue (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In premenopausal women, these effects may be even more pronounced due to abrupt estrogen suppression (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite its significance, sexuality and sexual health in the context of breast cancer often remain unaddressed in clinical practice partly due to being a taboo topic (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Communication barriers may also include healthcare providers\u0026rsquo; lack of time and felt incompetence in talking about it and offering support (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Partners are often excluded from discussions about the impact of breast cancer on sexuality (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). However, research indicates that the impact of breast cancer diagnosis and treatment extends beyond the patient, affecting intimate relationships and partners, who often struggle with emotional and communicative challenges (\u003cspan additionalcitationids=\"CR25 CR26\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Changes in intimacy, sexual activity, and relationship dynamics in the context of breast cancer have been documented in previous studies (\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Transitioning from the roles of patient and caregiver back to sexual partners can be difficult, and communication about sexuality is frequently avoided due to fear, insecurity, or lack of communication skills (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Persistent communication barriers may negatively affect relationship quality (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). However, open communication, mutual support, and shared coping can strengthen relationships, foster emotional closeness, and improve psychological well-being (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). While some couples experience strain, others report strengthened bonds through mutual support (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite the recognized importance of sexual health, many breast cancer patients and their partners report insufficient guidance from healthcare professionals (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis study aimed to assess problems with sexuality and sexual health among breast cancer survivors and their partners in Germany. The focus was on the following three key aspects: sexual satisfaction, perceived changes in partner sexuality before vs. after breast cancer diagnosis, and unmet needs for information on sexuality and sexual health in the context of breast cancer.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design and procedures\u003c/h2\u003e\u003cp\u003eA cross-sectional study was initiated by the Clinic for Obstetrics and Women\u0026rsquo;s health of the University Medical Center Mainz, Germany. Two groups were enrolled: Women who had undergone surgery for primary breast cancer between January 2017 and June 2022, aged between 18 and 80 years at the time of data collection (Group 1) and their partners (Group 2). Patients without a partner at the time of the survey were excluded.\u003c/p\u003e\u003cp\u003eInvitations were sent via post to all eligible patients (N\u0026thinsp;=\u0026thinsp;1008). Study materials were sent via post to all interested patients and their partners who fulfilled the inclusion criteria (N\u0026thinsp;=\u0026thinsp;190). The individuals were asked to return the completed questionnaires and signed consent forms in stamped return envelopes. Data collection was conducted from February 2023 to September 2023. Reminder letters were sent once in July 2023.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eInstruments\u003c/h3\u003e\n\u003cp\u003eQuestionnaire sets were created for the two Groups, with the following structure: a questionnaire documenting medical history and sociodemographic characteristics; a question on satisfaction with partner sexuality (before and after diagnosis) from the \"Sexual Medicine Questionnaire for Chronic Diseases\" (SFCE) by Ahlers et al. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), adjusted for the current study. Sexual satisfaction was assessed using the \u0026ldquo;Sexual Satisfaction\u0026rdquo; scale of the European Organisation for Research and Treatment of Cancer (EORTC) Sexual Health Questionnaire (EORTC QLQ-SH22) (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), with higher scores indicating greater satisfaction. Quality of life was assessed using the EORTC Quality of Life Core Questionnaire (EORTC QLQ-C30) (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Questions about the care situation were taken from the \u0026ldquo;Sexual Medicine Questionnaire for Chronic Diseases\u0026rdquo; (SFCE) by Ahlers et al. (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eStatistical analyses were conducted using R statistical software (version 4.3.2). Frequencies, percentages, means, standard deviations (SD), and quartiles were used to describe the characteristics of the participants. Given the dyadic nature of the relationships studied, patients and partners were treated as dependent samples in group comparisons. Accordingly, inferential statistical methods for dependent samples were applied. Prior to each comparison, the assumption of normally distributed differences required for paired t-tests was assessed using the Shapiro-Wilk test. If the assumption was met, paired t-tests were used; if not, the non-parametric Wilcoxon signed-rank test was applied. To examine the association between the sexual satisfaction of breast cancer patients and that of their partners, the Pearson correlation coefficient was computed.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eEthical consideration\u003c/h3\u003e\n\u003cp\u003e The study was approved by the Ethics Committee of the State Medical Association of Rhineland-Palatinate on October 13, 2022 (Protocol No. 2022\u0026ndash;16713_1). The legal basis for data processing in this study was the informed consent of participants in accordance with Article 6(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) of the General Data Protection Regulation (GDPR).\u003c/p\u003e\n\u003ch3\u003eUse of Large Language Models\u003c/h3\u003e\n\u003cp\u003eThe manuscript was proofread by ChatGPT-5 (OpenAI; USA) to increase readability. Following the utilization of these tools, the authors examined and revised the content as required, assuming complete responsibility for the publication's material.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eData was collected from 128 individuals, comprising 64 breast cancer patients (Group 1) and 64 partners (Group 2). The response rate to the invitation letters was 9%. Of those who received the study materials, 67% completed and returned them.\u003c/p\u003e\n\u003ch3\u003eDemographic characteristics\u003c/h3\u003e\n\u003cp\u003eThe mean age of the total sample was 60.1 years (SD\u0026thinsp;=\u0026thinsp;11.3). Breast cancer patients were 58.4 years old on average (SD\u0026thinsp;=\u0026thinsp;11.1, min 36, max 77), their partners 61.8 years (SD\u0026thinsp;=\u0026thinsp;11.4, min 30, max 81). 98% of breast cancer patients identified as female, 98% of partners identified as male. None of the participants identified as non-binary. That said, only one homosexual couple answered to the study invitation but could not be included due to unmet study inclusion criteria. A total of 53% of participants held a university entrance qualification (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). About 92% reported being financially well or very well off; 56% identified with a religious community, however 91% reported that religious values had no or only minor influence on their daily lives, sexuality, or relationships. Family planning was reported as completed by 95% of participants (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\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\u003eDemographics of the sample\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal Sample\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBreast Cancer Patients\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePartners\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIndividuals N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e128 (100)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64 (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64 (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender Identification N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63 (49.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63 (98.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e63 (98.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e63 (49.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo answer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge in Years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60.1 (11.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e58.4 (11.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61.8 (11.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedian (1st Quartile, 3rd Quartile)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e61 (51, 69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e59 (50.5, 67.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e64 (54, 70.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHighest Level of Education N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimary/Secondary School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19 (14.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (10.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (18.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntermediate/Secondary School/10th Grade\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23 (18.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (26.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (9.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUniversity of Applied Sciences\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (11.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (9.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9 (14.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh/ Upper Secondary School\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e68 (53.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33 (51.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35 (54.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther/No Answer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (2.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (3.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFinancial Situation N (%)\u003c/p\u003e\u003cp\u003e(How well do you manage with the money available to you each money?)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery poor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7 (5.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (4.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGood\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66 (51.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (46.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36 (56.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery good\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e52 (40.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28 (43.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23 (35.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo answer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (2.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (3.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow strongly do religious beliefs influence your daily life, especially your sexuality and partnership? N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot at all\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e94 (73.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45 (70.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49 (76.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSlightly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e22 (17.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11 (17.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11 (17.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStrongly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (6.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (7.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (4.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery strongly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo answer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFamily Planning completed N(%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e122 (95.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e61 (95.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e61 (95.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (3.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (4.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo answer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (0.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePostmenopausal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55 (85.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6 (9.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-\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\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eBreast cancer specific medical history\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTNM Staging\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBreast Cancer Patients, N\u0026thinsp;=\u0026thinsp;64\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDignity N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInvasive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e54 (84.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDuctal Carcinoma in Situ (DCIS)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (15.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT-Stadium N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10 (15.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (56.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17 (26.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eT3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (1.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN-Stadium N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNX\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9 (14.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (64.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (17.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (3.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eN3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1 (1.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM0-Stadium N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eM0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64 (100)\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\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eQuality of Life\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBreast Cancer Patients N\u0026thinsp;=\u0026thinsp;64\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePartners N\u0026thinsp;=\u0026thinsp;64\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eImportance of Sexual Activity *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59.1 (27.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64.0 (28.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommunication with Professionals \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14.8 (24.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (14.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eConfidence Erection *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66.7 (33.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSexual Satisfaction *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55.0 (20.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56.7 (12.0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDecreased Libido \u003csup\u003e\u003cb\u003e#\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57.9 (34.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.5 (26.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncontinence \u003csup\u003e\u003cb\u003e#\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17.5 (29.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.1 (19.2)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFatigue \u003csup\u003e\u003cb\u003e#\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e48.7 (34.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.7 (26.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTreatment \u003csup\u003e\u003cb\u003e#\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e49.2 (35.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25.8 (37.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePartnership (insecurity about ability to satisfy partner) \u003csup\u003e\u003cb\u003e#\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32.2 (33.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.4 (32.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBody Image (female) \u003csup\u003e\u003cb\u003e#\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17.5 (28.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVaginal Dryness \u003csup\u003e\u003cb\u003e#\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55.2 (36.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSexual Pain \u003csup\u003e\u003cb\u003e#\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29.4 (29.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.0 (15.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGlobal Health/Quality of Life *\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e67.1 (18.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e73.9 (14.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"3\"\u003e\u003cem\u003eNotes: * denotes function scales, with high scores representing good quality of life. # denotes symptom scales, with high scores representing poor quality of life.\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eBreast cancer specific medical history\u003c/h3\u003e\n\u003cp\u003eNone of the patients reported recurrence or distant metastases after the diagnosis. The majority (84%) had invasive tumors at the time of diagnosis, while 15% were diagnosed with ductal carcinoma in situ. All participants were within five years post-primary treatment. Breast-conserving surgery was performed in 82% of cases, while 17% underwent mastectomy.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eQuality of life\u003c/h2\u003e\u003cp\u003eBreast cancer patients reported a mean Global Health/Quality life score of 67.1 (SD\u0026thinsp;=\u0026thinsp;18.9). Their partners showed slightly higher scores, with a mean of 73.9 (SD\u0026thinsp;=\u0026thinsp;14.3) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Sexual Satisfaction Between Patients and Partners\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\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=\"left\" 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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal Sample N\u0026thinsp;=\u0026thinsp;120\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBreast Cancer Patients N = 60\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePartners N\u0026thinsp;=\u0026thinsp;60\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMean difference (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-Value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSexual Satisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.7 (-6.3 to 2.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedian (Q1, Q3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e58.33 (41.67, 70.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54.17 (41.25, 70.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e58.33 (44.79, 70.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55.81 (20.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54.95 (20.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e56.67 (19.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRange\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.00, 100.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.33, 91.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.67, 100.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eCI\u0026thinsp;=\u0026thinsp;Confidence Interval\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003ePaired t-test\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\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChange in Satisfaction with Partnered Sexuality Before and After Diagnosis\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\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=\"left\" 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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN\u0026thinsp;=\u0026thinsp;228\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBefore Diagnosis, N\u0026thinsp;=\u0026thinsp;114\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAfter Diagnosis, N\u0026thinsp;=\u0026thinsp;114\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMean difference (95% KI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSatisfaction with partner sexuality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.56 (0.40 to 0.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedian (Q1, Q2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.00 (2.00, 3.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.00 (3.00, 4.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.00 (2.00, 3.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.86 (0.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.14 (0.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.58 (0.95)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRange\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.00, 4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.00, 4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.00, 4.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eCI\u0026thinsp;=\u0026thinsp;Confidence Interval\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e\u003cp\u003eWilcoxon signed rank test with continuity correction\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eSexual Satisfaction\u003c/h2\u003e\u003cp\u003eBreast cancer patients reported a mean sexual satisfaction score of 55 (SD\u0026thinsp;=\u0026thinsp;20.9), partners of 56.7 (SD\u0026thinsp;=\u0026thinsp;20), with no differences between patients and partners (p 0.46) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). A moderate-to-strong positive correlation was observed between patients\u0026rsquo; and partners\u0026rsquo; sexual satisfaction (Pearson\u0026rsquo;s r\u0026thinsp;=\u0026thinsp;0.62, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.38, power\u0026thinsp;=\u0026thinsp;99.9%) (Fig.\u0026nbsp;4).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eSatisfaction with partner sexuality before vs. after breast cancer diagnosis\u003c/h2\u003e\u003cp\u003eSatisfaction with partner sexuality was lower after the diagnosis (M\u0026thinsp;=\u0026thinsp;2.58, SD\u0026thinsp;=\u0026thinsp;0.95) compared to the remembered satisfaction before (M\u0026thinsp;=\u0026thinsp;3.14, SD\u0026thinsp;=\u0026thinsp;0.74) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, r\u0026thinsp;=\u0026thinsp;0.54). There was no evidence for differences in the change in satisfaction with partner sexuality before vs. after diagnosis between the two study groups (p\u0026thinsp;=\u0026thinsp;0.63; Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eHealthcare provision concerning sexuality following breast cancer\u003c/h2\u003e\u003cp\u003eAbout 75% of participants reported not having received information on potential sexual problems related to breast cancer (patients: 73%, partners: 77%). A majority (64%) expressed a desire for more information on sexuality in the context of breast cancer (patients: 69%, partners 59%), preferably provided by medical or mental health care professionals (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eInformation received on sexuality-related concerns in the context of breast cancer\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\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=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTotal Sample, N\u0026thinsp;=\u0026thinsp;128\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBreast Cancer Patients, N\u0026thinsp;=\u0026thinsp;64\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePartners, N\u0026thinsp;=\u0026thinsp;64\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHave you received information about possible sexual problems related to breast cancer? N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e26 (20.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (21.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (18.8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e96 (75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47 (73.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e49 (76.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (4.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (4.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (4.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHow satisfied where you with the amount of the information received? N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNot at all\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45 (35.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23 (35.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22 (34.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA little\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36 (28.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20 (31.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuite a bit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29 (22.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13 (20.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVery much\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 (1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (4.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (10.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7 (10.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7 (10.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWould you like to receive more information about sexuality in the context of breast cancer in the future? N (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e82 (64.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e44 (68.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38 (59.4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (31.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17 (26.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23 (35.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6 (4.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (4.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3 (4.7)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIf yes, who would you prefer to receive this information from? N (% )\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysicians\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e77 (60.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41 (64.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36 (56.3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychologists\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43 (33.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27 (24.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePharmacists\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2 (1.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (4.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther professional caregivers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (2.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (4.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3 (2.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 (3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo answer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41 (32.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18 (28.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23 (35.9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored sexuality and sexual health in breast cancer patients and their partners, focusing on three key aspects: sexual satisfaction, perceived changes in partner sexuality before versus after breast cancer diagnosis, and unmet informational needs. The study sample consisted of heterosexual, cisgender individuals with a high level of education and satisfactory financial resources. The sample is unrepresentative of same-sex couples or non-binary individuals. Although the study was open to same-sex couples, only one responded\u0026ndash; and had to be excluded due to not meeting study inclusion criteria. Sexual und gender minority populations remain underrepresented in literature and often experience distress, as well as potential stigma and discrimination (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). Many questionnaires are built around heteronormative assumptions, which can contribute to feelings of exclusion and lower response rates. For most participants, religious beliefs had little impact on sexuality or partnership; however prior research suggests a significant influence of cultural and religious factors on sexual adjustment in breast cancer patients (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). Thus, the findings may not be generalizable to populations with different cultural or religious backgrounds. Most participants had completed family planning. Given that fertility concerns can significantly affect the quality of life and satisfaction of breast cancer patients (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e), the results may not apply to couples who still have unmet desire for children.\u003c/p\u003e\u003cp\u003ePrevious studies focused mainly on sexual functioning, not sexual satisfaction. A universally accepted definition or concept for measuring \"sexual satisfaction\" does currently not exist. Some authors assessed sexual satisfaction using a single question (\u003cspan additionalcitationids=\"CR44\" citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). Others utilized multi-item instruments which encompass various dimensions of sexuality (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). In this study, both methodological approaches were applied.\u003c/p\u003e\u003cp\u003eUnidimensional assessment revealed a significantly lower satisfaction with partner sexuality after compared to before diagnosis - indicating a significant negative impact of breast cancer. Breast cancer patients and their partners were equally less satisfied with partner sexuality after versus before diagnosis.\u003c/p\u003e\u003cp\u003eHowever, multidimensional assessment showed that sexual satisfaction of breast cancer patients and their partners was comparable to general population norms (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). Given the physical and emotional burdens associated with breast cancer, lower levels of sexual satisfaction compared to a general population might have been expected.\u003c/p\u003e\u003cp\u003eIn previous research, some authors found reduced sexual satisfaction among breast cancer patients compared to \u0026ldquo;healthy\u0026rdquo; control groups (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e), while others, especially when using more complex instruments, even reported higher sexual satisfaction levels (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). This discrepancy in literature as well as the findings of the present study may reflect a renegotiation of sexuality in the context of breast cancer. In this regard, the findings are in line with previous research suggesting a renegotiation of relationship dynamics, sexuality, and intimacy after breast cancer (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Although breast cancer has a significant effect on sexuality and sexual health, when using a multidimensional approach to measure sexual satisfaction deficits in specific sexual domains may be offset by gains in intimacy or other relational aspects.\u003c/p\u003e\u003cp\u003eThere was a moderate-to-strong positive correlation between the sexual satisfaction of breast cancer patients and that of their partners, suggesting dyadic interdependence. This supports the hypothesis that sexual satisfaction within couples is mutually influenced\u0026mdash;a dynamic also described by other authors (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eImportantly, 75% of participants reported not having received information about sexuality in the context of breast cancer, and 64% expressed a desire for more information on this topic. This underlines a persistent unmet need for information on sexual health in breast cancer care, consistent with previous research (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Tailored, accessible information \u0026ndash; delivered at various stages of the cancer journey \u0026ndash; could help bridge this gap.\u003c/p\u003e\u003cp\u003eIn conclusion, this study highlights the importance of addressing the perspectives of both patients and their partners. Partners and relationship dynamics should be considered in breast cancer care, especially in relation to sexuality and sexual health.\u003c/p\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and limitations\u003c/h2\u003e\u003cp\u003eOur study offers several strengths. It applied a multimodal approach to sexuality and sexual health, addressing physiological, psychosocial, and emotional aspects based on WHO definitions. The use of validated instruments enhances reliability and validity. Our study assessed sexuality and sexual health in breast cancer patients and their \u0026ldquo;healthy\u0026rdquo; partners using elements of the EORTC QLQ-SH22. The questionnaire used in our study is applicable to both heterosexual and same-sex couples. Although ultimately no same-sex couple was represented in the study sample, the use of inclusive tools sets an important precedent for future research. Our study sample is relatively homogeneous in terms of cancer type, stage, and timing (five years post-primary treatment), enhancing internal validity.\u003c/p\u003e\u003cp\u003eLimitations include potential response bias, as self-reported data may reflect socially desirable answers, especially on sensitive topics. It remains unclear whether partners completed the survey independently, which could influence responses. The single-center design limits generalizability to other settings. While consistent with international findings indicating unmet informational needs regarding sexuality in the context of breast cancer, the sample lacks diversity in gender identity, sexual orientation, and socioeconomic status. It does not represent individuals with advanced disease, minority identities, or those with fertility considerations. The cross-sectional design prevents assessment of temporal changes in sexual satisfaction, and the absence of baseline data limits retrospective accuracy. Finally, the use of some non-validated items reduces comparability and data reliability.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study showed a significant impact of breast cancer on the satisfaction with partner sexuality - both patients and their partners were significantly less satisfied after the diagnosis than before. This goes for a unidimensional measurement of sexual satisfaction. When sexual satisfaction was assessed multidimensionally, the results demonstrated minimal deviation from those reported in previous studies of the general population. This could possibly reflect a renegotiation of sexuality in the context of breast cancer. We could show a moderate to strong positive correlation between the sexual satisfaction of breast cancer patients and that of their partners. This highlights the importance of considering couple dynamics in breast cancer care and involving partners in the process. Most study participants reported having received insufficient information regarding potential sexual health problems, indicating a high need for information. Addressing sexuality and sexual health may help to improve quality of life and psychosocial adjustment of breast cancer patients and their partners. Future research should focus on larger and more diverse samples (including the perspectives of sexual minorities). Sexuality and sexual health should be examined as multidimensional concepts in accordance with WHO definitions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eParts of the presented results are part of the doctoral thesis of Anna Sophia Flechtenmacher.\u003c/p\u003e\n\u003cp\u003eAuthor Contribution Information\u003c/p\u003e\n\u003cp\u003eAS Flechtenmacher: Protocol/project development, data collection, data analysis, manuscript writing/editing, final review of the manuscript\u003c/p\u003e\n\u003cp\u003eS Singer: Protocol/project development, manuscript editing, final review of the manuscript\u003c/p\u003e\n\u003cp\u003eLJ Schiestl: Manuscript editing, final review of the manuscript\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA Hasenburg: Project development, manuscript editing, final review of the manuscript\u003c/p\u003e\n\u003cp\u003eConflicts of interest\u003c/p\u003e\n\u003cp\u003eAnna Sophia Flechtenmacher: None\u003c/p\u003e\n\u003cp\u003eLina Judit Schiestl: None\u003c/p\u003e\n\u003cp\u003eSusanne Singer reports honoraria for reviewing scientific papers from Lilly, outside the submitted work.\u003c/p\u003e\n\u003cp\u003eAnnette Hasenburg reports\u0026nbsp;honoraria and expenses from AstraZeneca, GSK, Lilly Deutschland, MedConcept GmbH, Med update GmbH, Pfizer, MSD, Streamedup!GmbH as well as work as a consultant for AstraZeneca, MSD and GSK. None were related to the submitted work.\u003c/p\u003e\n\u003cp\u003eAvailability of data\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe data of this study are available from the first author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis work received no funding.\u003c/p\u003e\n\u003cp\u003eEthics approval\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study was approved by the local ethics board. Approval number 2022-16713_1.\u003c/p\u003e\n\u003cp\u003eConsent to participate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients were given time to consider the study and ask any questions before consenting and participating. All participants provided written informed consent.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eFerlay J, Colombet M, Soerjomataram I, Parkin DM, Pi\u0026ntilde;eros M, Znaor A, et al. Cancer statistics for the year 2020: An overview. International Journal of Cancer. 2021;149(4):778-89.\u003c/li\u003e\n \u003cli\u003eGilbert E, Ussher JM, Perz J. Sexuality after breast cancer: a review. Maturitas. 2010;66(4):397-407.\u003c/li\u003e\n \u003cli\u003eWHO. Sexual health and its linkages to reproductive health: an operational approach. 2017:2-10.\u003c/li\u003e\n \u003cli\u003eEsmat Hosseini S, Ilkhani M, Rohani C, Nikbakht Nasrabadi A, Ghanei Gheshlagh R, Moini A. Prevalence of sexual dysfunction in women with cancer: A systematic review and meta-analysis. Int J Reprod Biomed. 2022;20(1):1-12.\u003c/li\u003e\n \u003cli\u003eBober SL, Varela VS. Sexuality in adult cancer survivors: challenges and intervention. J Clin Oncol. 2012;30(30):3712-9.\u003c/li\u003e\n \u003cli\u003eDorfm\u0026uuml;ller M. Die Bedeutung der Brust f\u0026uuml;r das weibliche K\u0026ouml;rperbild. 1997:169-72.\u003c/li\u003e\n \u003cli\u003eRodrigues ECG, Neris RR, Nascimento LC, de Oliveira-Cardoso \u0026Eacute; A, Dos Santos MA. Body image experience of women with breast cancer: A meta-synthesis. Scand J Caring Sci. 2023;37(1):20-36.\u003c/li\u003e\n \u003cli\u003eAndersen KG, Duriaud HM, Kehlet H, Aasvang EK. The Relationship Between Sensory Loss and Persistent Pain 1 Year After Breast Cancer Surgery. J Pain. 2017;18(9):1129-38.\u003c/li\u003e\n \u003cli\u003eKootstra JJ, Dijkstra PU, Rietman H, de Vries J, Baas P, Geertzen JH, et al. A longitudinal study of shoulder and arm morbidity in breast cancer survivors 7 years after sentinel lymph node biopsy or axillary lymph node dissection. Breast Cancer Res Treat. 2013;139(1):125-34.\u003c/li\u003e\n \u003cli\u003eHidding JT, Beurskens CH, van der Wees PJ, van Laarhoven HW, Nijhuis-van der Sanden MW. Treatment related impairments in arm and shoulder in patients with breast cancer: a systematic review. PLoS One. 2014;9(5):e96748.\u003c/li\u003e\n \u003cli\u003eArraras JI, Manterola A, Asin G, Illarramendi JJ, Cruz Sde L, Iba\u0026ntilde;ez B, et al. Quality of life in elderly patients with localized breast cancer treated with radiotherapy. A prospective study. Breast. 2016;26:46-53.\u003c/li\u003e\n \u003cli\u003eSharma N, Purkayastha A. Impact of Radiotherapy on Psychological, Financial, and Sexual Aspects in Postmastectomy Carcinoma Breast Patients: A Prospective Study and Management. Asia Pac J Oncol Nurs. 2017;4(1):69-76.\u003c/li\u003e\n \u003cli\u003eGanz PA, Rowland JH, Desmond K, Meyerowitz BE, Wyatt GE. Life after breast cancer: understanding women\u0026apos;s health-related quality of life and sexual functioning. J Clin Oncol. 1998;16(2):501-14.\u003c/li\u003e\n \u003cli\u003eIlyas AB, Bahaj RK, Shaikh AA, Khawandanah BS, Al-Foheidi M, Omer TY. Breast Cancer Patients\u0026apos; Perceptions of Their Experience With Chemotherapy-Induced Nausea and Vomiting and Its Impact on Quality of Life in Jeddah, Saudi Arabia. Cureus. 2020;12(12):e12038.\u003c/li\u003e\n \u003cli\u003eDi Nardo P, Lisanti C, Garutti M, Buriolla S, Alberti M, Mazzeo R, et al. Chemotherapy in patients with early breast cancer: clinical overview and management of long-term side effects. Expert Opin Drug Saf. 2022;21(11):1341-55.\u003c/li\u003e\n \u003cli\u003eAmir E, Seruga B, Niraula S, Carlsson L, Oca\u0026ntilde;a A. Toxicity of Adjuvant Endocrine Therapy in Postmenopausal Breast Cancer Patients: A Systematic Review and Meta-analysis. JNCI: Journal of the National Cancer Institute. 2011;103(17):1299-309.\u003c/li\u003e\n \u003cli\u003eZhu Y, Cohen SM, Rosenzweig MQ, Bender CM. Symptom Map of Endocrine Therapy for Breast Cancer: A Scoping Review. Cancer Nurs. 2019;42(5):E19-e30.\u003c/li\u003e\n \u003cli\u003eFranzoi MA, Agostinetto E, Perachino M, Del Mastro L, de Azambuja E, Vaz-Luis I, et al. Evidence-based approaches for the management of side-effects of adjuvant endocrine therapy in patients with breast cancer. Lancet Oncol. 2021;22(7):e303-e13.\u003c/li\u003e\n \u003cli\u003eMarsh S, Borges VF, Coons HL, Afghahi A. Sexual health after a breast cancer diagnosis in young women: clinical implications for patients and providers. Breast Cancer Res Treat. 2020;184(3):655-63.\u003c/li\u003e\n \u003cli\u003eTraumer L, Jacobsen MH, Laursen BS. Patients\u0026apos; experiences of sexuality as a taboo subject in the Danish healthcare system: a qualitative interview study. Scand J Caring Sci. 2019;33(1):57-66.\u003c/li\u003e\n \u003cli\u003eJonsdottir JI, Zo\u0026euml;ga S, Saevarsdottir T, Sverrisdottir A, Thorsdottir T, Einarsson GV, et al. Changes in attitudes, practices and barriers among oncology health care professionals regarding sexual health care: Outcomes from a 2-year educational intervention at a University Hospital. Eur J Oncol Nurs. 2016;21:24-30.\u003c/li\u003e\n \u003cli\u003eShaffer KM, Kennedy E, Glazer JV, Clayton AH, Cohn W, Reese JB, et al. Including partners in discussions of sexual side effects from breast cancer: a qualitative study of survivors, partners, and providers. Support Care Cancer. 2022;30(6):4935-44.\u003c/li\u003e\n \u003cli\u003eMangiardi-Veltin M, Hequet D, Segura-Djezzar C, Rouzier R, Bonneau C. Sexuality after breast cancer, how to provide a global and contemporary approach. Bull Cancer. 2023;110(1):113-28.\u003c/li\u003e\n \u003cli\u003eNorthouse LL, Cracchiolo-Caraway A, Appel CP. Psychologic consequences of breast cancer on partner and family. Seminars in Oncology Nursing. 1991;7(3):216-23.\u003c/li\u003e\n \u003cli\u003eMoreira H, Canavarro MC. Psychosocial adjustment and marital intimacy among partners of patients with breast cancer: a comparison study with partners of healthy women. J Psychosoc Oncol. 2013;31(3):282-304.\u003c/li\u003e\n \u003cli\u003eChristophe V, Duprez C, Congard A, Fournier E, Lesur A, Antoine P, et al. Evaluate the subjective experience of the disease and its treatment in the partners of young women with non-metastatic breast cancer. Eur J Cancer Care (Engl). 2016;25(5):734-43.\u003c/li\u003e\n \u003cli\u003eKeesing S, Rosenwax L, McNamara B. A dyadic approach to understanding the impact of breast cancer on relationships between partners during early survivorship. BMC Womens Health. 2016;16(1):57.\u003c/li\u003e\n \u003cli\u003eLoaring JM, Larkin M, Shaw R, Flowers P. Renegotiating sexual intimacy in the context of altered embodiment: the experiences of women with breast cancer and their male partners following mastectomy and reconstruction. Health Psychol. 2015;34(4):426-36.\u003c/li\u003e\n \u003cli\u003eGorman JR, Smith E, Drizin JH, Lyons KS, Harvey SM. Navigating sexual health in cancer survivorship: a dyadic perspective. Support Care Cancer. 2020;28(11):5429-39.\u003c/li\u003e\n \u003cli\u003eCanzona MR, Fisher CL, Ledford CJW. Perpetuating the cycle of silence: the intersection of uncertainty and sexual health communication among couples after breast cancer treatment. Support Care Cancer. 2019;27(2):659-68.\u003c/li\u003e\n \u003cli\u003eBelcher AJ, Laurenceau JP, Graber EC, Cohen LH, Dasch KB, Siegel SD. Daily support in couples coping with early stage breast cancer: maintaining intimacy during adversity. Health Psychol. 2011;30(6):665-73.\u003c/li\u003e\n \u003cli\u003eRottmann N, Gils\u0026aring; Hansen D, dePont Christensen R, Hagedoorn M, Frisch M, Nicolaisen A, et al. Satisfaction with sex life in sexually active heterosexual couples dealing with breast cancer: a nationwide longitudinal study. Acta Oncol. 2017;56(2):212-9.\u003c/li\u003e\n \u003cli\u003eFlynn KE, Reese JB, Jeffery DD, Abernethy AP, Lin L, Shelby RA, et al. Patient experiences with communication about sex during and after treatment for cancer. Psychooncology. 2012;21(6):594-601.\u003c/li\u003e\n \u003cli\u003eAlbers LF, Van Ek GF, Krouwel EM, Oosterkamp-Borgelink CM, Liefers GJ, Den Ouden MEM, et al. Sexual Health Needs: How Do Breast Cancer Patients and Their Partners Want Information? J Sex Marital Ther. 2020;46(3):205-26.\u003c/li\u003e\n \u003cli\u003eAhlers CJ, Schaefer GA, Beier KM. Erhebungsinstrumente in der klinischen Sexualforschung und der sexualmedizinischen Praxis \u0026ndash; Ein Überblick über die Fragebogenentwicklung in Sexualwissenschaft und Sexualmedizin. Sexuologie. 2004;11:74-97.\u003c/li\u003e\n \u003cli\u003eAhlers CJ, Neutze J, Mundt I, Hupp E, Konrad A, Beier KM, et al. Erhebungsinstrumente in der klinischen Sexualforschung und der sexualmedizinischen Praxis--Teil II. Sexuologie. 2008;15(3):82.\u003c/li\u003e\n \u003cli\u003eGreimel E, Nagele E, Lanceley A, Oberguggenberger AS, Nordin A, Kuljanic K, et al. Psychometric validation of the European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire Sexual Health (EORTC QLQ-SH22). Eur J Cancer. 2021;154:235-45.\u003c/li\u003e\n \u003cli\u003eAaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365-76.\u003c/li\u003e\n \u003cli\u003e(Destatis) SB. Bildungsstand: Statistisches Bundesamt (Destatis); 2024 [Available from: https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Bildung-Forschung-Kultur/Bildungsstand/_inhalt.html.\u003c/li\u003e\n \u003cli\u003eKano M, Jaffe SA, Rieder S, Kosich M, Guest DD, Burgess E, et al. Improving Sexual and Gender Minority Cancer Care: Patient and Caregiver Perspectives From a Multi-Methods Pilot Study. Front Oncol. 2022;12:833195.\u003c/li\u003e\n \u003cli\u003eWoloski-Wruble AC, Dekeyzer Ganz F, Jiang Y, Qiang WM, Kadmon I. Israeli and Chinese partners of women with breast cancer: a cross-cultural view of marital issues. Psychooncology. 2012;21(3):324-31.\u003c/li\u003e\n \u003cli\u003eJ\u0026auml;kel K, Richter D, Leuteritz K, Sender A, Hinz A. Sexuality, fertility, family planning, family life, and partnership in young breast cancer patients: a longitudinal study. Front Psychol. 2023;14:1127359.\u003c/li\u003e\n \u003cli\u003eD\u0026eacute;sfalvi J, Lakatos C, Csuka SI, Sallay V, Filep O, Dank M, et al. [Attachment style, relationship and sexual satisfaction: comparing breast cancer patients and healthy women]. Orv Hetil. 2020;161(13):510-8.\u003c/li\u003e\n \u003cli\u003eMartins R, Otero P, Torres \u0026Aacute; J, V\u0026aacute;zquez FL. Quality of Life and Sexual Satisfaction in Women with Breast Cancer Undergoing a Surgical Treatment and in Their Male Partners. J Clin Med. 2022;11(23).\u003c/li\u003e\n \u003cli\u003eMonta\u0026ntilde;\u0026eacute;s-Muro P, Mart\u0026iacute;nez-Tom\u0026eacute; M, Garc\u0026iacute;a-Manzano G. Psychosocial Care Needs of Women with Breast Cancer: Body Image, Self-Esteem, Optimism, and Sexual Performance and Satisfaction. Health Soc Work. 2023;48(2):115-23.\u003c/li\u003e\n \u003cli\u003eFouladi N, Feizi I, Nadermohammadi M, Mehrara E, Adldoosti R, Alimohammadi S. The Predictors of Sexual Satisfaction among Iranian Women with Breast Cancer. Asian Pac J Cancer Prev. 2021;22(2):391-6.\u003c/li\u003e\n \u003cli\u003e\u0026Aring;sberg RE, Nilsen M, Hjermstad MJ, Reinertsen KV, Karlsen J, Giske\u0026oslash;deg\u0026aring;rd GF, et al. Norwegian general population normative data for the European Organization for Research and Treatment of Cancer questionnaires: the Quality of Life Questionnaire-Core 30, the Sexual Health Questionnaire QLQ-SHQ22 and the sexual domains of the QLQ-BR23/BR45. Eur J Cancer. 2023;190:112943.\u003c/li\u003e\n \u003cli\u003eFinck C, Barradas S, Agudelo D. CUANDO EL C\u0026Aacute;NCER DE SENO NO SIGNIFICA INSATISFACCI\u0026Oacute;N SEXUAL. UN ESTUDIO COMPARATIVO ENTRE PACIENTES Y UN GRUPO DE MUJERES SANAS EN COLOMBIA. Psicooncologia. 2012;9:41-64.\u003c/li\u003e\n \u003cli\u003eFisher WA, Donahue KL, Long JS, Heiman JR, Rosen RC, Sand MS. Individual and Partner Correlates of Sexual Satisfaction and Relationship Happiness in Midlife Couples: Dyadic Analysis of the International Survey of Relationships. Archives of Sexual Behavior. 2015;44(6):1609-20.\u003c/li\u003e\n \u003cli\u003eHummel SB, van Lankveld J, Oldenburg HSA, Hahn DEE, Kieffer JM, Gerritsma MA, et al. Sexual Functioning and Relationship Satisfaction of Partners of Breast Cancer Survivors Who Receive Internet-Based Sex Therapy. J Sex Marital Ther. 2019;45(2):91-102.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"EORTC QLQ-C30, EORTC QLQ-SH22, patient-reported outcomes, quality of life, sexuality","lastPublishedDoi":"10.21203/rs.3.rs-7842806/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7842806/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eTo examine sexual health in breast cancer survivors and their partners.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eBreast cancer patients and their partners completed self-report-questionnaires covering personal characteristics, a question on satisfaction with partner sexuality before versus after diagnosis (based on the Sexual Medicine Questionnaire for Chronic Diseases (SFCE)), the EORTC (European Organisation for Research and Treatment of Cancer) Sexual Health Questionnaire (EORTC QLQ-SH22) together with the EORTC Quality of Life Core Questionnaire (EORTC QLQ-C30), and a questionnaire assessing sexual health care. Descriptive statistics were used to summarize demographic and clinical data. For group comparisons, dyadic dependencies were accounted for, applying paired t-tests when normality (Shapiro-Wilk test) was met and Wilcoxon signed-rank test otherwise.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 128 participants (64 patients, 64 partners) were enrolled. Sexual satisfaction did not differ between patients (M\u0026thinsp;=\u0026thinsp;55, SD\u0026thinsp;=\u0026thinsp;20.9) and partners (M\u0026thinsp;=\u0026thinsp;56.7, SD\u0026thinsp;=\u0026thinsp;20) (t-test, p\u0026thinsp;=\u0026thinsp;0.46). A positive correlation was found between patients\u0026rsquo; and partners\u0026rsquo; sexual satisfaction (r\u0026thinsp;=\u0026thinsp;0.62, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Satisfaction with partner sexuality was lower after diagnosis (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, r\u0026thinsp;=\u0026thinsp;0.54) \u0026ndash; with both patients and partners being less satisfied after the diagnosis (M\u0026thinsp;=\u0026thinsp;2.58, SD\u0026thinsp;=\u0026thinsp;0.95) than before (M\u0026thinsp;=\u0026thinsp;3.14, SD\u0026thinsp;=\u0026thinsp;0.74). Overall, 75% of the study participants reported not having received information about sexual health issues related to breast cancer, while 64% expressed a desire for more information.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe findings of this study highlight the importance of considering couple dynamics in breast cancer care. Patients and partners have unmet needs concerning sexual health in the context of breast cancer. Addressing sexuality and sexual health may improve quality of life and psychosocial adjustment. Future research should include larger, more diverse samples and focus on assessing sexuality and sexual health as multidimensional constructs in line with WHO (World Health Organization) definitions.\u003c/p\u003e","manuscriptTitle":"Sexual health of breast cancer survivors and their partners","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-03 10:18:40","doi":"10.21203/rs.3.rs-7842806/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-02T19:35:17+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"340015106688362535568121670622022469576","date":"2025-10-29T19:44:21+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-28T08:46:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"125003238453083175984289014835786231363","date":"2025-10-26T09:12:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-25T20:09:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-25T15:51:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"218385990283587488957443299461333874966","date":"2025-10-25T13:21:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"237840859790939114976462250555524851021","date":"2025-10-24T18:42:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"308932888229305589152738928325400047022","date":"2025-10-24T08:35:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-22T18:38:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-13T21:43:25+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-13T12:38:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"Archives of Gynecology and Obstetrics","date":"2025-10-12T19:56:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"archives-of-gynecology-and-obstetrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"arch","sideBox":"Learn more about [Archives of Gynecology and Obstetrics](https://www.springer.com/journal/404)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/arch/default.aspx","title":"Archives of Gynecology and Obstetrics","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"7b07cda7-4aec-4249-ba9f-47e074805b73","owner":[],"postedDate":"November 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-26T16:01:19+00:00","versionOfRecord":{"articleIdentity":"rs-7842806","link":"https://doi.org/10.1007/s00404-026-08314-5","journal":{"identity":"archives-of-gynecology-and-obstetrics","isVorOnly":false,"title":"Archives of Gynecology and Obstetrics"},"publishedOn":"2026-01-22 15:57:34","publishedOnDateReadable":"January 22nd, 2026"},"versionCreatedAt":"2025-11-03 10:18:40","video":"","vorDoi":"10.1007/s00404-026-08314-5","vorDoiUrl":"https://doi.org/10.1007/s00404-026-08314-5","workflowStages":[]},"version":"v1","identity":"rs-7842806","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7842806","identity":"rs-7842806","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}