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Sexual Function in Breast Cancer Survivorship: The Surgical Impact
*Sarah E Pesek1, *Michaela Onstad2, *Fogarty Sara3, *Ashley Stuckey1, *Christina Raker1, *Melissa Clark4, Jennifer Gass1
1Women & Infants' Hospital of Rhode Island, Providence, RI;2MD Anderson, Houston, TX;3Greater Baltimore Medical Center, Baltimore, MD;4Brown University, Providence, RI

Objective: Sexual dysfunction is common among breast cancer survivors and is often attributed to systemic therapy. Sexual function, as measured by the female sexual function index (FSFI), does not vary by surgery type. Mastectomy with reconstruction (MR) causes an insensate skin envelope. We sought to determine if FSFI is affected by perceived pleasurable stimulation of the treated breast and whether the treated breast remains a part of intimacy.
Design: Prospective survey
Setting: Academic Breast Health Center
Patients: Women over the age of 21 who underwent surgery for breast cancer between 2000 and 2013 without pre-existing sexual dysfunction
Interventions: Lumpectomy or MR
Main Outcome Measures: Treated breast as part of intimacy, Pleasurable stimulation of the breast, FSFI score
Results: 237 patients who underwent lumpectomy or MR completed the survey. Lumpectomy patients were older than MR patients (61.5 vs. 51.8, p<0.01) Mean FSFI for all patients qualified as sexual dysfunction. An equal percentage of lumpectomy and MR patients reported that their treated breast remained part of intimacy (62.3% vs. 60%, p=0.9). More lumpectomy patients reported pleasurable breast stimulation (52% vs. 28.6%, p=0.007). Median FSFI was higher in patients when the treated breast remained a part of intimacy (28.8 vs 22.0, p=0.03), and for patients who reported pleasurable breast stimulation (28.8 vs. 25.5, p=0.01).
Conclusions: Though FSFI does not differ by surgical modality, sexual function is improved from dysfunction when the breast remains a part of intimacy and the patient perceives pleasurable stimulation. With this knowledge, surgeons may be better equipped to counsel patients pre-operatively regarding treatment options and sexual function in survivorship.


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