Çekin Ruhper, Şenocak Didar, Arici Serdar
Department of Oncology, Okan University Hospital, Istanbul, Türkiye.
Department of Oncology, University of Health Sciences, Sultan Abdulhamid Khan Training and Research Hospital, Istanbul, Türkiye.
Medicine (Baltimore). 2025 Jul 18;104(29):e43516. doi: 10.1097/MD.0000000000043516.
Although numerous studies have explored the connection between breast cancer surgery and sexual function, research on chemotherapy's temporal effects is limited. Addressing the impact of chemotherapy on sexual dysfunction is critical for improving quality of life. The aim of this study is to investigate changes in sexual function before, during, and after chemotherapy treatment, with a focus on associated factors. A total of 101 sexually active, reproductive-aged women diagnosed with locally advanced breast cancer were included in the study. The sexual dysfunction was evaluated by using the female sexual function index (FSFI) across 3 treatment phases: before, during, and after chemotherapy. Covariates such as age, baseline sexual dysfunction, tumor localization, comorbidity, family history of cancer, and receptor-related factors were analyzed for their influence on score changes during specific periods. A mixed-effects model was employed to evaluate associations and interactions between these variables and sexual function outcomes. Sexual function scores significantly declined across treatment phases. Notable reductions were observed in desire (P < .001), arousal (P < .001), lubrication (P < .001), orgasm (P < .01), and satisfaction (P < .01), while pain scores increased (P < .01). Total FSFI scores significantly dropped during and after chemotherapy (P < .001 and P < .01, respectively). Patients with preexisting sexual dysfunction experienced significantly greater declines in desire, lubrication, and satisfaction, along with more pronounced increases in pain-related discomfort scores, particularly in the FSFI pain subscale (P < .01). Older age, comorbidity, and tumor localization were significantly associated with worsening sexual function, whereas receptor status and histopathology showed no meaningful effect. Our findings confirm a high prevalence of sexual dysfunction among women with breast cancer. These results highlight the multifaceted impact of chemotherapy on sexual function and reveal a clear temporal pattern of changes across treatment phases.
尽管众多研究探讨了乳腺癌手术与性功能之间的联系，但关于化疗的时间效应的研究却很有限。解决化疗对性功能障碍的影响对于提高生活质量至关重要。本研究的目的是调查化疗治疗前、治疗期间和治疗后的性功能变化，并重点关注相关因素。共有101名被诊断为局部晚期乳腺癌的性活跃育龄妇女纳入了该研究。通过女性性功能指数（FSFI）在化疗前、化疗期间和化疗后这3个治疗阶段评估性功能障碍。分析年龄、基线性功能障碍、肿瘤定位、合并症、癌症家族史和受体相关因素等协变量对特定时期分数变化的影响。采用混合效应模型评估这些变量与性功能结果之间的关联和相互作用。性功能评分在各治疗阶段均显著下降。在性欲（P <.001）、性唤起（P <.001）、润滑（P <.001）、性高潮（P <.01）和满意度（P <.01）方面观察到显著降低，而疼痛评分增加（P <.01）。化疗期间和化疗后FSFI总分显著下降（分别为P <.001和P <.01）。既往存在性功能障碍的患者在性欲、润滑和满意度方面的下降更为显著，同时与疼痛相关的不适评分增加更为明显，尤其是在FSFI疼痛子量表中（P <.01）。年龄较大、合并症和肿瘤定位与性功能恶化显著相关，而受体状态和组织病理学则无显著影响。我们的研究结果证实乳腺癌女性中性功能障碍的患病率很高。这些结果突出了化疗对性功能的多方面影响，并揭示了各治疗阶段变化的明显时间模式。
