The Relationship between Body Image and Sexuality after Surgical Treatment in Women with Breast Cancer

Aim: Surgical treatment of breast cancer has a profound and chronic negative impact on a woman's body image and sexuality. The present study aimed to determine the relationship between body image and sexuality after surgical treatment in women with breast cancer (BC). Methods: A cross-sectional and descriptive design was used, and the study included a total of 177 women with BC who had the surgical BC treatment. Data were collected using a questionnaire and the Sexual Adjustment and Body Image Scale (SABIS) in the women’s homes. Results: The average age of the women was 48.11 years (from 28 to 64 years). The women’s prior body image score was 10.82 and post body image score was 7.39, prior sexual adjustment score was 6.81, sexual functioning score was -3.79, and sexual importance of breasts score was 6.98. The post body image score was positively correlated with three of the SABIS subscales: prior sexual adjustment (r= .201), prior body image (r= .221), and impact on sexual functioning (r= .263) and negatively correlated with sexual importance of breasts (r= -.265). The sexual functioning subscale was positively correlated with post body image (r= .263) and sexual importance of breasts (r= .245). According to the lumpectomy, radical mastectomy was found to be worse in the SABIS body image and sexual adjustment dimension scores. The difference between the education level of the women, the type of surgery, and the stage of cancer and the body image score were significant. In addition, it was determined that there was a statistically significant difference between the subscales of sexual adjustment with age and the sexual significance of the breasts with age, type of surgery, the time after surgical treatment, and the sexual function score of women who have problems with their husband after BC (p

Meme Kanserli Kadınlarda Cerrahi Tedavi Sonrası Beden İmajı ve Cinsellik Arasındaki İlişki

Amaç: Meme kanserinin cerrahi tedavisi, bir kadının beden imajı ve cinselliği üzerinde derin ve kronik olumsuz etkiye sahiptir. Bu çalışma, meme kanserli kadınlarda cerrahi tedavi sonrası beden imajı ile cinsellik arasındaki ilişkiyi belirlemek amacı ile yapıldı. Yöntem: Kesitsel ve tanımlayıcı tasarım kullanılan çalışma, meme kanseri nedeni ile cerrahi tedavi geçirmiş olan toplam 177 meme kanserli kadını içeriyordu. Veriler kadınların evlerinde anket formu ve cinsel uyum ve beden imajı ölçeği (SABIS) kullanılarak toplandı. Bulgular: Kadınların yaş ortalaması 48.11 (28-64 yıl) idi. Kadınların SABİS’in önceki beden imajı skoru 10.82, sonraki beden imajı skoru 7.39, cinsel uyum skoru 6.81, cinsel fonksiyon skoru -3.79, cinsel meme önem skoru 6.98 olarak belirlendi. Sonraki beden imajı ile SABİS’in üç alt boyutu ile pozitif: önceki beden imajı (r= .221), önceki cinsel uyum (r = .201) ve cinsel işlevsellik (r= .263) ve memelerin cinsel önemi ile (r= -.265) negatif korelasyon gösterdiği bulundu. Cinsel işlevsellik boyutunun, sonraki beden imajı (r= .263) ve memelerin cinsel önemi arasında (r= .245) pozitif korelasyon belirlendi. Radikal mastektomi yapılanların lumpektomi yapılanlara göre, SABIS beden imajı ve cinsel uyum boyutu puanları daha kötü bulundu. Kadınların eğitim düzeyi, ameliyat şekli ve kanser evresi ile beden imajı skorları arasındaki fark anlamlıydı. Ek olarak yaş ile cinsel uyumun tüm boyutları ve yaş, cerrahinin tipi, mastektomi sonrası geçen süre ile memelerin seksüel önemi üzerinde ve meme kanseri sonrası kocası ile sorun yaşayan kadınların seksüel fonksiyon puanları arasındaki fark istatistiksel olarak önemli bulundu (p

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1. Sheppard LA, Ely S. Breast cancer and sexuality. Breast J. 2008;14(2):176- 81. doi: 10.1111/j.1524-4741.2007.00550.x.

2. Özalp E, Karslıoğlu EH, Aydemir Ö, Soygür H, Erkek BM, Peker SE, et al. Validating the sexual adjustment and body image scale (SABIS) with breast cancer patients. Sex Disabil. 2015;33(2):253-67. doi: 10.1007/ s11195-014-9367-3.

3. Ussher JM, Perz J, Gilbert E. Changes to sexual well-being and intimacy after breast cancer. Cancer Nurs. 2012;35(6):456-65. doi: 10.1097/ NCC.0b013e3182395401.

4. Takahashi M, Ohno S, Inoue H, Kataoka A, Yamaguchi H, Uchida Y, et al. Impact of breast cancer diagnosis and treatment on women's sexuality: a survey of Japanese patients. Psychooncology. 2008;17(9):901-7. doi: 10.1002/pon.1297.

5. Aerts L, Chrsitiaens MR, Enzlin P, Neven P, Amant F. Sexual functioning in women after mastectomy versus breast conserving therapy for earlystage breast cancer: A prospective controlled study. Breast. 2014;23(5):629-36. doi: 10.1016/j.breast.2014.06.012.

6. Boquiren VM, Esplen MJ, Wong J, Toner B, Warner E, Malik N. Sexual functioning in breast cancer survivors experiencing body image disturbance. Psychooncology. 2016;25(1):66-76. doi: 10.1002/ pon.3819.

7. Wang F, Chen F, Huo X, Xu R, Wu L, Wang J, et al. A neglected issue on sexual well-being following breast cancer diagnosis and treatment among Chinese women. PLoS One. 2013;8(9):e74473. doi: 10.1371/ journal. pone.0074473.

8. Male DA, Fergus KD, Cullen K. Sexual identity after breast cancer: sexuality, body image, and relationship repercussions. Curr Opin Support Palliat Care. 2016;10(1):66-74. doi: 10.1097/ SPC.0000000000000184.

9. Muzzatti B, Annunziata MA. Body image assessment in oncology: an update review. Support Care Cancer. 2017;25(3):1019-29. doi: 10.1007/s00520-016-3538-y.

10. Unukovych D, Johansson H, Brandberg Y. Preoperative psychosocial characteristics may predict body image and sexuality two years after risk-reducing mastectomy: a prospective study. Gland Surg. 2017;6(1):64-72. doi: 10.21037/gs.2017.01.04.

11. Erol Ursavaş F, Karayurt Ö. Adaptation of sexual adjustment and body scale in Turkish breast cancer women. Int J Nurs Knowl. 2016;27(3):162- 9. doi: 10.1111/2047-3095.12087.

12. Dalton EJ, Rasmussen VN, Classen CC, Grumann M, Palesh OG, Zarcone J, et al. Sexual Adjustment and Body Image Scale (SABIS): a new measure for breast cancer patients. Breast J. 2009;15(3):287-90. doi: 10.1111/j.1524-4741.2009.00718.x.

13. Jun EY, Kim S, Chang SB, Oh K, Kang HS, Kang SS. The Effect of a sexual life reframing program on marital intimacy, body image, and sexual function among breast cancer survivors. Cancer Nursing. 2015;34(2):142-9. doi: 10.1097/NCC.0b013e3181f1ab7a.

14. Koçan S, Gürsoy A. Body image of women with breast cancer after mastectomy: A qualitative research. J Breast Health. 2016;12(4):145-50. doi: 10.5152/tjbh.2016.2913.

15. Esmaili R, Saiidi JA, Majd HA, Esmaieli M. A Survey of the body image of mastectomies women referring to Imam Khomeini and Imam Hussein hospitals in Tehran, Iran. Indian J Psychol Med. 2010; 32(1):34-7. doi: 10.4103/0253-7176.70528.

16. Erturhan Türk, Yılmaz M. The effect on quality of life and body image of mastectomy among breast cancer survivors. Eur J Breast Health. 2018;14(14):205-10. doi: 10.5152/ejbh.2018.3875.

17. Fobair P, Stewart SL, Chang S, D'Onofrio C, Banks PJ, Bloom JR. Body image and sexual problems in young women with breast cancer. Psychooncology. 2006; 15(7):579-94. doi: 10.1002/pon.991.

18. Gopie JP, Mureau MA, Seynaeve C, ter Kuile MM, Menke-Pluymers MB, Timman R, et al. Body image issues after bilateral prophylactic mastectomy with breast reconstruction in healthy women at risk for hereditary breast cancer. Fam Cancer. 2013;12(3):479-87. doi: 10.1007/s10689-012-9588-5.

19. Andrzejczak E, Markocka-Mączka K, Lewandowski A. Partner relationships after mastectomy in women not offered breast reconstruction. Psychooncology. 2013;22(7):1653-57. doi: 10.1002/ pon.3197.

20. Hart AM, Pinell-White X, Egro FM, Losken A. The psychosexual impact of partial and total breast reconstruction a prospective one-year longitudinal study. Annals of Plastic Surgery. 2015;75(3):281-6. doi: 10.1097/SAP.0000000000000152.

21. Chua AS, DeSantis SM, Teo I, Fingeret MC. Body image investment in breast cancer patients undergoing reconstruction: Taking a closer look at the appearance schemas inventory-revised. Body Image. 2015;13:33- 7. doi: 10.1016/j.bodyim.2014.12.003.

22. Fang SY, Lin YC, Chen TC, Lin CY. Impact of marital coping on relationship between body image and sexuality among breast cancer survivors. Support Care Cancer. 2015;23(9):2551-9. doi: 10.1007/ s00520-015-2612-1.

23. Lee M, Kim YH, Jeon MJ. Risk factors for negative impacts on sexual activity and function in younger breast cancer survivors. Psychooncology. 2015; 24:1097-103. doi: 10.1002/pon.3772.

24. Raggio GA, Butryn ML, Arigo D, Mikorski R, Palmer SC. Prevalence and correlates of sexual morbidity in long-term breast cancer survivors. Psychol Health. 2014;29:632-50. doi: 10.1080/08870446.2013.879136.

25. Kedde H, van de Wiel HB, Weijmar Schultz WC, Wijsen C. Subjective sexual well-being and sexual behavior in young women with breast cancer. Support Care Cancer. 2013;21(7):1993-2005. doi: 10.1007/ s00520-012-1521-9.

26. Harirchi I, Montazeri A, Zamani Bidokhti F, Mamishi N, Zendehdel K. Sexual function breast cancer patients: a prospective study from Iran. J Exp Clin Cancer Res. 2012;31(1):20. doi: 10.1186/1756-9966-31-20.

27. Dizon DS, Suzin D, McIlvenna S. Sexual health as a survivorship issue for female cancer survivors. Oncologist. 2014;19(2):202-10. doi: 10.1634/theoncologist.2013-0302.

28. Denizgil T, Sönmez I. Comparison of self esteem, body image, sexual satisfaction and sexual experiences between women who had mastectomy or breast conserving surgery for breast carcinoma. Yeni Symposium. 2015;53(3):17-25. Available from: http://yenisymposium. com/Pdf/EN-YeniSempozyum-0b52f2e2.pdf

29. Boquiren VM, Esplen MJ, Wong J, Toner B, Warner E. Exploring the influence of gender-role socialization and objectified body consciousness on body image disturbance in breast cancer survivors. Psychooncology. 2013;22(10):2177-85. doi: 10.1002/pon.3271.

30. Browall M, Gaston-Johansson F, Danielson E. Postmenopausal women with breast cancer: their experiences of the chemotherapy treatment period. Cancer Nurs. 2006;29(1):34-42. doi: 10.1097/00002820- 200601000-00006.

31. Suwankhong D, Liamputtong P. Experiences of changes and social stigma among Thai women in Southern Thailand. Cancer Nurs. 2016;39(3):213-20. doi: 10.1097/NCC.0000000000000255.

32. Uçar T, Uzun Ö. Examination of effect on body image, self-esteem and marital adjustment of mastectomy in women with breast cancer. J Breast Health. 2008;4(3):162-8. Available from: https://eurjbreasthealth.com/ en/examination-of-effect-on-body-image-self-esteem-and-maritaladjustment-of-mastectomy-in-women-with-breast-cancer-161584

33. Zimmermann T, Scott JL, Heinrichs N. Individual and dyadic predictorsof body image in women with breast cancer. Psychooncology. 2010;19(10):1061-8. doi: 10.1002/pon.1660.

34. Paterson CL, Lengacher CA, Donovan KA, Kip KE, Tofthagen CS. Body image in younger breast cancer survivors. Systematic Review. Cancer Nurs. 2016;39(1):E39-58. doi: 10.1097/NCC.0000000000000251.

35. Nasiri A, Taleghani F, Irajpour A. Men's sexual issues after breast cancer in their wives: a qualitative study. Cancer Nurs. 2012;35(3):236-44. doi: 10.1097/NCC.0b013e31822d48e5.

36. Quintard B, Constant A, Lakdja F, Labeyrie-Lagardère H. Factors predicting sexual functioning in patients 3 months after surgical procedures for breast cancer: the role of the Sense of Coherence. Eur J Oncol Nurs. 2014;18(1):41-5. doi: 10.1016/j.ejon.2013.09.008.

37. Alder J, Zanetti R, Wight E, Urech C, Fink N, Bitzer J. Sexual dysfunction after premenopausal stage I and II breast cancer: do androgens play a role? J Sex Med. 2008;5(8):1898-906. doi: 10.1111/j.1743-6109.2008.00893.x.

38. Panjari M, Bell RJ, Davis SR. Sexual function after breast cancer. J Sex Med. 2011;8(1):294-302. doi: 10.1111/j.1743-6109.2010.02034.x.

39. Yesilbalkan Usta O, Gokcol D. Sexual dysfunction in women with breast cancer receiving chemotherapy. International Journal of Caring Sciences. 2017;10(3):1439-46. Available from: http://web.archive.org/ web/20200717101722/https://www.internationaljournalofcaringsciences. org/docs/37_yesibalkan_original_10_3.pdf