Sexuality and body image in younger women with breast cancer.

Breast cancer has the potential to be most devastating to the sexual function and self-esteem of premenopausal women. Nevertheless, not one study has systematically compared the impact of breast cancer treatment on sexual issues across age groups. Research shows that younger women with breast cancer have more severe emotional distress than older cohorts. In a group of patients seeking sexual rehabilitation in a cancer center, younger couples were more distressed, but also had the best prognosis with treatment. In theory, loss of a breast or poor breast appearance would be more distressing to women whose youth gives them high expectations for physical beauty. Seeking new dating relationships after breast cancer treatment is a special stressor for single women. Potential infertility also may impact on a woman's self-concept as a sexual person. Systemic treatment disrupts sexual function by causing premature menopause, with estrogen loss leading to vaginal atrophy and androgen loss perhaps decreasing sexual desire and arousability. Research on mastectomy versus breast conservation across all ages of women has demonstrated that general psychological distress, marital satisfaction, and overall sexual frequency and function do not differ between the two treatment groups. Women with breast conservation do rate their body image more highly and are more comfortable with nudity and breast caressing. There is some evidence that breast conservation offers more psychological "protection" for younger women. Research on the impact of breast reconstruction is sparse, but reveals similar patterns. Future studies should use rigorous methodology and focus on the impact of premature menopause and the effectiveness of sexual rehabilitation for younger women.