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12 November 2026

15 Pages

Sexual Dysfunction in Breast and Gynaecological Cancer Survivors: Prevalence, Quality-of-Life Associations, and Sexual Healthcare Experiences

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1
Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto (FADEUP), 4200-450 Porto, Portugal
2
Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
3
School of Health Sciences and the Research Units ciTechCare and CDRSP, University of Leiria and Oeste, Morro do Lena, Alto do Vieiro, 2411-901 Leiria, Portugal
4
Body Keeper—Physiotherapy, Osteopathy, and Nutrition Clinic, 3030-489 Coimbra, Portugal
Curr. Oncol.2026, 33(11), 702;https://doi.org/10.3390/curroncol33110702
This article belongs to the Special Issue Enhancing Sexual Health as a Core Component of Cancer Survivorship
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Simple Summary

Sexual difficulties are common after breast and gynaecological cancer, but they are still not routinely discussed or addressed during follow-up care. In this study, 246 women with a history of breast and/or gynaecological cancer completed questionnaires about sexual function, quality of life, and their experiences of sexual healthcare. The questionnaire indicated possible sexual dysfunction in 89% of participants. Fewer sleep problems were consistently associated with better sexual function. The relationship with physical functioning was less certain across analyzes. The associations with age and menopausal status remained uncertain. Only a small proportion of women reported that healthcare professionals had raised the topic of sexuality, and follow-up after treatment recommendations was limited. These findings reinforce the need to include sexual health more consistently in cancer survivorship care and to provide individualized assessment, referral, and support according to each woman’s needs.

Abstract

Sexual dysfunction is a frequent but often under-recognised consequence of cancer and its treatment in women, with potential implications for quality of life and survivorship care. This cross-sectional study evaluated sexual dysfunction, health-related quality of life, and sexual healthcare experiences in 246 women with a history of breast and/or gynaecological cancer. Sexual function was assessed using the Female Sexual Function Index and health-related quality of life using the EORTC QLQ-C30. Female Sexual Function Index scores were ≤26.55 in 89.0% of participants, with a mean total score of 14.9 ± 8.94. Lubrication and orgasm were the most impaired domains. In the primary analysis, better physical functioning and lower insomnia were independently associated with better sexual function. In sensitivity analyzes, the insomnia association persisted, while physical functioning estimates were smaller and their confidence intervals included zero: no statistically significant independent associations were detected for age or menopausal status, although these findings require cautious interpretation given the subgroup imbalance. A healthcare professional initiated a discussion about sexuality in 46/246 participants (18.7%). These findings highlight the high prevalence and multidimensional nature of sexual dysfunction after cancer and support more systematic assessment, individualized management, and integration of sexual health into survivorship care.

1. Introduction

Advances in early diagnosis, screening programs and cancer treatments have contributed to increased survival in various types of cancer, particularly breast cancer [1]. In Portugal, five-year survival rates are higher than the European average for some of the most common cancers, including breast and cervical cancer [2]. This increase in survival makes it particularly relevant to pay attention to the physical, psychological and social consequences of cancer and its treatments, including the impact on quality of life and sexual health of survivors [3].
Sexual dysfunction is a frequent and potential consequence of cancer treatment [4]. In breast cancer survivors, changes in desire, arousal, lubrication, orgasm, satisfaction and sexual pain are frequently described [5]. In survivors of gynecological cancer, sexual dysfunction is also highly prevalent and can significantly affect quality of life [6]. These changes can result from the disease itself, but also from the treatments, including surgery, chemotherapy, radiotherapy, endocrine therapy, and immunotherapy, which can compromise sexual health at different stages of cancer survival [6,7]. These effects may involve physical, hormonal, gynecological, neurological, and psychosocial dimensions, contributing to an often complex and multifactorial sexual experience [8]. The study focused on breast and gynaecological cancers because of their well-documented impact on sexual health, particularly through hormonal, genitourinary, and psychosocial changes.
International clinical recommendations reinforce that sexual problems should be evaluated and addressed throughout the oncological trajectory, including through education, counseling, psychosocial interventions, pelvic physiotherapy, and strategies aimed at addressing genitourinary symptoms [9]. Despite these recommendations, sexual health remains insufficiently addressed in cancer survivorship [10,11]. Many women do not receive systematic information about possible sexual alterations, are not questioned about this dimension during consultations, and are unaware of the possible therapeutic options available [10,12]. Likewise, health professionals report feeling a lack of training, time, resources, or adequate referral to address these complaints [10,13]. Together, these findings suggest a persistent gap between recommended sexual healthcare and its implementation in routine oncology and survivorship care.
The experience of sexuality after cancer is not limited to the presence or absence of sexual activity. For many women, it involves changes in body perception, femininity, self-esteem, marital relationship, intimacy, desire, pleasure, pain, fear of recurrence, fatigue, induced menopause, vaginal changes, and emotional distress [14,15]. Thus, understanding the impact of sexual dysfunction requires a multidimensional approach integrating clinical, functional, relational, and subjective dimensions [3]. This understanding is essential to identify unmet needs and to guide more appropriate therapeutic responses, namely in the context of rehabilitation, pelvic physiotherapy, sex education, psychological support, the use of vaginal devices, local therapies, or other non-pharmacological strategies [9,16].
This cross-sectional study aimed to estimate the prevalence of sexual dysfunction in women with a history of breast and/or gynecological cancer, examine the association between sexual function and health-related quality of life, and to describe women’s sexual healthcare experiences, including information received, discussions with healthcare professionals, recommended interventions, and access to and follow-up of sexual health care. By integrating measures of sexual function and quality of life with women’s reported healthcare experiences, this study sought to provide a more comprehensive understanding of sexual health needs during cancer survivorship that will be useful to inform more structured, accessible, and person-centered survivorship care.
By examining these dimensions together in a Portuguese sample that includes women with breast and gynaecological cancers, the study aims to provide a more integrated account of sexual health needs and the care reported by participants.

2. Materials and Methods

2.1. Study Design and Participants

A cross-sectional observational study was developed, based on an online questionnaire, to evaluate sexual dysfunction, quality of life, therapeutic responses, and individual experiences related to sexual health in women with a history of breast or gynecological cancer. This study was approved by the Ethics Committee of the Faculty of Sport of the University of Porto (CEFADE 23_2025). Participants were recruited using a non-probability, convenience-based, self-selected sampling strategy. No formal a priori sample size calculation was performed, and all eligible responses collected during the predefined recruitment period were included.
For this study, cancer survivorship was defined as the period from diagnosis onwards, including individuals living with cancer and those who are cancer-free [17]. Women aged 18 years or older, with a previous diagnosis of breast and/or gynaecological cancer, who had undergone cancer treatment and who were able to understand and complete the questionnaire in Portuguese, were considered eligible.

2.2. Recruitment and Data Collection

Participants were invited to complete an anonymous, self-administered online questionnaire developed using Microsoft Forms (Microsoft Corporation, Redmond, WA, USA). Data were collected between July 2025 and April 2026. The questionnaire was disseminated digitally through social media, healthcare professionals, cancer patient support associations, and institutions involved in the care and follow-up of women with breast and/or gynaecological cancer. Invitations were shared using a direct electronic link and/or QR code, and healthcare professionals and participating organizations were asked to distribute the study invitation to potentially eligible women. As recruitment was conducted through open online dissemination, the total number of individuals reached or who accessed the questionnaire without completing it could not be determined. Participation was voluntary, and questionnaire completion could only proceed after electronic informed consent had been provided. No identifying data of the participants was collected, and all responses were stored and analyzed electronically in an anonymized way. No directly identifying personal data or IP addresses were collected. As participation was anonymous and no technical restriction was implemented to prevent multiple submissions by the same individual, duplicate responses could not be formally excluded. The median questionnaire completion time was 5 min. All 246 submitted questionnaires included informed consent and were complete. No questionnaires were excluded from the analysis.

2.3. Instruments and Variables

2.3.1. Sociodemographic and Clinical Data

Sociodemographic, clinical, and physical activity data were collected using 17 study-specific questions. Variables included age, marital status, educational level, employment status, district of oncological care, cancer type, time since and year of diagnosis, cancer treatments received or ongoing, menopausal status, regular physical activity, type, frequency, and weekly duration of physical activity, and whether physical activity had been recommended by a healthcare professional, including the professional involved and the guidance provided.

2.3.2. Sexual Function Assessment

Sexual function was assessed using the Female Sexual Function Index (FSFI). The FSFI is a questionnaire composed of 19 items that evaluates six domains of female sexual function: desire, arousal, lubrication, orgasm, satisfaction, and pain, which has been translated and validated for the Portuguese population [18]. The items refer to the last four weeks. Higher scores indicate better sexual function, with the total score being between 2 and 36. An FSFI total score ≤ 26.55 was used as a screening threshold for possible sexual dysfunction [19].

2.3.3. Quality of Life

Health-related quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) [20]. The questionnaire comprises 30 items organized into five functional scales (physical, role, emotional, cognitive, and social functioning), three multi-item symptom scales (fatigue, nausea/vomiting, and pain), six single-item symptom measures (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties), and a global health status/quality-of-life scale.
Items 1–28 are scored on a four-point response scale ranging from 1 (“not at all”) to 4 (“very much”), whereas items 29 and 30 are scored on a seven-point scale ranging from 1 (“very poor”) to 7 (“excellent”). Raw scores were calculated and linearly transformed to a 0–100 scale according to the EORTC QLQ-C30 scoring manual. Higher scores on the functional scales and global health status/quality-of-life scale indicate better functioning and quality of life. In contrast, higher scores on the symptom scales and single-item symptom measures indicate greater symptom burden.

2.3.4. Therapeutic Responses and Supportive Care

Sexual healthcare experiences were assessed using 11 study-specific questions, including dichotomous and multiple-choice items, some of which were conditionally displayed according to previous responses. These questions addressed sexual health communication with healthcare professionals, therapeutic recommendations, follow-up, treatment completion and perceived improvement, as well as access to pelvic floor physiotherapy. The study-specific questions were developed by the research team based on the study objectives. No formal content-validation procedure was performed.

2.4. Statistical Analysis

Categorical variables were presented as frequencies and percentages, and continuous variables as mean ± standard deviation and/or median [25th–75th percentile], according to data distribution. Associations between the FSFI total score and EORTC QLQ-C30 scales were assessed using Spearman’s rank correlation coefficient (ρ). Group comparisons were performed using the Mann–Whitney U test for two groups and the Kruskal–Wallis test for three or more groups, with r and ε2 as effect sizes, respectively.
Exploratory comparisons of FSFI total and six domain scores between breast and gynaecological cancer groups were unadjusted for confounders, with Holm correction across seven tests. Women reporting both diagnoses were excluded from these tests and described separately.
Multiple linear regression models for FSFI total and domain scores included age, menopausal status, physical functioning and insomnia. Results were reported as unstandardized coefficients (B), 95% confidence intervals and p values. Residuals and collinearity (tolerance/VIF) were assessed. Sensitivity analyses repeated the total-score model with the same predictors after excluding women reporting no sexual activity on item 3 and, separately, women with any zero response on items 3–14 or 17–19. Total-score models were also examined using HC3 robust standard errors.
Main study variables were complete for all 246 participants; no data were imputed. Sexual healthcare items were reported as n/N (%), with denominators reflecting conditional or non-applicable responses. Tests were two-sided, with p < 0.05 considered statistically significant. All statistical analyses were performed using IBM SPSS Statistics (version 29.0.2.0, IBM Corp., Armonk, NY, USA).

3. Results

3.1. Participant Characteristics

A total of 246 completed questionnaires were received and included in the analysis. Of these participants, 72.4% were aged ≥46 years. Most were married or living in a de facto union (69.1%), had higher education (72.8%), and were professionally active (52.4%).
Breast cancer was the most frequent diagnosis (79.7%), followed by gynecological cancer (15.9%), while 4.5% of the participants reported a history of both. Almost half of the sample had been diagnosed 2–5 years ago. The most frequent treatments were surgery (94.3%), radiotherapy (77.2%), chemotherapy (68.3%), and hormone therapy (60.6%). Most participants were menopausal at the time of the study (83.7%), with 157 women reporting treatment-related menopause, corresponding to 63.8% of the total sample and 76.2% of women in menopause. Sociodemographic and clinical characteristics are shown in Table 1.
Table 1. Sociodemographic and clinical characteristics of the study participants.

3.2. Sexual Function

In this self-selected sample, 89.0% of participants (219/246) met the FSFI criterion for sexual dysfunction. Of the 246 participants, 47 (19.1%) reported no sexual activity during the previous four weeks on FSFI item 3, and all these participants had an FSFI total score ≤ 26.55 (47/47, 100.0%). The mean total FSFI score was 14.85 ± 8.94, with lubrication and orgasm showing the lowest mean domain scores (Table 2). Response distributions for all 19 FSFI items are presented in Supplementary Table S7.
Table 2. Female Sexual Function Index scores of the sample.
In sensitivity analyses, the proportion with FSFI scores ≤ 26.55 was 172/199 (86.4%) after excluding women reporting no sexual activity on item 3, and 135/162 (83.3%) after excluding any zero response on items 3–14 or 17–19. The corresponding mean total scores were 17.53 ± 7.76 and 19.47 ± 7.12, respectively.
In the bivariate analyses, no statistically significant differences in total FSFI scores were observed according to age group (p = 0.161), cancer diagnosis across the three groups (p = 0.512), or treatment-related menopause (p = 0.578). Median FSFI scores [P25–P75] among women who received versus did not receive treatment were 14.40 [7.20–22.80] versus 10.20 [7.20–20.40] for surgery (p = 0.319), 14.40 [7.20–22.20] versus 13.20 [8.40–22.80] for chemotherapy (p = 0.518), 13.20 [7.20–21.60] versus 15.00 [7.20–23.40] for radiotherapy (p = 0.491), and 13.20 [7.20–20.40] versus 14.40 [8.40–24.00] for hormone therapy (p = 0.295). None of the treatment-related comparisons were statistically significant.
Additional exploratory comparisons between women with breast cancer and those with gynaecological cancer, excluding those reporting both diagnoses, showed median total FSFI scores of 14.40 [7.20–22.80] and 13.20 [8.40–16.80], respectively (Mann–Whitney U, p = 0.366; r = 0.059). Effect sizes across the total score and six domains were small (|r| = 0.004–0.090), and none of the seven comparisons was statistically significant after Holm correction. The proportions meeting the FSFI cut-off criterion were 175/196 (89.3%) and 35/39 (89.7%), respectively. Supplementary Table S1 presents the total and domain scores by cancer group, including women reporting both diagnoses.

3.3. Health-Related Quality of Life and Associations with Sexual Function

Regarding quality of life, the highest functional scores were observed in physical and role functioning domains, while the lowest occurred in emotional and cognitive functioning domains. Among the symptom scales and items, the highest mean scores were observed for fatigue, insomnia, and pain (Table 3).
Table 3. EORTC QLQ-C30 scores of the sample.
In the comparison between women with and without sexual dysfunction, participants with sexual dysfunction had poorer role and social functioning, as well as greater fatigue, insomnia, and financial difficulties. Effect sizes were small across significant comparisons (Table S2 of the Supplementary Material).
The correlations between the total FSFI score and the EORTC QLQ-C30 scales are shown in Table 4. No significant association was observed with global health status/quality of life. Better physical, role, emotional, cognitive, and social functioning was associated with better sexual functioning, while greater fatigue, pain, insomnia, and financial difficulties were associated with lower FSFI scores.
Table 4. Correlations between FSFI total score and EORTC QLQ-C30 domains.
In multiple linear regression, better physical functioning and lower insomnia remained independently associated with better sexual function after adjusting for age and menopausal status. Physical functioning was positively associated with total FSFI (B = 0.113, 95% CI 0.041 to 0.184; p = 0.002), while insomnia was negatively associated (B = −0.057, 95% CI −0.090 to −0.024; p < 0.001). No statistically significant independent associations with the total FSFI score were detected for age ≥ 46 years or menopausal status. Overall, the multivariable model was statistically significant, F(4, 241) = 8.309, p < 0.001, and explained 12.1% of the variance in FSFI total score (R2 = 0.121; adjusted R2 = 0.107) (Table 5). No evidence of problematic multicollinearity was observed (tolerance = 0.865–0.922; VIF = 1.085–1.156).
Table 5. Adjusted associations with the FSFI total score in the primary and sensitivity analyses.
In both sensitivity models, the physical functioning estimates were smaller, and their confidence intervals included zero, whereas insomnia remained inversely associated with total FSFI (Table 5). No statistically significant associations were detected for age or menopausal status. The pattern of statistical significance was unchanged with HC3 robust standard errors.
In the adjusted domain-specific analyses, no statistically significant associations were detected for age or menopausal status. In contrast, better physical functioning was associated with better scores in all domains, while greater insomnia was associated with lower scores for desire, arousal, lubrication, orgasm, and satisfaction, with no significant association with the pain domain. The differences initially observed between menopausal and non-menopausal women in lubrication and orgasm were no longer significant after adjusting for age, physical functioning, and insomnia (Table S3 of the Supplementary Material).

3.4. Sexual Healthcare Experiences

A healthcare professional initiated a discussion about sexuality in 46/246 participants (18.7%), while 88/246 (35.8%) reported having initiated a discussion about their sexual health after the cancer diagnosis. Among participants who evaluated the response received, 59/98 (60.2%) considered it adequate. Following a therapeutic recommendation, 25/92 (27.2%) reported having received follow-up by a healthcare professional, and 74/93 (79.6%) reported completing the recommended treatment. Among participants who evaluated the treatment outcome, 31/75 (41.3%) reported improvement in their sexual life.
Among the professionals involved in discussions about sexual health, physicians were the most frequently mentioned, followed by nurses. The responses received mainly included practical strategies or advice and verbal information; however, 23/109 participants (21.1%) reported that their complaints had been minimized or devalued. Among participants who did not complete the recommended treatment, the most frequently reported reasons were lack of professional support, physical discomfort or pain during treatment, and lack of time or availability. Details regarding sexual health care experiences, the professionals involved, the types of response received, the context of pelvic physiotherapy and the barriers to treatment completion are presented in Tables S4–S6 of the Supplementary Material.

4. Discussion

The high frequency of low FSFI scores in this self-selected sample should be interpreted in relation to its demographic composition. A Portuguese population-based study identified age as a significant predictor of sexual problems [21], highlighting the limitations of comparisons based solely on overall prevalence estimates. The findings are consistent with the broader literature documenting sexual health difficulties following cancer and its treatment [22].
A meta-analysis on sexual dysfunction in women with cancer estimated an overall prevalence of 66%, with significant variation across studies, populations, and assessment methodologies [23]. In addition, a systematic review of FSFI-based studies in women not selected for specific health conditions reported prevalence estimates ranging widely across community populations, further highlighting the influence of sampling and assessment methodology on prevalence estimates [24].
Evidence from the Dutch general population [25] and a Portuguese community study [26] supports interpreting FSFI scores in relation to age and menopausal status. These characteristics may contribute to the sexual function profile of our sample alongside cancer-related factors. However, differences in age categories, recruitment and recent sexual activity limit direct comparisons. Both reference studies restricted FSFI analyses to sexually active women, whereas our sample also included women reporting no recent sexual activity. These studies therefore provide context for interpretation, but do not provide an age-standardised comparison with our sample or establish an excess burden attributable to cancer or its treatment.
In the present study, the FSFI domains with the lowest mean scores were lubrication and orgasm, followed by desire and pain. These results are partially consistent with previous studies in oncological populations, in which lubrication is frequently among the most compromised domains [27,28]. Variability between studies may reflect differences in the type of cancer, treatments received, menopausal status, time since diagnosis, and clinical characteristics of the samples.
The predominance of breast cancer and the small, broadly defined gynaecological subgroup limit generalizability. Exploratory, unadjusted comparisons cannot establish equivalence or isolate the contribution of cancer type, highlighting the need for more balanced samples with detailed clinical characterization.
The high proportion of women in menopause and frequent exposure to treatments with hormonal and genitourinary impact may contribute to the impairment of lubrication observed. This interpretation is biologically plausible, since the reduction in estrogen levels, particularly in the context of antiestrogen therapy, can alter the response of genitourinary tissues, promote vulvovaginal changes and contribute to dryness, less lubrication and dyspareunia [29]. In the unadjusted analysis, menopausal women had worse lubrication and orgasm scores. However, these differences were no longer statistically significant after adjusting for age, physical functioning, and insomnia. The role of menopausal status remains uncertain in this sample. The orgasmic response depends on multiple factors and can be influenced by genital changes, pain, arousal, fatigue, emotional factors, body image, and relational aspects [30].
The limited representation of younger and non-menopausal women may have reduced the precision of the adjusted estimates and the ability to detect associations. The absence of statistical significance should therefore not be interpreted as evidence that age or menopausal status is unrelated to sexual function. Studies with better representation of these groups are needed to clarify these relationships.
Although the total FSFI score did not correlate significantly with global health status/quality of life, significant associations were observed with several specific domains of the EORTC QLQ-C30. This pattern suggests that the relationship with sexual function may not be adequately reflected by a global measure of quality of life, becoming more evident in specific dimensions of functioning and symptomatology. In fact, women with sexual dysfunction had poorer role and social functioning, as well as greater fatigue, insomnia, and financial difficulties. The absence of association with global health status/quality of life should not, therefore, be interpreted as an absence of clinical relevance, since global instruments may not capture specific needs related to sexual health. In this sense, the literature recommends targeted assessment of sexual function and health in cancer survivors [31].
The association between cognitive and sexual functioning may reflect shared factors, such as fatigue, sleep disturbances, and emotional distress. As the EORTC QLQ-C30 assesses self-reported memory and concentration difficulties rather than objective cognitive impairment, this finding should be interpreted cautiously [32,33].
The relationships of physical functioning and sleep with sexual function should be interpreted considering recent sexual activity and the populations represented in each analysis. These relationships can be interpreted considering the International Classification of Functioning, Disability and Health (ICF), which conceptualizes functionality as the interaction between body functions and structures, activities, participation, and contextual factors [34]. The application of this framework in women with breast cancer has demonstrated the relevance of integrating physical, psychological, and contextual dimensions in the understanding of functionality and quality of life after cancer [35]. In this context, sleep functions and sexual functions are part of the body functions component, while functional limitations and difficulties in intimate relationships can be reflected in the dimensions of activity and participation [30]. The association between insomnia and poorer sexual function is also consistent with previous observational studies in women [36]. However, due to the cross-sectional design of the present study, it is not possible to establish the direction of these relationships or determine whether they reflect common factors that have not been evaluated.
The relatively modest explanatory power of the multivariable model may partly reflect the multidimensional nature of sexuality after cancer and the contribution of factors not captured by the model. Previous studies have reported associations between sexual function and body image [37], psychological symptoms, quality of the relationship, and communication with the partner, in addition to the effects of cancer treatments [14].
The results related to sexual health care also show a relevant care gap. The low frequency with which health professionals addressed sexuality contrasts with the high prevalence of sexual dysfunction observed and suggests that this dimension remains insufficiently integrated into cancer treatment follow-up [13]. This interpretation is consistent with Portuguese data showing that only a limited proportion of women with breast or gynaecological cancer receive specific sexual health counselling [38]. In addition to the identification of the problem, results suggest limitations in the structuring and continuity of the care provided. Sexual dysfunction after cancer may involve genitourinary alterations, pain, functional alterations, psychological factors, body image and relational dimensions, so a one-off or exclusively informative recommendation may be insufficient in view of the complexity of the needs presented by survivors [9,39].
The clinical recommendations advocate a structured approach, including directed evaluation, identification of contributing factors, individualized intervention, and referral to specialized professionals when indicated [9,40]. The lack of professional support among the barriers most frequently mentioned by the participants who did not complete the recommended treatment reinforces the possible importance of guidance, monitoring, and adaptation of strategies throughout the therapeutic process. This need for individualized intervention is particularly relevant in view of the high frequency of menopause in this population. In addition to vulvovaginal alterations, hypoestrogenism may be associated with alterations in connective tissue and pelvic floor function such that alterations in strength, coordination, or pelvic floor relaxation capacity may also coexist [39,41]. Thus, when pain, difficulties in penetration or changes in muscle function are present, the intervention should not be limited to addressing vaginal dryness or atrophy. These findings support the need for individualized multidisciplinary care, in which pelvic health physiotherapy may constitute one component of management alongside genitourinary treatment and psychosocial support when clinically indicated [40].
Recent research, including a systematic review and meta-analysis of sexual dysfunction after breast cancer [42] and a Portuguese study of unmet sexual-healthcare needs [43], has addressed sexual difficulties and gaps in supportive care. The present study provides complementary evidence examining sexual function and its associations with health-related quality of life, alongside women’s reports of communication, therapeutic recommendations, and follow-up, while also including gynaecological cancer survivors.
The results of this study should be interpreted considering several methodological limitations. The cross-sectional design precludes establishing temporal or causal relationships. The use of a non-probability, convenience-based, self-selected sampling strategy may have introduced selection bias and limits representativeness. Therefore, the sample cannot be assumed to represent the broader population of breast and gynaecological cancer survivors in Portugal. The relatively high educational level, predominance of women with breast cancer, and high proportion of menopausal participants may further limit generalizability. The smaller non-menopausal and younger subgroups may also have limited the precision of the adjusted estimates and the ability to detect associations with these characteristics. Because the survey was anonymous and no technical restriction to one submission per participant was implemented, duplicate participation could not be formally excluded. In addition, data on sexual healthcare experiences and therapeutic responses were self-reported and retrospective, and the study was not designed to assess the comparative effectiveness of individual therapeutic strategies. Most participants received multiple cancer treatments, and detailed information on treatment regimens, including radiotherapy techniques, was unavailable. Therefore, the independent contribution of each treatment to sexual dysfunction could not be determined. Finally, the multivariable model’s modest explanatory power suggests that other relevant psychological, relational, and body-image factors were not captured.
FSFI scores can be lowered by responses indicating no sexual activity or no attempted penetration, which do not necessarily indicate impaired sexual function [44,45]. Marital status alone does not establish whether a woman is sexually active or has a sexual partner. Restricting the analysis to women without these responses changes the population assessed and may exclude women whose inactivity is related to sexual difficulties. Because the FSFI does not assess sexual distress, the cut-off represents a screening classification rather than a clinical diagnosis [44].
These findings support considering sexual health alongside physical functioning and sleep within a broader assessment of survivorship needs. These results are therefore mostly hypothesis generating and longitudinal studies should clarify the direction of these associations and prospectively explore physical, genitourinary, psychological, and relational factors. The multidimensional nature of the difficulties identified reinforces the relevance of integrated approaches that combine targeted sexual health assessment, treatment of genitourinary symptoms, physiotherapy, education, psychosocial support, and specialized follow-up according to individual needs.

5. Conclusions

A large majority of women in this self-selected sample met the FSFI criterion for sexual dysfunction, confirming a substantial burden of sexual health difficulties among women with a history of breast and/or gynaecological cancer. Greater insomnia was consistently associated with poorer sexual function across the primary and sensitivity analyses. The role of physical functioning requires more cautious interpretation. The adjusted analyses did not detect statistically significant associations with age or menopausal status, but these findings remain uncertain given the unequal subgroup sizes.
These findings support further investigation of physical, psychological, relational, and treatment-related factors in sexual health after cancer.
Simultaneously, sexual health was infrequently addressed by healthcare professionals, and follow-up after therapeutic recommendations was limited. This gap between the frequency of sexual difficulties and the level of clinical attention devoted to them highlights the need for sexual health to be more consistently incorporated into survivorship care. Systematic assessment, appropriate referral, individualized multidisciplinary management, and continued follow-up should be considered according to each woman’s needs. By combining sexual function, quality-of-life associations, and women’s experiences of sexual healthcare, this study provides a broader perspective on sexual health needs among Portuguese breast and gynaecological cancer survivors. Future longitudinal studies are, however, needed to clarify the direction of the observed associations and to better identify the physical, genitourinary, psychological, and relational factors that contribute to sexual function after cancer.

Supplementary Materials

The following supporting information can be downloaded at https://www.mdpi.com/article/10.3390/curroncol33110702/s1, Table S1: FSFI scores according to menopausal status and cancer diagnosis group; Table S2: EORTC QLQ-C30 scores according to sexual dysfunction status; Table S3: Adjusted associations of menopausal status, age, physical functioning and insomnia with FSFI domain scores; Table S4: Sexual healthcare experiences and therapeutic responses after cancer diagnosis; Table S5: Healthcare professionals involved in sexual health discussions and types of responses received; Table S6: Reasons for not completing the recommended treatment; Table S7: Item-level response distributions for the Female Sexual Function Index (FSFI).

Author Contributions

J.B.-A. contributed to conceptualization, methodology, investigation, data curation, formal analysis, software, visualization, and writing of the original draft. P.C.S. and H.F. contributed to conceptualization, methodology, supervision, and review and editing of the manuscript. A.L.-M. contributed to visualization and review and editing. A.S.-S. contributed to formal analysis, software, visualization, and review and editing. M.A.C. contributed to conceptualization, methodology, investigation, data curation, supervision, preparation of the original draft, and review and editing of the manuscript. All authors have read and agreed to the published version of the manuscript.

Funding

This work was supported by FCT–Fundação para a Ciência e a Tecnologia, I.P., through doctoral grant 2024.04605.BDANA (https://doi.org/10.54499/2024.04605.BDANA).

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Faculty of Sport of the University of Porto (protocol code CEFADE 23_2025, approved on the 17 July 2025).

Data Availability Statement

The data that support the findings of this study are not publicly available due to privacy and ethical considerations but may be made available by the corresponding author upon reasonable request, subject to applicable ethical and data protection requirements.

Acknowledgments

The authors acknowledge Carlos Morgado Santos, from Body Keeper, for the logistical support provided within the non-academic host setting of the corresponding author’s doctoral fellowship. The authors also acknowledge the support of RoboCorp Laboratory, i2A, Polytechnic University of Coimbra. M.A.C. acknowledges the institutional funding provided through national funds from FCT—Fundação para a Ciência e a Tecnologia, I.P., to the research units with which she is affiliated, namely CEMMPRE under projects UID/00285/2025 (https://doi.org/10.54499/UID/00285/2025) and LA/P/0112/2020 (https://doi.org/10.54499/LA/P/0112/2020), CDRSP under project UID/04044/2025 (https://doi.org/10.54499/UID/04044/2025), and ciTechCare under project UID/05704/2025 (https://doi.org/10.54499/UID/05704/2025). These grants did not fund the present study.

Conflicts of Interest

Joana Boa-Alma’s affiliation with Body Keeper—Physiotherapy, Osteopathy, and Nutrition Clinic relates to her FCT-funded doctoral research in a non-academic setting. The company supports her doctoral project by providing access to its facilities, when required, for research interventions. She has no employment or ownership relationship with the company. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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