Navigating sexual challenges in couples post breast cancer treatment: a qualitative study

Breast cancer (BC) treatment affects BC survivors' sexual health, causing relational challenges. Sexual health is an under-communicated topic in cancer survivorship, and partner perspectives are often neglected. This qualitative study explored (1) how sexual health is affected by BC diagnosis and treatment, and (2) how couples navigate the resulting sexual and relational challenges.

Semi-structured interviews were performed separately of 37 BC survivors and 19 of their partners. The study included 19 heterosexual couples and 18 BC survivors who either did not have a partner or whose partner did not participate. The participants were Norwegians aged 28 to 67 years. Thematic content analysis was carried out using systematic text condensation.

BC survivors experienced side effects post treatment that affected sexual health, particularly reduced sexual desire, fatigue, bodily pain, vaginal dryness and body-image concerns. Both BC survivors and partners lacked guidance regarding sexual health during BC follow-up. As a result, they developed positive and negative strategies to address their sexual and relational concerns. Positive strategies, such as redefining intimacy through alternative sexual approaches, prioritizing open communication, showing love and support, seeking help, accepting the present and maintaining hope for improvement helped couples navigate challenges constructively. In contrast, negative strategies, including skepticism toward new sexual approaches, avoiding intimacy, lack of open dialogue and feelings of guilt and rejection, often created barriers and hindered intimacy.

Our findings highlight a significant gap in sexual health support for BC survivors in Norway, with partners often overlooked in the process. Integrating sexual health as a routine part of survivorship care through dedicated roles, clear guidelines, and consistent, timely conversations can help bridge this gap. Additionally, this study provides suggestions for topics and strategies that healthcare professionals can discuss with BC survivors and their partners as part of follow-up care. Future work should include more diverse survivor groups, evaluate implementation of stepped-care models in real-world settings, and develop multimodal interventions that combine biological, behavioral, and psychosocial components. Comparative studies across cancer types are needed to inform flexible and scalable models of sexual-health support.