The Explanatory Three-Layer Model of Post-Treatment Sexual Adjustment: A Qualitative Study of Breast Cancer Survivors

Sexual adjustment following breast cancer treatment emerges from a complex interplay of bodily, relational, and sociocultural processes. Despite growing attention to individual dimensions of sexual wellbeing, limited insight exists into how survivors experience these domains as an integrated process of recovery. This qualitative study sought to develop an explanatory model of post-treatment sexual adjustment grounded in survivors' narratives. Thirty-one breast cancer survivors were recruited through social media, hospital networks, and community organizations. Semi-structured interviews and written narrative responses explored changes in body image, sexual identity, sexual self-concept, sexual attitude, partner dynamics, and cultural norms. Data were analyzed using reflexive thematic analysis supported by NVivo 14. Matrix coding and hierarchical cluster analysis were applied to examine demographic patterns, code co-occurrence, and structural similarity, enabling triangulation across analysis. Three interrelated domains were identified: embodied disruptions (e.g. pain, altered body image, changes in desire), relational dynamics (e.g. partner responses, communication, emotional closeness), and cultural - systemic influences (e.g. norms, healthcare communication). These domains interacted to shape divergent pathways of sexual adjustment, including disrupted, adaptive, and transformational trajectories. The findings highlight that sexual adjustment after breast cancer is a dynamic, multi-dimensional process shaped by interactions across embodied, relational, and sociocultural domains. This study contributes an empirically grounded framework that supports a more integrated understanding of post-treatment sexual wellbeing.