Sexual Health and Breast Cancer: Healing Beyond Survival

By Prof. Faysal El Kak, President of the World Association for Sexual Health (WAS)

Breast cancer affects millions of people each year - and thanks to advances in prevention, diagnosis, and treatment, survival rates continue to rise. Globally, an estimated 2.3 million women were diagnosed in 2020, and more than 8 million are living as survivors today.

Yet survival is only the first step in a lifelong process of recovery.

For many, recovery brings new and unexpected challenges. Changes in hormones, body image, arousal, and confidence can profoundly affect sexual well-being. Yet conversations about sexuality remain rare in oncology settings. Too often, sexual health is overlooked - when it should be recognized as a cornerstone of holistic healing and overall quality of life.

According to the World Health Organization (WHO) and the World Association for Sexual Health (WAS),

“Sexual health is a state of physical, emotional, mental, and social well-being in relation to sexuality - not merely the absence of disease, dysfunction, or infirmity.”

This definition reminds us that healing after breast cancer must include every dimension of a person’s life - body, mind, and relationships.

The Overlooked Dimension of Sexual Health and Breast Cancer

As a gynecologist, I have witnessed how breast cancer touches every layer of a person’s intimate life - from hormonal shifts to changes in self-esteem, desire, and relationships.

Surgery, chemotherapy, radiation, and hormonal therapies can all affect libido and sexual comfort. Many survivors experience vaginal dryness, pain during intercourse, or reduced sensation, while others face anxiety, depression, or fear of rejection.

These effects are not trivial. They are predictable consequences of treatment that deserve systematic attention.

Sexuality after cancer may change in form or expression, but it remains a vital part of health and identity. When clinicians acknowledge this openly, they help survivors rebuild confidence and connection.

Understanding the Biological and Emotional Pathways

Breast cancer treatments often disrupt hormonal balance. Chemotherapy and endocrine therapy can induce premature menopause, lowering estrogen levels and leading to vaginal atrophy, decreased lubrication, and discomfort during sex.

Surgery and reconstruction may alter sensation and self-perception, while radiation therapy can affect tissue elasticity and body image. The emotional impact is equally significant. Studies show that 40–80% of breast cancer survivors report sexual problems, yet fewer than 20% receive any form of counseling or intervention.

Addressing sexual health and breast cancer early in survivorship can improve not only intimacy but also mental health, adherence to treatment, and overall well-being.

Evidence-Based Interventions That Work

Health systems and providers can take concrete steps to improve post-treatment sexual well-being:

• Integrate sexual-health counseling into cancer survivorship programs, ensuring routine discussion of intimacy and function.

• Train healthcare professionals to initiate these conversations with empathy and competence.

• Offer evidence-based treatments such as vaginal moisturizers, lubricants, pelvic floor therapy, and safe hormonal or non-hormonal therapies.

• Include partners and families in education and support to foster open communication and mutual understanding.

• Use tailored approaches for different populations - for example, younger survivors, LGBTQ+ individuals, or those in low-resource settings.

Qualitative research highlights that survivors value clinicians who “normalize” sexual concerns and validate the emotional side of recovery.

Embedding these steps in survivorship care transforms cancer follow-up from disease monitoring into true restoration of health and identity.

Equity, Justice, and the Right to Healing

Access to post-treatment sexual-health support remains deeply unequal worldwide. In many low- and middle-income countries, survivors may have limited access even to basic cancer care, let alone sexual rehabilitation services.

Cultural taboos and lack of provider training further silence these needs, leaving survivors to navigate intimate changes alone.

The Porto Proclamation on Sexual Health, Rights, and Justice, adopted at the World Sexual Health Assembly, calls for inclusive, equitable care across the life course - including for those living with and beyond cancer. It reminds us that sexual wellbeing is an essential element of recovery - and a fundamental human right.

Barriers and Implementation Challenges

Barriers to integrating sexual health into cancer care are multifaceted. Clinicians cite time constraints, limited training, or discomfort discussing sexuality, while patients may fear embarrassment, cultural stigma, or being dismissed.

Addressing these challenges requires institutional commitment: policies, clinical pathways, and education that make sexual health a standard part of oncology care rather than an afterthought.

Research underscores the importance of interdisciplinary collaboration in addressing sexual function, identity, and well-being in people with chronic illness and disability - including cancer survivors.

A Call to Action for Health Professionals

As professionals, educators, and advocates, we share a responsibility to see the person beyond the patient. We can:

• Normalize discussions of sexual health in oncology and primary care.

• Establish referral pathways between cancer specialists, gynecologists, sex therapists, and mental-health professionals.

• Support research that explores sexual recovery across diverse genders, ages, and cultural contexts.

By taking these steps, we uphold the vision reaffirmed by WAS, that sexual health, rights, justice, and pleasure are for everyone, everywhere, every time.

Sexual Rights Do Not End With Illness

The WAS Declaration on Sexual Rights (2014) affirms that every person has the right to sexual information, education, and healthcare - and the right to pursue satisfying, safe, and pleasurable sexual experiences, regardless of health status or age.

For those who have survived breast cancer, these rights are essential to complete recovery. Healing is not only the absence of disease; it is the return of confidence, connection, and self-trust.

At WAS, we champion a holistic, evidence-based, and rights-driven approach to sexual health. Integrating sexual well-being into cancer care brings us closer to a world where survivors are supported not only to live, but to thrive - physically, emotionally, and sexually.