乳腺癌患者女性性功能障碍研究进展

doi:10.3969/j.issn.1009-976X.2025.04.009

摘要/Abstract

摘要： 乳腺癌是全球女性中最常见的恶性肿瘤,其诊疗过程中常伴随女性性功能障碍（FSD）的发生,表现为性欲减退、性唤起困难、性高潮障碍及性交疼痛等。FSD不仅影响患者的心理状态和亲密关系,还显著降低其生活质量。乳腺癌患者的FSD受社会人口学特征、治疗方式及认知-情感因素的共同影响。目前已有多种评估工具被用于识别FSD状况和困扰水平,为临床评估提供了依据。心理干预逐渐成为解决FSD相关困扰的重要方式之一,对改善FSD具有积极意义。本文系统综述乳腺癌患者FSD的评估工具、影响因素与心理干预方式,旨在为临床提供理论参考,改善乳腺癌患者的性健康问题。

关键词: 乳腺癌, 女性性功能障碍, 评估工具, 影响因素, 干预措施

Abstract: Breast cancer is the most common malignancy among women worldwide. Female sexual dysfunction （FSD） frequently occurs during the diagnosis and treatment of breast cancer, manifesting as decreased sexual desire, difficulties in arousal, orgasmic disorders, and dyspareunia. FSD not only affects patients′ psychological well-being and intimate relationships but also significantly reduces their overall quality of life. The development of FSD in breast cancer patients is influenced by a combination of sociodemographic characteristics, treatment modalities, and cognitive-emotional factors. Various assessment tools have been employed to identify the presence and severity of FSD, providing a clinical basis for evaluation. Psychological interventions have gradually emerged as an important approach to alleviating FSD-related distress and have shown positive effects in improving sexual function. This review systematically summarizes the assessment tools, influencing factors, and psychological interventions for FSD in breast cancer patients, aiming to offer theoretical support for clinical practice and improve the sexual health of this population.

Key words: breast neoplasms, female sexual dysfunction, clinical assessment instruments, influencing factors, evidence-based interventions

中图分类号:

R737.9

钟有限, 严靖雯. 乳腺癌患者女性性功能障碍研究进展[J]. 岭南现代临床外科, 2025, 25(04): 267-272.

ZHONG You-xian, YAN Jing-wen. Research advances in female sexual dysfunction among breast cancer patients[J]. Lingnan Modern Clinics In Surgery, 2025, 25(04): 267-272.

参考文献

[1] Ferlay J, Colombet M, Soerjomataram I, et al.Cancer statistics for the year 2020: An overview[J]. Int J Cancer, 2021. doi: 10.1002/ijc.33588.
[Online ahead of print]
[2] Zhang Y, Zhang X, Li N, et al.Factors associated with psychosocial adjustment in newly diagnosed young to middle-aged women with breast cancer: A cross-sectional study[J]. Eur J Oncol Nurs, 2023, 65: 102357.
[3] Mayer S, Iborra S, Grimm D, et al.Sexual activity and quality of life in patients after treatment for breast and ovarian cancer[J]. Arch Gynecol Obstet, 2019, 299(1): 191-201.
[4] Qi A, Li Y, Sun H, et al.Incidence and risk factors of sexual dysfunction in young breast cancer survivors[J]. Ann Palliat Med, 2021, 10(4): 4428-4434.
[5] 陈泽刚, 王永兵, 周泉, 等. 乳腺癌术后患者性功能和性活动状况及影响因素[J]. 慢性病学杂志, 2023, 24(3): 369-374.
[6] Reed MA.Female Sexual Dysfunction[J]. Clin Plast Surg, 2022, 49(4): 495-504.
[7] Jehan M, Azam S, Taimuri MA, et al.Care for breast cancer survivors in Asian countries: A review of sexual dysfunction[J]. Womens Health (Lond), 2024, 20: 17455057241237687.
[8] 徐若媛, 孟利敏, 宁淑艳. 女性乳腺癌患者术后性功能障碍现状研究进展[J]. 中国性科学, 2021, 30(7): 75-77.
[9] Rosen R, Brown C, Heiman J, et al.The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function[J]. J Sex Marital Ther, 2000, 26(2): 191-208.
[10] Sun X, Li C, Jin L, et al.Development and validation of Chinese version of female sexual function index in a Chinese population-a pilot study[J]. J Sex Med, 2011, 8(4): 1101-1111.
[11] Derogatis LR, Rosen R, Leiblum S, et al.The Female Sexual Distress Scale (FSDS): initial validation of a standardized scale for assessment of sexually related personal distress in women[J]. J Sex Marital Ther, 2002, 28(4): 317-330.
[12] Derogatis L, Clayton A, Lewis-D'Agostino D, et al. Validation of the female sexual distress scale-revised for assessing distress in women with hypoactive sexual desire disorder[J]. J Sex Med, 2008, 5(2): 357-364.
[13] Ooi PS, Draman N, Muhamad R, et al.Sexual Dysfunction Among Women With Breast Cancer in the Northeastern Part of West Malaysia[J]. Sex Med, 2021, 9(3): 100351.
[14] Huberts AS, Peeters NJMCV, Pastoor H, et al.Let's talk about sex！ Why should healthcare professionals address sexual distress in breast cancer patients and survivors[J]. Eur J Oncol Nurs, 2024, 71: 102606.
[15] Yan R, Wang J, Yu J.Association of sexual attitudes with sexual dysfunction and sexual distress among Chinese breast cancer survivors: a cross-sectional study[J]. Support Care Cancer, 2023, 31(3): 154.
[16] Mancha RG, Muoz M, Cruz-Merino LDL, et al. Development and validation of a sexual relations satisfaction scale in patients with breast cancer - “SEXSAT-Q”[J]. Health Qual Life Outcomes, 2019, 17(1): 143.
[17] 孔双春, 陈玉琴, 李玲, 等. 乳腺癌患者性生活满意度问卷的汉化及信效度检验[J]. 护理管理杂志, 2022, 22(10): 754-758.
[18] 邵志敏, 沈镇宙, 徐兵河. 乳腺肿瘤学(第三版)[M]. 上海:复旦大学出版社, 2022.
[19] Jafari A, Alami A, Charoghchian E, et al.The impact of effective communication skills training on the status of marital burnout among married women[J]. BMC Womens Health, 2021, 21(1): 231.
[20] Salakari M, Nurminen R, Sillanmaki L, et al.The importance of and satisfaction with sex life among breast cancer survivors in comparison with healthy female controls and women with mental depression or arterial hypertension: results from the Finnish nationwide HeSSup cohort study[J]. Support Care Cancer, 2020, 28(8): 3847-3854.
[21] Morais FDD, Freitas-Junior R, Rahal RMS, et al.Sociodemographic and clinical factors affecting body image, sexual function and sexual satisfaction in women with breast cancer[J]. J Clin Nurs, 2016, 25(11-12): 1557-1565.
[22] 潘伶俐, 胡桂风, 单春剑, 等. 女性乳腺癌病人性功能障碍影响因素的Meta分析[J]. 循证护理, 2024, 10(20): 3645-3650.
[23] Cortés-Flores AO, Vargas-Meza A, Morgan-Villela G, et al.Sexuality Among Women Treated for Breast Cancer: A Survey of Three Surgical Procedures[J]. Aesthetic Plast Surg, 2017, 41(6): 1275-1279.
[24] Öztürk D, Akyolcu N.Assessing sexual function and dysfunction in Turkish women undergoing surgical breast cancer treatment[J]. Jpn J Nurs Sci, 2016, 13(2): 220-228.
[25] Hernández-Blanquisett A, Quintero-Carreño V, Álvarez-Londoño A, et al.Sexual dysfunction as a challenge in treated breast cancer: in-depth analysis and risk assessment to improve individual outcomes[J]. Front Oncol, 2022, 12: 955057.
[26] Moskalewicz A, Tomaso AD, Kachura JJ, et al.Gynecologic Symptoms among Hormone Receptor-Positive Breast Cancer Patients on Oral Endocrine Therapy: A Cross-Sectional Study[J]. Curr Oncol, 2022, 29(3): 1813-1827.
[27] Gan L, Miao Y, Dong X, et al.Investigation on sexual function in young breast cancer patients during endocrine therapy: a latent class analysis[J]. Front Med (Lausanne), 2023, 10: 1218369.
[28] Albornoz CR, Matros E, Mccarthy CM, et al.Implant breast reconstruction and radiation: a multicenter analysis of long-term health-related quality of life and satisfaction[J]. Ann Surg Oncol, 2014, 21(7): 2159-2164.
[29] 周志豪, 梁培禾, 陈衍霖, 等. 乳腺癌对患者配偶性功能的影响[J]. 中华男科学杂志, 2022, 28(1): 26-31.
[30] Streicher L, Simon JA.Sexual Function Post-Breast Cancer[J]. Cancer Treat Res, 2018, 173: 167-189.
[31] Tahir K, Khan N.Mediating role of body image between sexual functioning and marital intimacy in Pakistani women with breast cancer[J]. Psychooncology, 2021, 30(2): 260-266.
[32] Yousaf A, Amir R, Hameed A. Body Image, Self-Compassion and Sexual Distress in Patients with Mastectomy[J]. Ann KEMU 2019, 25(1):22-27.
[33] 杨洁, 袁晓玲, 吴雨霏, 等. 乳腺癌术后患者婚姻调适现状及其影响因素分析[J]. 中华现代护理杂志, 2021, 27(15): 2039-2044.
[34] Shaw L, Sherman KA, Fitness J, et al.Factors associated with romantic relationship formation difficulties in women with breast cancer[J]. Psychooncology, 2018, 27(4): 1270-1276.
[35] Ursavaş FE, Karayurt Ö.Effects of a Roy's Adaptation Model-Guided Support Group Intervention on Sexual Adjustment, Body Image, and Perceived Social Support in Women With Breast Cancer[J]. Cancer Nurs, 2021, 44(6): E382-E394.
[36] 安靖华, 周凯娜, 王雯, 等. 乳腺癌病人体像现状及其影响因素的研究[J]. 护理研究, 2018, 32(7): 1042-1047.
[37] Brotto LA, Walker L, Sears C, et al.A randomized comparison of online mindfulness-based group sex therapy vs supportive group sex education to address sexual dysfunction in breast cancer survivors[J]. J Sex Med, 2024, 21(5): 452-463.
[38] 张馨戈. 乳腺科医护人员对乳腺癌生存者性功能障碍知信行量表的研制[D]. 唐山: 华北理工大学, 2019.
[39] Yao L, Li Y, Wang T, et al.Chinese medical staff′s knowledge, attitudes and practices towards breast cancer patients′ sexual health management: A cross-sectional study[J]. Heliyon, 2023, 9(9): e19701.
[40] Abril-Requena A, García-Torres F, Alós FJ.Sexual dysfunction and phobic anxiety in breast cancer survivors[J]. Psychooncology, 2019, 28(1): 195-197.
[41] Oberguggenberger A, Martini C, Huber N, et al.Self-reported sexual health: Breast cancer survivors compared to women from the general population-an observational study[J]. BMC Cancer, 2017, 17(1): 599.
[42] Avis NE, Johnson A, Canzona MR, et al.Sexual functioning among early post-treatment breast cancer survivors[J]. Support Care Cancer, 2018, 26(8): 2605-2613.
[43] 杨海银, 董勇, 杨诗瑶, 等. 心理复原力在乳腺癌患者配偶支持感知与尊严受损之间的中介作用[J]. 昆明医科大学学报, 2025, 46(3): 164-170.
[44] Reese JB, Lepore SJ, Sorice KA, et al.Efficacy of a couple-based intervention addressing sexual concerns for breast cancer survivors: Results of a randomized controlled trial[J]. Cancer, 2025, 131(1): e35685.
[45] Chang Y, Chang S, Chiu S.Sexual Problems of Patients With Breast Cancer After Treatment: A Systematic Review[J]. Cancer Nurs, 2019, 42(5): 418-425.
[46] Reese JB, Porter LS, Casale KE, et al.Adapting a couple-based intimacy enhancement intervention to breast cancer: A developmental study[J]. Health Psychol, 2016, 35(10): 1085-1096.
[47] 康婷婷, 郑蔚, 刘梦丽, 等. 亲密加强疗法对育龄期乳腺癌患者生育忧虑的影响[J]. 护理学杂志, 2021, 36(10): 6-9.
[48] Cullen K, Fergus K.Acceptability of an online relational intimacy and sexual enhancement (iRISE) intervention after breast cancer[J]. J Marital Fam Ther, 2021, 47(2): 515-532.
[49] Chen W, Li H, Qin N, et al.Effectiveness of couple-based interventions for prostate cancer patients and their spouses on their quality of life: a systematic review and meta-analysis[J]. Support Care Cancer, 2022, 31(1): 34.
[50] Annon JS. Behavioral treatment of sexual problems: Brief therapy[M]. Oxford: Harper & Row, 1976: xv, 166.
[51] 傅静静, 杜天宇. 普里西特模式联合家庭支持应用于育龄期乳腺癌患者护理中的效果分析[J]. 中国社区医师, 2024, 40(12): 127-129.
[52] 武佩佩, 强万敏, 王盈, 等. 乳腺癌患者术后性健康教育培训内容的构建[J]. 中华护理杂志, 2016, 51(11): 1325-1329.
[53] Conger JA, Kanungo RN.The empowerment process: Integrating theory and practice[J]. AcadManag Rev, 1988, 13(3): 471-482.
[54] Perkins DD, Zimmerman MA.Empowerment theory, research, and application[J]. Am J Community Psychol, 1995, 23(5): 569-579.
[55] Rodwell CM.An analysis of the concept of empowerment[J]. J Adv Nurs, 1996, 23(2): 305-313.
[56] Lambrinou E, Hansen TB, Beulens JW.Lifestyle factors, self-management and patient empowerment in diabetes care[J]. Eur J Prev Cardiol, 2019, 26(2_suppl): 55-63.
[57] 叶巧兮, 谢秋红, 严龙丹. 赋能理论指导对乳腺癌根治术患者心理压力和婚姻质量的影响[J]. 中国医药导报, 2024, 21(14): 168-171.