The study drew on data from 356 women who had been diagnosed with breast cancer and were interviewed five years later as part of the VICAN5 survey, a large French national cohort designed to follow cancer survivors’ lives across health, work, and psychosocial domains. To characterize sexual dysfunction, the researchers selected five items from the Relationship and Sexuality Scale, a validated instrument covering dimensions of sexual life relevant to cancer survivors. Because sexual dysfunction is multidimensional, encompassing desire, arousal, comfort, and satisfaction, the team applied latent class analysis, a data-driven method that identifies unobserved subgroups within a population based on patterns of responses across multiple indicators. Instead of imposing arbitrary cutoff scores, latent class analysis lets the data reveal how symptoms cluster together in real people.

The analysis pointed decisively to a three-class model. The largest group, comprising 133 women or 37.4 percent of the sample, experienced moderate sexual dysfunction. A second group of 124 women, or 34.8 percent, reported no or low dysfunction. But the third group, 99 women representing 27.8 percent of survivors, reported high sexual dysfunction five years after diagnosis. In other words, nearly two-thirds of women in remission carried at least a moderate burden of sexual problems, and more than one in four carried a heavy one, at a point in their care when routine oncology follow-up has typically shifted focus to surveillance for recurrence rather than quality-of-life issues.

To understand what distinguished women in the higher-severity classes, the researchers used ordinal logistic regression, a statistical approach suited to outcomes that fall into ordered categories, in this case the ordered severity classes of dysfunction. The strongest association by far was psychological: women who reported feeling less sexually attractive had nearly five times the odds of belonging to a higher dysfunction class, with an adjusted odds ratio of 4.72. This finding places body image at the center of the sexual health picture for breast cancer survivors, consistent with a broader literature linking surgical scars, hair loss, weight changes, and altered breast sensation to diminished sexual self-concept and avoidance of intimacy.

Treatment exposures also left measurable marks. Women who had received radiotherapy had 2.36 times the odds of higher dysfunction, and those still taking adjuvant endocrine therapy at the time of the survey had 1.87 times the odds. Endocrine therapies, including tamoxifen and aromatase inhibitors, are taken for years and work by suppressing estrogen signaling, which can induce menopausal symptoms such as vaginal dryness, hot flashes, and decreased libido even in premenopausal women. The finding that current endocrine therapy use remained associated with sexual dysfunction at five years underscores that these drugs’ side effects are not transient inconveniences but persistent burdens that can erode adherence and quality of life.

Persistent physical symptoms emerged as another cluster of risk factors. Women reporting frequent excessive sweating had 1.67 times the odds of higher dysfunction, and those with frequent paresthesia, abnormal tingling or numbness in the breast or arm, had 1.78 times the odds. Both symptoms point to lasting physiological changes from treatment: vasomotor instability driven by endocrine effects, and nerve injury or sensory loss following surgery and radiation. Breast and nipple sensation plays a documented role in sexual response, and its loss is increasingly recognized as a distinct outcome, sometimes described as sensorisexual function, that deserves attention in its own right rather than being dismissed as a minor sensory change.

The analysis also flagged factors that might be modifiable. Women diagnosed after age 50 had 2.30 times the odds of higher dysfunction, a finding that likely reflects the interplay of natural menopause with treatment-induced hormonal changes. Frequent alcohol consumption was associated with 2.00 times the odds, and use of hypnotic medications, typically prescribed for sleep disturbance, with 1.66 times the odds. The hypnotic finding is particularly intriguing because sedative-hypnotic drugs have known effects on sexual function, and sleep disorders themselves are linked to sexual problems in women. Whether hypnotics are a cause, a marker of underlying distress, or both cannot be resolved in a cross-sectional analysis, but the association suggests that sleep management in survivors may have benefits that extend beyond rest.

The VICAN5 cohort itself deserves attention as a model for survivorship research. Funded by the French National Institute of Cancer, the VICAN surveys followed nationally representative samples of cancer patients at two and five years after diagnosis, capturing not only clinical outcomes but employment, social life, and intimate relationships. This breadth allowed the current analysis to situate sexual dysfunction within women’s whole lives rather than within the clinic alone. The study was approved by French ethics and data protection authorities, and all participants gave informed consent, meeting the standards expected of research touching on highly personal subject matter.

Certain limitations temper the conclusions. The analysis is cross-sectional, meaning it captures a single snapshot at five years and cannot establish whether the associated factors preceded the dysfunction or followed from it. The five RSS items, while validated, provide a narrower window on sexual function than comprehensive instruments such as the Female Sexual Function Index, and the sample of 356 women, though drawn from a national survey, may not represent all survivors, particularly those who declined to answer questions about sexuality. Sexual health questions are notoriously subject to underreporting, which means the true prevalence of dysfunction could be even higher than the study suggests.

Even with those caveats, the message for clinical practice is clear and increasingly urgent. The authors argue that sexual health assessment should be built into routine survivorship care for breast cancer, including dedicated oncosexual consultations, psychosexual support for body image concerns, and active management of persistent treatment symptoms such as vasomotor complaints and neuropathic sensations. Recent trials of newer agents for endocrine-therapy-related vasomotor symptoms show that effective options are emerging, and evidence-based non-pharmacological approaches to sleep and distress are available. What has been missing, the study implies, is the will to ask. Most survivors are never asked about their sexual lives by their oncology teams, and most do not raise the topic themselves. A simple, structured screening question at follow-up visits, targeted especially at women reporting feeling less sexually attractive or struggling with persistent symptoms, could open a door that too many women have been left to face alone.

Subject of Research: Patterns and predictors of sexual dysfunction among breast cancer survivors five years after diagnosis

Article Title: Patterns of sexual dysfunction among breast cancer survivors five years after diagnosis: a latent class analysis of the French VICAN5 study

Article References: Radwan, E., Seguin, L., Provansal, M., Mancini, J., & Bouhnik, A.-D. (2026). Patterns of sexual dysfunction among breast cancer survivors five years after diagnosis: a latent class analysis of the French VICAN5 study. Journal of Cancer Survivorship. https://doi.org/10.1007/s11764-026-02108-z

Image Credits: AI Generated

DOI: 10.1007/s11764-026-02108-z

Keywords: breast cancer survivors, sexual dysfunction, latent class analysis, VICAN5, adjuvant endocrine therapy, body image, radiotherapy, paresthesia, vasomotor symptoms, survivorship care, hypnotic use, quality of life