Letters to the Editor

Sexual Health Communication Strategies for Breast Cancer Survivors


Am Fam Physician. 2020 Jun 1;101(11):644.

Original Article: Primary Care of Breast Cancer Survivors

Issue Date: March 15, 2019

Available online at: https://www.aafp.org/afp/2019/0315/p370.html

To the Editor: We greatly appreciate Drs. Zoberi and Tucker for highlighting the sexual adverse effects that breast cancer survivors commonly experience. Up to 50% of breast cancer survivors have sexual adverse effects associated with treatment, which may worsen over time.1 These sexual adverse effects often go far beyond vaginal dryness and are complex in psychological and relational ways.

Our research involving 40 survivor and 36 clinician interviews suggests that family physicians should consider three specific tactics. First, we found that clinicians and patients valued providing concrete (not general) advice to alleviate symptoms.2 Second, we uncovered a significant disconnect between clinician intentions and patients' reception of body image assurances. Although clinicians used assurances to help patients feel better about their posttreatment bodies,3,4 these rang hollow. Third, the commonly used, seemingly reassuring term “new normal” had a frustrating, dismissive effect on patient-clinician interaction and is best avoided. We propose that clinicians should directly address concerns this way: “Many survivors have sexual adverse effects such as vaginal dryness. This vaginal dryness is very treatable. Is this something you are experiencing?”

Conveying hope and openness overcomes barriers to effective sexual health care after breast cancer. Directly addressing symptoms with specific treatment strategies signals the importance sexual health plays in the well-being of these patients.

The opinions and assertions contained herein are the private views of the authors and do not reflect the official policy or position of the U.S. Air Force, the Department of Defense, or the U.S. government.

This letter was sent to the authors of “Primary Care of Breast Cancer Survivors,” who declined to reply.

Author disclosure: No relevant financial affiliations.


show all references

1. Ligibel JA, Denlinger CS. New NCCN guidelines for survivorship care. J Natl Compr Canc Netw. 2013;11(5 suppl):640–644....

2. Canzona MR, Fisher CL, Ledford CJW. Perpetuating the cycle of silence: the intersection of uncertainty and sexual health communication among couples after breast cancer treatment. Supportive Care Cancer. 2019;27(2):659–668.

3. Canzona MR, Fisher CL, Wright KB, et al. Talking about sexual health during survivorship: understanding what shapes breast cancer survivors' willingness to communicate with providers. J Cancer Surviv. 2019;13(6):932–942.

4. Canzona MR, Ledford CJW, Fisher CL, et al. Clinician barriers to initiating sexual health conversations with breast cancer survivors: the influence of assumptions and situational constraints. Fam Syst Health. 2018;36(1):20–28.

Send letters to afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680. Include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the AAFP permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, Associate Deputy Editor for AFP Online.



Copyright © 2020 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions


Sep 2021

Access the latest issue of American Family Physician

Read the Issue

Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article