Table 3.

Effective interventions for managing sexual health in breast cancer survivors

Body image distress	Sexual response (desire, arousal, or orgasm)	Genital symptoms	Intimacy/relationships
Psychosocial and/or psychosexual counseling -Couples-based interventions if partnered -Self-compassionate writing	Psychosocial and/or psychosexual counseling, including cognitive behavioural therapy Regular stimulation (including masturbation)	Vaginal and/or vulvar atrophy such as dryness: -Lubricants for sexual activity or touch in addition to vaginal moisturizers -Temporary, low-dose vaginal estrogens (gynecologist evaluation + discussion of risks and benefits) -Lidocaine for persistent introital pain and dyspareunia (gynecologist evaluation)	Psychosocial and/or psychosexual counseling, including cognitive behavioural therapy Couples-based interventions
		Vaginismus/vaginal stenosis: -Vaginal dilators
		Urinary tract symptoms -Pelvic floor (Kegel) exercises -Cognitive behavioral therapy -Referral to a urologist/urogynecologist
		Pelvic floor dysfunction/ pelvic pain -Pelvic floor physiotherapy
		Vaginal discharge/leakage -Skin protectants/sealants
Patient education and symptom management advice should be offered to all patients based on the patient’s diagnosis and potential sexual health determinants: -Concomitant symptoms: pain, fatigue, and depression/anxiety -Social aspects: finances -Treatment-induced imaged changes: alopecia, nail changes, and breast surgery -Weight management

Adapted from Carter et al.⁴⁶