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. 2026 Jul 31;14(5):qfag064. doi: 10.1093/sexmed/qfag064

Meta-analysis of the effect of sexual health nursing interventions on improving post-treatment sexual dysfunction and partner relationship satisfaction in breast cancer patients

Qian Yu 1, Lihong Wang 2, Yuhong Xu 3, Jie Wang 4,✉
PMCID: PMC13426239  PMID: 42540624

Abstract

Introduction

Breast cancer survivors frequently experience sexual dysfunction and impaired partner relationships after treatment, but the effectiveness of nursing interventions in improving these post-treatment outcomes remains uncertain. To evaluate the efficacy of sexual health, nursing interventions on sexual dysfunction and quality of life in breast cancer survivors through a systematic review and meta-analysis of randomized controlled trials.

Methods

We searched PubMed, Embase, and Web of Science for randomized controlled trials published from database inception to January 31, 2026. Two reviewers independently screened the studies, extracted the relevant data, and assessed methodological quality. Meta-analysis was conducted using RevMan 5.4, with standardized mean difference (SMD) or mean difference (MD) and 95% CIs used according to the type of outcome measure.

Outcomes

The primary outcomes were sexual dysfunction, Female Sexual Function Index (FSFI) scores, and Sexual Quality of Life (SQOL) scores.

Results

Sixteen randomized controlled trials involving 1929 patients were included. Compared with usual care, sexual health nursing interventions significantly improved sexual dysfunction (SMD = 0.92, 95% CI: 0.60-1.24, P < .001), FSFI scores (MD = 3.97, 95% CI: 3.07-4.86, P < .001), and SQOL scores (MD = 7.05, 95% CI: 5.94-8.15, P < .001). Subgroup analyses further confirmed the efficacy of sexual health nursing interventions across different intervention types. Sensitivity analysis showed that the pooled results were robust, and no evidence of publication bias was detected by Egger’s test (P > .05).

Discussion

These findings support the integration of sexual health nursing interventions into routine rehabilitation care for breast cancer survivors, as such interventions may help to alleviate post-treatment sexual dysfunction and improve SQOL. The strengths of this study include a comprehensive database search, rigorous methodology with independent reviewers, and robust sensitivity analysis. The limitations include potential heterogeneity across intervention contents and outcome measures, as well as the inclusion of studies conducted only in high-income countries, which may limit the generalizability of the findings. Sexual health nursing interventions effectively alleviate sexual dysfunction and improve SQOL in breast cancer survivors.

Keywords: breast cancer, sexual dysfunction, partner relationship satisfaction, sexual health nursing intervention, meta-analysis, randomized controlled trial

Introduction

Breast cancer is one of the most prevalent malignant tumors among women worldwide. In recent years, the age at onset has shown a decreasing trend, and the proportion of young patients with breast cancer has gradually increased, posing an important public health threat to the well-being of young women.1–3 After treatment, breast cancer patients often experience various manifestations of sexual dysfunction, including vaginal dryness, decreased sexual desire, dyspareunia, and sexual arousal disorders. The incidence of sexual dysfunction is significantly higher than that among healthy women of the same age, with some studies reporting rates of 60%-80%.4,5 Sexual dysfunction not only causes physical discomfort but also contributes to negative psychological responses, including anxiety, depression, and reduced self-identity. This further impairs intimate interactions with partners, reduces partner relationship satisfaction, and may potentially affect family stability.6,7 However, the sexual health needs of breast cancer patients have long remained insufficiently addressed, partly because sexual health remains a sensitive topic in many cultural contexts and partly because clinical medical staff often pay insufficient attention to this field.8,9 Currently, several original studies have explored the effects of different sexual health interventions in breast cancer patients. However, the findings have been inconsistent, and individual studies are limited by small sample sizes and heterogeneity in intervention design and intensity.10 Therefore, this study used a meta-analysis approach to integrate and quantitatively evaluate the existing evidence, with the aim of clarifying the overall effectiveness and potential influencing factors of sexual health nursing interventions in improving sexual dysfunction and enhancing partner relationship satisfaction in breast cancer patients after treatment. Also, we aimed to determine whether sexual health nursing interventions, compared with usual care, would improve sexual function, sexual quality of life (SQOL), and partner relationship satisfaction in breast cancer survivors after treatment.

Materials and methods

The present meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol for this meta-analysis was registered in INPLASY under the registration number INPLASY202630032 and is available at https://inplasy.com/inplasy-2026-3-0032/.

Literature search

A systematic search was conducted in English-language databases, including PubMed, Embase, and Web of Science Core Collection. In addition, manual searches were performed by screening the reference lists of the included studies. The search strategy combined subject headings and free-text terms, with appropriate adjustments made according to the specific characteristics of each database. The English search terms included breast cancer, adolescent breast cancer, sexual health intervention, sexual care, sexual dysfunction, hypoactive sexual desire disorder, female orgasmic disorder, female sexual arousal disorder, dyspareunia, partner relationship satisfaction, and marital satisfaction. The retrieval period extended from the inception of each database to January 31, 2026. Although no restriction was imposed on publication language during the search stage, only studies published in English were ultimately included.

Inclusion and exclusion criteria for literature

Inclusion criteria

Study type: Randomized controlled trial (RCT), regardless of whether blinding was used.

Study subjects: Female patients with a histologically confirmed diagnosis of breast cancer; patients who had received anti-tumor treatments, such as surgery, chemotherapy, and endocrine therapy, and who presented with sexual dysfunction or had sexual health needs; and patients with a stable partner.

Intervention: Participants in the experimental group received sexual health nursing interventions, including but not limited to sexual health education and counseling, cognitive behavioral psychotherapy, intimate relationship counseling for couples, pelvic floor muscle training, and nurse-led educational guidance on the use of vaginal moisturizers or lubricants as a self-care behavioral component. In this context, the intervention referred to nursing-delivered education and skill counseling rather than the pharmacological product itself. The intervention formats included in-person sessions, online courses, one-on-one consultations, and group therapy.

Control measures: The control group received usual care, defined as standard postoperative rehabilitation guidance, generic survivorship health education, such as wound care, lymphedema prevention, medication adherence, and follow-up information, and non-specific psychological support, without any targeted sexual health intervention.

Outcome measures: The primary focus was the improvement of sexual dysfunction, which was assessed using standardized scales such as the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale-Revised (FSDS-R).

Exclusion criteria

Studies were excluded if they met any of the following criteria: non-RCTs; studies in which the experimental arm contained a sexual health component embedded within a broader multi-component program, making the specific effect on sexual outcomes difficult to isolate from that of the other components; studies whose outcome measures did not involve sexual dysfunction or partner relationship satisfaction; studies with incomplete data, including missing means, SDs, or sample sizes for the outcome of interest, with no response after contacting the corresponding author, or studies from which usable effect estimates, including means with measures of variance, could not be derived for at least one of the prespecified outcomes; and non-original research literature, such as reviews, meta-analyses, case reports, and conference abstracts.

Literature screening and data extraction

Two researchers independently performed literature screening and data extraction, and any disagreements were resolved through discussion or consultation with a third researcher. First, the titles and abstracts of the retrieved records were screened, and studies that clearly did not meet the inclusion criteria were excluded; subsequently, the full texts of the remaining records were reviewed to further determine their eligibility. For the included studies, the extracted information comprised the following: (1) basic study information, including first author, publication year, country, and study design type; (2) characteristics of research participants, including sample size, patient age, intervention method, intervention content, intervention duration, and intervention frequency; and (3) outcome measures, including baseline and post-intervention scores for each scale, as well as the pre-post intervention score differences. The primary assessment scales included the FSFI,11 the Sexual Quality of Life Questionnaire (SQL),12 the SQOL-Female (SQOL-F),13 and the Sexual Satisfaction Scale for Women (SSS-W).14 Briefly, the FSFI is a 19-item self-report measure that assesses 6 domains of female sexual function, including desire, arousal, lubrication, orgasm, satisfaction, and pain, over the previous 4 weeks, with higher scores indicating better sexual function. Sexual Quality of Life Questionnaire is a generic instrument designed to capture the impact of sexual functioning on overall quality of life. Sexual Quality of Life-Female is an 18-item female-specific questionnaire that assesses the psychosocial impact of sexual dysfunction on quality of life, with higher scores reflecting better SQOL. Sexual Satisfaction Scale for Women is a 30-item validated multidimensional scale that measures sexual satisfaction and distress across 5 domains, including contentment, communication, compatibility, relational concern, and personal concern.

Quality evaluation of included research

The Cochrane Risk of Bias tool for randomized trials, version 1 (RoB 1; Higgins et al., Cochrane Handbook for Systematic Reviews of Interventions, version 6.4, updated August 2023), was used to evaluate the methodological quality of the included studies. Each of the 7 domains, including random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other bias, was rated as “low risk,” “high risk,” or “unclear risk,” and an overall risk-of-bias judgment was made for each study. Considering the behavioral nature of nursing interventions, blinding of participants and personnel is rarely achievable; therefore, this domain was interpreted with caution and is further discussed in the “Discussion” section.

Statistical analysis

Meta-analyses were performed using Review Manager (RevMan) software, version 5.4.1 (The Cochrane Collaboration; 2020). Egger’s test for small-study effects was performed using Stata, version 17.0 (StataCorp LLC). The Q test and I2 statistic were used to evaluate heterogeneity among studies. If P ≥ .1 and I2 ≤ 50%, heterogeneity among studies was considered low, and a fixed-effect model was used for pooled analysis. If P < .1 or I2 > 50%, heterogeneity among studies was considered substantial; in such cases, potential sources of heterogeneity, such as differences in intervention protocols or measurement tools for outcome indicators, were examined, and a random-effects model was used for pooled analysis, with subgroup analyses conducted when necessary. For continuous outcome measures, such as FSFI scores and Marital Adjustment Test (MAT) scores, mean difference (MD) or standardized mean difference (SMD) was used as the effect size, together with 95% CIs.

Subgroup analysis: When substantial heterogeneity (I2 > 50%) was detected, results were stratified by intervention type, including psychological/counseling-based, educational, and couple-/partner-based interventions; delivery format, including in-person vs online/remote delivery; and intervention duration, including ≤8 weeks vs >8 weeks, where data permitted, to explore potential sources of heterogeneity. Random-effects meta-regression was considered a priori; however, owing to the limited number of studies per outcome and incomplete reporting of moderator-level data, it could not be reliably performed, and this is acknowledged as a limitation.

Sensitivity analysis: A leave-one-out approach was used, whereby each study was sequentially excluded and the pooled effect size was recalculated to assess the stability of the overall result.

Detection of publication bias: When the number of included studies for a given outcome was ≥10, a funnel plot was generated to visually assess publication bias, and Egger’s regression test was used to further evaluate small-study effects, with P < .05 indicating statistically significant asymmetry. Considering that substantial between-study heterogeneity can reduce the power and reliability of both funnel plots and Egger’s test, these results were interpreted with caution.

Results

Literature inclusion outcomes

Literature inclusion process

Through systematic searches of the selected databases, a total of 1287 relevant articles were initially retrieved. After 245 duplicate articles were removed using EndNote software, 1042 articles remained for further screening. By reviewing the titles and abstracts, 926 articles that clearly did not meet the inclusion criteria were excluded. After the full texts of the remaining 116 articles were read, a further 100 articles were excluded, including 62 non-RCT studies, 21 studies in which the interventions did not specifically target sexual health, and 17 studies from which valid outcome data could not be extracted. Ultimately, 16 RCTs that met the eligibility criteria were included in this meta-analysis. The literature screening process is illustrated in Figure 1.

Figure 1.

PRISMA flow diagram showing study selection. Records were identified through database searching of PubMed, Embase, and Web of Science. After removing duplicates, records were screened by title and abstract, with a number excluded. Full-text articles were then assessed for eligibility, and further reports were excluded for stated reasons (such as wrong study design, wrong population, or lack of relevant outcomes). Sixteen randomized controlled trials were included in the final qualitative and quantitative metaanalysis.

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Flow chart of the literature screening process.

Basic characteristics of included studies

The 16 included studies15–30 were published between 2010 and 2025, and were conducted in 9 countries, including the United States, Iran, and China. The total sample size across the included studies was 1929 patients, with a generally balanced distribution between the experimental and control groups. The main intervention measures included mindfulness interventions, psychological counseling, and couple-based interventions, among others, and the intervention durations ranged from 4 weeks to 12 months. The detailed basic characteristics of the included studies are presented in Table 1.

Table 1.

Basic characteristics of the included studies.

Author and year Number of cases in OG Number of cases in CG Age of OG Age of CG Participants Main intervention for observation group Intervention duration Region Study type
Bokaie 202315 32 33 40.6 ± 4.05 40.6 ± 4.05 Breast cancer patients Online solution-oriented counseling 1 month (twice a week, 60–90 min) Iran RCT
Brotto 202416 42 48 50.9 ± 7.5 49.0 ± 11.0 Breast cancer patients Online mindfulness group therapy and supportive group education 8 weeks (once a week, 2 h) Canada RCT
Faghani 201617 50 50 45.65 ± 4.05 Not reported Postoperative breast cancer patients PLISSIT model 4 sessions (90 min each) Iran RCT
Fatehi 201918 51 49 44.84 ± 6.7 43.86 ± 6.6 Breast cancer survivors Psychological counseling 6 weeks (once a week, 90–120 min) Iran RCT
Haghighi 202419 34 36 46.18 ± 5.66 47.42 ± 4.54 Breast cancer patients Sexual health counseling 8 sessions (90 min each) Iran RCT
Hummel 201720 84 85 51.6 ± 7.7 50.5 ± 6.8 Breast cancer patients Internet-based cognitive behavioral therapy 12 weeks Netherlands RCT
Jamshidi 202521 22 23 42.64 ± 4.88 43.44 ± 5.20 Breast cancer patients Self-efficacy theory-based sexual education 4 weeks Iran RCT
Kayser 201022 24 23 43.7 ± 9.19 48.8 ± 9.8 Breast cancer patients Partner-based intervention 9 sessions (once every 2 weeks) USA RCT
Nazarzadeh 202423 45 45 37.36 ± 6.51 37.38 ± 7.49 Breast cancer survivors WhatsApp-based optimized sexual function counseling 6 weeks Iran RCT
Nicolaisen 201824 102 96 54.2 ± 11 52.6 ± 10 Breast cancer patients Attachment-oriented couple intervention 4-8 sessions Denmark RCT
Olcer 202225 30 30 40.6 ± 4.7 40.0 ± 4.4 Breast cancer patients Problem counseling 4 weeks Turkey RCT
Price 202026 36 41 39.67 ± 5.44 38.78 ± 5.08 Breast cancer survivors Mindfulness intervention 8 weeks USA RCT
Reese 202527 61 59 50.39 ± 9.60 51.12 ± 9.97 Breast cancer survivors Couple intervention 4 weeks USA RCT
Schmidt 202528 177 178 54.9 ± 11.6 55.9 ± 10.7 Metastatic breast cancer patients Exercise intervention 9 months Germany RCT
Suo 202529 42 41 46.6 ± 7.59 48.2 ± 7.80 Breast cancer patients Phased health education 5 sessions (60-110 min each) China RCT
Toija 201930 130 130 60.3 ± 9.8 59.7 ± 11.3 Newly diagnosed breast cancer patients Peer support intervention 1-5 sessions Finland RCT
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Abbreviations: CG, control group; OG, observation group; RCT, randomized controlled trial.

Risk of bias assessment of included studies

The risk of bias in the 16 included studies was evaluated using the Cochrane Risk of Bias tool. Most studies adequately described random sequence generation and allocation concealment. However, given the behavioral nature of nursing interventions, blinding of participants and personnel was inherently difficult and was not reported in the majority of studies; one study explicitly did not describe blinding and was therefore rated as unclear, whereas the remaining studies were judged to have high or unclear risk for performance bias. Blinding of outcome assessment was rated as unclear in several studies because the outcomes were mainly patient-reported and lacked independent assessor verification. One additional study was rated as unclear in the “other bias” category. Although the attrition and selective-reporting domains were generally judged to be at low risk, the overall risk-of-bias profile should be interpreted as indicating moderate, rather than uniformly low, methodological quality, particularly with respect to the performance- and detection-bias domains, which are intrinsically vulnerable in unblinded behavioral trials. Specific details are presented in Figure 2.

Figure 2.

Risk-of-bias assessment table for the included randomized controlled trials, rated with the Cochrane tool. Rows list each study and columns list bias domains: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other bias. Cells are colored green for low risk, yellow for unclear risk, and red for high risk, with most domains rated low or unclear risk across studies.

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Risk-of-bias assessment of the included studies.

Meta-analysis

Improvement of sexual dysfunction

All 16 articles reported improvement in patients’ sexual dysfunction, although the assessment scales used across studies varied. Therefore, SMD was applied to pool the data. Heterogeneity analysis showed an I2 value of 91%, and a random-effects model was therefore selected. The meta-analysis results showed a pooled effect size of SMD = 0.92, 95% CI: 0.60-1.24, with Z = 5.58 and P < .001, indicating that sexual health nursing interventions can effectively improve sexual function in breast cancer patients following treatment, as illustrated in Figure 3.

Figure 3.

Forest plot of a meta-analysis comparing sexual health nursing interventions with usual care for improving sexual dysfunction, using standardized mean difference with 95% confidence intervals. Each study is shown as a square with horizontal confidenceinterval lines, and the pooled diamond favors the intervention group with an overall standardized mean difference of 0.92 (95% CI 0.60 to 1.24), statistically significant. Heterogeneity statistics are reported below the plot.

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Forest plot of the effect of sexual health nursing interventions on sexual dysfunction in breast cancer patients.

SQL scale changes

Three articles reported changes in SQL scale scores before and after the intervention. Heterogeneity analysis showed an I2 value of 90%, and a random-effects model was therefore selected. The meta-analysis results showed that the pooled effect size was MD = 7.05, 95% CI: 5.94-8.15, with Z = 12.52 and P < .001, indicating that sexual health nursing interventions can significantly improve SQL scale scores in breast cancer patients after treatment, as shown in Figure 4.

Figure 4.

Forest plot showing subgroup analysis of the intervention effect by intervention type. Studies are grouped into subgroups, each with its own pooled estimate, and an overall pooled diamond. The effect estimates consistently favor the sexual health nursing intervention over usual care across subgroups, with confidence intervals shown for each study and subgroup total.

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Forest plot of the effect of sexual health nursing interventions on Sexual Quality of Life Questionnaire (SQL) scores.

Changes in FSFI scores

Nine articles reported changes in FSFI scores before and after the intervention. Heterogeneity analysis showed an I2 value of 99%, and a random-effects model was therefore selected for meta-analysis. The results showed a pooled MD of 3.97, with a 95% CI of 3.07-4.86, a Z-value of 8.68, and a P-value <.001. These findings suggest that sexual health nursing interventions significantly improve FSFI scores in breast cancer patients following treatment (Figure 5).

Figure 5.

Forest plot of a meta-analysis of Female Sexual Function Index (FSFI) scores comparing intervention with usual care, using mean difference with 95 percentage confidence intervals. Individual study estimates are plotted with the pooled diamond favoring the intervention, showing an overall mean difference of 3.97 (95 percentage CI 3.07 to 4.86), statistically significant, with heterogeneity statistics reported below.

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Forest plot of the effect of sexual health nursing interventions on Female Sexual Function Index (FSFI) scores.

SQOL-F score changes

Five articles reported changes in SQOL-F scores before and after the intervention. Heterogeneity analysis showed an I2 value of 100%, and a random-effects model was therefore selected. The meta-analysis results showed that the pooled effect size was MD = 22.43, 95% CI: 12.21-32.66, with Z = 4.30 and P < .001, indicating that sexual health nursing interventions can significantly improve SQOL-F scores in breast cancer patients after treatment (Figure 6).

Figure 6.

Forest plot of a meta-analysis of Sexual Quality of Life (SQOL) scores comparing intervention with usual care, using mean difference with 95 percentage confidence intervals. Study estimates are plotted with a pooled diamond favoring the intervention, showing an overall mean difference of 7.05 (95 percentage CI 5.94 to 8.15), statistically significant, with heterogeneity statistics shown.

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Forest plot of the effect of sexual health nursing interventions on Sexual Quality of Life-Female (SQOL-F) scores.

Changes in SSS-W scores

Four articles reported changes in SSS-W scores before and after the intervention. Heterogeneity analysis showed an I2 value of 100%, and a random-effects model was therefore selected. The meta-analysis results showed a pooled effect size of MD = 11.76, 95% CI: 7.83-15.69, with Z = 5.86 and P < .001, indicating that sexual health nursing interventions significantly improved SSS-W scores in breast cancer patients following treatment, as shown in Figure 7.

Figure 7.

Forest plot of a meta-analysis of Sexual Satisfaction Scale for Women (SSS-W)/partner relationship satisfaction scores comparing intervention with usual care, using mean difference with 95 percentage confidence intervals. Each study is shown with its point estimate and confidence interval, and the pooled diamond favors the intervention group over usual care, with heterogeneity statistics reported.

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Forest plot of the effect of sexual health nursing interventions on Sexual Satisfaction Scale for Women (SSS-W) scores.

Subgroup analysis

To explore the sources of heterogeneity and differences in the effects of different intervention models, subgroup analysis was conducted according to the core elements and implementation focus of the intervention measures. The pooled effect sizes of all subgroups were statistically significant, indicating that all 3 types of intervention measures could effectively improve sexual dysfunction in breast cancer patients. However, heterogeneity within each subgroup remained high, with I2 values >80%, suggesting that, in addition to intervention orientation, other factors such as specific program content, intervention intensity, and cultural background may also be important sources of heterogeneity. The details are shown in Table 2.

Table 2.

Subgroup analysis results based on intervention orientation.

Intervention orientation Number of included studies Pooled effect size (SMD) 95% CI Heterogeneity test (I2 ) Subgroup effect test (Z-value, P-value)
A. Counseling and psychotherapy-oriented 10 1.15 0.94-1.36 89% Z = 10.69, P < .001
B. Partner and relationship-oriented 3 0.95 0.43-1.47 88% Z = 3.57, P < .001
C. Education and skill training-oriented 3 0.82 0.21-1.43 92% Z = 2.63, P = .008
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Abbreviation: SMD, standardized mean difference.

Sensitivity analysis

Sensitivity analysis was performed using the leave-one-out method, in which each of the 16 included studies was sequentially removed and the pooled effect size for the overall improvement in sexual dysfunction was recalculated. The results showed that the recalculated SMD values ranged from 0.98 to 1.18, with the lower bounds of the 95% CIs exceeding 0.70 and the upper bounds remaining below 1.40. In addition, the statistical significance of all pooled results remained unchanged, with all P values <.001. These findings indicate that the results of this meta-analysis are robust and were not unduly influenced by any single study.

Literature publication bias

Publication bias was assessed for the overall improvement in sexual dysfunction, which included data from 16 studies. After the funnel plot was generated, the study points were generally distributed symmetrically, as shown in Figure 8. Further assessment using Egger’s test showed P > .05, and no obvious publication bias was detected, suggesting that the findings of this study are relatively reliable. However, given the substantial between-study heterogeneity for this outcome, with I2 = 91%, both visual inspection of the funnel plot and Egger’s test have reduced power and reliability in detecting small-study effects. Therefore, the absence of statistically significant asymmetry should not be interpreted as definitive evidence that publication bias was completely absent.

Figure 8.

Funnel plot assessing publication bias, plotting standard error of the effect estimate on the vertical axis against the effect size on the horizontal axis, with dashed lines forming an inverted funnel around the pooled estimate. The study points are distributed roughly symmetrically within the funnel, indicating no clear evidence of publication bias, consistent with the non-significant Egger's test.

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Funnel plot for the assessment of publication bias.

Discussion

This meta-analysis systematically integrated evidence from 16 RCTs, and the results showed that sexual health nursing interventions can significantly improve post-treatment sexual dysfunction in breast cancer patients, while also enhancing sexual-related quality of life and partner relationship satisfaction across multiple dimensions. The pooled effect sizes demonstrated that sexual health interventions had clear and clinically significant positive effects, not only on the overall improvement of sexual dysfunction, but also on specific scale indicators, including FSFI, SQL, SQOL-F, and SSS-W scores. These findings suggest that targeted sexual health nursing interventions are not limited to alleviating a single physiological symptom but may produce comprehensive improvements in multiple dimensions, such as sexual desire, sexual arousal, sexual pain, sexual satisfaction, and sexual harassment. This multidimensional benefit is consistent with the complex mechanisms underlying sexual dysfunction after breast cancer treatment, and further supports the necessity of systematically incorporating sexual health interventions into the nursing care of breast cancer patients.

The marked decline in estrogen levels, changes in body image, psychological trauma, and partner relationship stress caused by breast cancer treatment jointly constitute a complex network of sexual health problems.31,32 On the one hand, treatments such as surgery, chemotherapy, and endocrine therapy can directly affect the sexual response cycle through mechanisms including decreased estrogen levels, vaginal mucosal atrophy, and nerve damage.33 On the other hand, patients’ concerns about altered body image, impaired fertility, and recurrence risk often lead to sexual avoidance, sexual anxiety, and reduced sexual self-efficacy.34,35

The interventions included in this study, such as cognitive behavioral therapy, mindfulness training, communication counseling between husband and wife, and targeted education, may exert their effects through multiple mechanisms. First, the provision of professional medical information and practical skills, such as the use of vaginal moisturizers and pelvic floor muscle exercises, can directly help to alleviate physiological symptoms.36 Second, the cognitive restructuring and psychological support may reduce anxiety, depression, and sexuality-related stigma, while enhancing self-identity and body acceptance.37 Third, promoting open dialog and emotional connection between partners can improve relationship intimacy and the quality of sexual communication, thereby enhancing sexual satisfaction for both partners.38 The subgroup analysis showed that interventions guided by “counseling and psychotherapy” had the largest effect, suggesting that professional psychological counseling and therapy may have core value in addressing the deeper psychological troubles and cognitive obstacles caused by the disease and its treatment.39

The findings of this study indicate that sexual health interventions oriented toward partner or marital relationships not only improve sexual dysfunction but also significantly enhance patients’ satisfaction with their partner relationships. Breast cancer patients are often in marriage or stable intimate relationships, in which sexual dysfunction is usually not merely an individual issue, but may also exert a substantial impact on emotional communication, role perception, and patterns of intimate interaction between partners.40 Partner-participation intervention models can promote mutual understanding of the disease and related sexual changes, reduce misunderstandings and avoidance behaviors, enhance emotional support and communication quality, and thereby improve the experience of sexual interaction and relationship satisfaction.41 This finding aligns with previous research suggesting that couple-centered coping patterns contribute to improvements in psychological outcomes and quality of life among cancer patients,42 and also indicates that, in clinical nursing practice, greater attention should be paid to the importance of partners as intervention targets, rather than viewing patients as the sole subjects of intervention.

In this meta-analysis, heterogeneity was high across multiple outcome indicators, with I2 values >80% and often >90%. Such substantial statistical heterogeneity is frequently reported in meta-analyses of complex behavioral and nursing interventions, in which the “intervention” encompasses a heterogeneous combination of components, such as education, psychological counseling, couple-based therapy, pelvic floor training, and online programs. These interventions were also delivered with variable intensity and duration, administered by providers with different training backgrounds, and evaluated using a range of patient-reported scales that captured overlapping but non-identical constructs of sexual function and quality of life. The subgroup analysis suggested that different intervention orientations could significantly improve sexual dysfunction, but heterogeneity was not completely eliminated, as in this residual heterogeneity, the pooled point estimates should be regarded as broad indicators of the average direction and magnitude of effect, rather than precise effect sizes applicable to any single intervention type or outcome scale. In addition, the clinical interpretability of pooling distinct instruments, such as FSFI, SQOL-F, and SSS-W, into a single SMD analysis is acknowledged to be limited. Potential sources of heterogeneity may include: (1) variations in intervention content and intensity, with considerable differences in intervention frequency, duration, and professional staffing across studies; (2) inconsistencies in outcome measurement tools, as different scales may focus on different dimensions of sexual function; (3) differences in the cultural backgrounds and social environments of participants, as variations in sexual attitudes and partner interaction patterns may influence intervention outcomes; and (4) inconsistencies in disease stages and treatment modalities among the enrolled patients. The combined effects of these factors may have contributed to the variability in effect sizes across studies.

This study provides evidence for nursing practice. First, the findings suggest that sexual dysfunction is common among breast cancer survivors and may be improved through targeted nursing interventions; therefore, clinical medical staff should consider incorporating sexual health assessment into routine follow-up care. Second, diversified and individualized intervention options should be provided according to the specific needs and available resources of patients and their partners. Interventions focusing on personal psychological adjustment, skill improvement, or couple-based relationship enhancement all showed beneficial effects, suggesting that medical institutions may integrate multidisciplinary resources and establish structured sexual health support pathways or referral systems. Finally, online intervention modes, such as Internet-based programs, smartphone applications, and remote consultations, showed feasibility and potential effectiveness in the trials included in this study, thereby providing more accessible options for patients with limited medical resources or geographical barriers.

Several limitations should be acknowledged in this study. First, although all included studies were RCTs, some had small sample sizes, which may have affected the precision of the effect estimates. Second, the included studies were limited to English-language publications conducted in high-income countries, which may have introduced language and selection bias and may also limit the generalizability of the findings to lower- and middle-income settings. Third, most studies had relatively short follow-up periods, and the long-term effects of the interventions remain unclear. Fourth, between-study heterogeneity was substantial across most outcomes, with I2 values often exceeding 90%. Although random-effects modeling and subgroup analyses were used, the planned meta-regression could not be performed because of the limited number of studies and incomplete reporting of moderator-level data; therefore, the pooled estimates should be interpreted with caution. Fifth, the included interventions differed in content, intensity, delivery format, and duration, and outcome data from several instruments, including FSFI, SQOL-F, SQL, and SSS-W, were combined. As a result, the pooled estimates reflect an average effect across overlapping but not identical constructs and have limited clinical interpretability for any single intervention or scale. In addition, some studies did not provide sufficient information on blinding implementation and intervention adherence, which may have influenced the reliability of the results. Future studies should conduct large-sample, multicenter RCTs, standardize the core components of interventions and outcome measures, and clarify the optimal combination and timing of different intervention modalities. Longer follow-up periods are also needed to evaluate the sustained effects of sexual health interventions on patients’ quality of life and partner relationships. In addition, emerging technologies, such as virtual reality and AI-assisted counseling, may be considered to further expand and optimize the delivery formats of sexual health interventions.

Conclusion

In summary, this meta-analysis suggests that sexual health nursing interventions can improve post-treatment sexual dysfunction in breast cancer patients and may also contribute to better sexual-related quality of life and relationship satisfaction. However, given the substantial between-study heterogeneity, the variability in intervention components and outcome instruments, and the fact that all included trials were conducted in high-income settings, these conclusions should be interpreted with appropriate caution and further confirmed in larger, methodologically rigorous trials with standardized core outcome sets and longer follow-up. Despite these limitations, the available evidence consistently supports the integration of systematic, multidimensional, and often partner-involved sexual health support into comprehensive rehabilitation care for breast cancer patients. Healthcare professionals, policymakers, and researchers should work together to reduce barriers to sexual health communication and care, so that sexual health can be recognized as an essential component of cancer survivorship care and contribute to improving the overall quality of life of this patient population.

Contributor Information

Qian Yu, Department of Medical Oncology, Ward 1, Hangzhou Cancer Hospital, Hangzhou 310002, China.

Lihong Wang, Department of Medical Oncology, Ward 3, Hangzhou Cancer Hospital, Hangzhou 310002, China.

Yuhong Xu, Intensive Care Unit (ICU), Hangzhou Cancer Hospital, Hangzhou 310002, China.

Jie Wang, Department of Medical Oncology, Ward 3, Hangzhou Cancer Hospital, Hangzhou 310002, China.

Author contributions

Q.Y.: Designed the study and carried them out, supervised the data collection, analyzed the data, interpreted the data, and prepared the manuscript for publication and reviewed the draft of the manuscript. L.W.: Supervised the data collection, analyzed the data, and interpreted the data. Y.X.: Supervised the data collection, analyzed the data, and interpreted the data. J.W.: Prepared the manuscript for publication and reviewed the draft of the manuscript.

Funding

No funding was used in this study.

Conflicts of interest

The authors state that there are no conflicts of interest to disclose.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Ethics approval

This article does not contain any studies with human participants or animals performed by any of the authors.

References

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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