Table 3.

Content of Sexual Health Communication for Women Who Did Not Report Sexual Problems (N = 17)

Patient Group	Quotes Illustrating How Sexual Health Communication is Raised	Major Topic of Discussion
a) Clinician Initiates /Patient Does Not Indicate Need (N = 8)	1. (a) You’re happy with it [the breast appearance]? (Patient: Mm hmm). (b) [in same patient visit as above] So this [tamoxifen] could cause that kind of stuff, hot flashes. It could cause decreased libido. It can cause some vaginal dryness and things like that. (Patient: Okay).	--
	2. (a) It looked like from the way the report was written that you’re pretty pleased with the result [of the revision surgery]? (Patient: Mm hmm). (b) [in same patient visit as above] One other thing we sometimes check in about that can happen with these medications is people can have a little bit of vaginal dryness or discomfort. That can happen on these medications. A lot of times we have things, information we give about lubricants and so forth. Have you found that’s an issue on anastrozole? (Patient: No).	--
	3. Any joint pain or vaginal dryness or any changes in mood or anything like that?	--
	4. Any sexual concerns, vaginal dryness, anything like that?	--
	5. (a) And how are things with your husband? (Patient: They’re good, yeah) (b) [in same patient visit as above] And your intimacy with him is good? (Patient: It’s good)	--
	6. And your intimate life? (Patient: I can’t even walk [Laughs]).	--
	7. Are you in any kind of intimate relationship? (Patient: No, no. I’m 71 years old, I’ve reached a point in my life where you know if there’s magic that would be wonderful but that’s unlikely so, yeah, I’m pretty realistic about that)	--
	8. And are you in an intimate relationship with anybody? (Patient: No, not at this time, no. No, just with my family.) Sometimes, you know, the medications can interfere with your libido or can give you dryness and things like that (Patient: Yeah, no. That’s the last thing on my mind).	--
b) Sexual Health Discussion Occurs (N = 9)	Clinician Initiates Discussion
	1. And how are things at home? (Patient: They’re good.) You and your husband getting along alright? (Patient: Oh, yeah) Has the medication affected your relationship at all? (Patient: No. We don’t really…) No? (Patient: Not too much. [Laughs] We’re too tired).	Sexual inactivity
	2. Clinician: Husband’s okay? (Patient: Yeah.) How’s your relationship with him? (Patient: Okay. 24/7, 365. So if you think about it.) So did the medicine, when you were on the Aromasin, did that affect your intimacy with him at all? (Patient: Yeah we don’t have any.) [then long discussion about that]	Sexual inactivity
	3. Okay. And are you sexually active? (Patient: No). No. Do you have a partner right now? (Patient: No…[then goes on to talk about that]).	Sexual inactivity
	4. So no more…any vaginal dryness with it [tamoxifen] or no more? (Patient: Mmmmmm) Yeah? (Patient: [whispers] I use coconut oil).	Vaginal dryness
	5. Are you happy with the cosmetic result? (Patient: Yes). You are, good. Any plans for the nipple?	Body image/breast appearance
	Patient Initiates Discussion
	6. I’ve been thinking about it for a couple years and I’m like ‘no’, because I’m metastatic so I’m like ‘what’s the point?’ but then I’m like ‘you know what? It can’t hurt’. It’s just one of those…it’s just so botched and it just, it doesn’t bother me a lot but it does bother me, you know?	Body image/breast appearance
	7. No. It’s just one of my breasts looks different than the other and that bothers me but I know that that’s the breast I had the surgery in. (in response to “Anything else that we need to discuss? Anything new?”).	Body image/breast appearance
	8. There’s no intimacy at my house. (in response to clinician mention of a research study about intimacy) [discussion continues]	Sexual inactivity
	Partner Initiates Discussion
	9. Husband: I guess one more question I should ask (Clinician: Go ahead, ask.) What about sex, is that…? (Clinician: That’s fine).	Safety of sexual activity