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Cognitive and emotional factors in sexuality of women with breast cancer: an ex-ploratory study
Author/s: Agnese Ruggiero, Stefano Magno, Laura Agostini, Annalisa Di Micco, Claudia Maggiore, Bianca Maria De Cesaris, Roberta Rossi, Chiara Simonelli, Filippo Maria Nimbi 
Year:  2021 Issue: Language: Italian 
Pages:  18 Pg. 5-22 FullText PDF:  221 KB
DOI:  10.3280/RSC2021-001001
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Breast cancer represents the most common malignant cancer in the female population and it is the cancer with the highest mortality in the world’s female population. It has been shown in the literature that women with breast cancer are more likely to develop sexual dysfunction than healthy women; women with breast cancer often develop difficulties in their body image and feminility, because cancer affects a secondary sex organ. The aim of current study was to explore the relationship between sexual dysfunction and cognitive or emotional factors in women with breast cancer, in particular we investigated the construct of alexi-thymia, cognitive schemas, automatic thoughts and sexual dysfunctional beliefs. The study was conducted on 156 women, divided in two groups: 60 women with breast cancer and 96 healthy women. The women of the clinical group have been recruited in the departments of senological oncology and integrated therapies of the Policlinico Agostino Gemelli in Rome and the women of the control group were randomly extrapolated from the database of the Clinical Sexology Institute (ISC) of Rome. All women completed 4 self-report questionnaire: Questionnaire of Cog-nitive Schema Activation in Sexual Context (QCSASC), Sexual Dysfunctional Be-liefs Questionnaire (SBDQ), Sexual Modes Questionnaire (SMQ) to explore cogni-tive factors and Toronto Alexithymia Scale (TAS-20) to assess emoctional as-pects. MANCOVA statistical analysis was used to highlight statistically significant differences between the two groups; the covariates included were age, level of ed-ucation and relational situation. Also it was used the Chi2 test for frequencies. Analysis of the data shows that women with breast cancer have higher levels of alexithymia and more dysfunc-tional beliefs in the sexual sphere than healthy women. Regarding to sexual be-liefs, women in the clinical group perceive feelings as very important during sexual activity and consider the advancement of the chronological age a negative ele-ment for the sexual sphere. Previous research shows that also women with sexual dysfunction believe that aging negatively affects sexuality; therefore this beliefs seems to be common to women with breast cancer and women with sexual dys-function. In women with breast cancer, this dysfunctional belief could be empha-sized by the iatrogenic induction of menopause. Regarding to alexithymia, women with breast cancer show higher scores in the subscale "difficult to identifying feeling" and "externally-oriented thinking". These results are partly in line with current literature, infact some studies have shown that women with breast cancer have more difficult to identify their feelings than healthy women, while according to other research there aren’t significant differ-ences in the alexithymia construct between women with breast cancer and healthy women. Finally in the questionnaires assessing automatic thoughts and cognitive schema there aren’t significant differences between clinical and control group. Fu-ture research could contribute to a better understanding of the role of cognitive and emotional aspects on the sexuality in women with breast cancer; prevention and treatment of sexual dysfunction and quality of life of women with breast cancer could be improved. The study has some limitation such as lack of previous scientific studies; this gap partially compromises the quality of the discussion of data emerged by the study and urges us to conduct further research, since this information could im-prove quality of life and health sex of women with cancer. Also the length of the protocol represents a limitation of the study, as it may have altered the reliability of the results; furthermore the research protocol is based exclusively on self-report questionnaires. Finally, there are significant differences related to age, educational level and relationship situation between two groups; however, to limit this problem, these variables have been included as covariates in MANCOVA statistical analysis.
Keywords: cancer, sexuality, emotion, cognitive schema, sexual beliefs.

  1. Anagnostopoulos F., Vaslamatzis G., Markidis M., Katsouyanni K., Vassilaros S., Stefanis C. (1993). An Investigation of Hostile and Alexithymic Characteristics in Breast Cancer Patients. Psychotherapy Psychosomatic, 59: 179-89., DOI: 10.1159/000288662
  2. Avis N.E., Crawford S., Manuel J. (2015). Quality of life among younger women with breast cancer. Journal of Clinical Oncology, 23(15): 3322-30., DOI: 10.1200/JCO.2005.05.13
  3. Bender C.M., Paraska K.K., Sereika S.M., Ryan C.M., Berga S.L. (2001). Cognitive Function and Reproductive Hormones in Adjuvant Therapy for Breast Cancer: A Critical Review. Journal of Pain and Symptom Management, 21(5): 407-24., DOI: 10.1016/S0885-3924(01)00268-
  4. Bolis G. (2017). Manuale di Ginecologia ed Ostetricia. Napoli: Edises.
  5. Carioli G., Malvezzi M., Rodriguez T., Bertuccio P., Negri E., La Vecchia C. (2017). Trends and predictions to 2020 in breast cancer mortality in Europe. Breast, 36, 89-95.
  6. Carvalho J., Nobre P.J. (2010). Predictors of Women’s Sexual Desire: The Role of Psychopathology, Cognitive-Emotional Determinants, Relationship Dimensions, and Medical Factors. Journal of Sexual Medicine, 7(2): 928-37.
  7. Carvalho J., Veríssimo A., Nobre P.J. (2013). Cognitive and Emotional Determinants Characterizing Women with Persistent Genital Arousal Disorder. Journal of Sexual Medicine, 10(6): 1549-55.
  8. Clerici C.A., Veneroni L. (2019). La psicologia clinica in ospedale: consulenza e modelli di intervento. Bologna: il Mulino.
  9. De Vries A.M.M., Forni V., Voellinger R., Stiefel F. (2012). Alexithymia in Cancer Patients: Review of the Literature. Psychotherapy Psychosomatic, 81: 79-86., DOI: 10.1159/00033088
  10. Di Giacomo D. (2019). Psiconcologia innovative per giovani donne con il cancro al seno. Milano: Franco Angeli.
  11. Gilbert E., Ussher J.M., Perz J. (2010). Sexuality after breast cancer: A review. Maturitas, 66(4): 397-407.
  12. Graziottin A., Baldi S., Sarti C.D. (2014). La sessualità in menopausa. -- Testo disponibile al sito: (2 dicembre 2020).
  13. Laumann E.O., Nicolosi A., Glasser D.B., Paik A., Gingell C., Moreira E., Wang T. (2005). Sexual problems among women and men aged 40-80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. International Journal of Impotence Research, 17: 39-57.
  14. Luminet O., Rokbani L., Ogez D., Jadoulle V. (2007). An evaluation of the absolute and relative stability of alexithymia in women with breast cancer. Journal of Psychosomatic Research, 62(6): 641-8.
  15. Madioni F., Mammana L.A. (2001). Toronto Alexithymia Scale in Outpatients with Sexual Disorders. Psychopathology, 34: 95-8., DOI: 10.1159/00004928
  16. Mulhall J.P., Incrocci L., Goldstein I., Rosen R.C. (2011). Cancer and sexual health. Milano: Spinger
  17. Nimbi F.M., Tripodi F., Simonelli C., Nobre P.J. (2018a). Sexual Modes Questionnaire (SMQ): Translation and Psychometric Properties of the Italian Version of the Automatic Thought Scale. Journal of Sexual Medicine, 15(3): 396-409.
  18. Nimbi F.M, Tripodi F., Simonelli C., Nobre P.J. (2018b). Questionnaire of Cognitive Schema Activation in Sexual Context: translation and psychometric properties of Italian version. International Journal of Impotence Research, 30: 253-264.
  19. Nimbi F.M., Tripodi F., Simonelli C., Nobre P.J (2018c). Sexual dysfunctional Belifes Questionnaire (SBDQ): Traslantion and psychometric properties of the Italian version. Sexologies, 28(2): e11-27.
  20. Nobre P.J., Pinto-Gouveia J. (2006). Emotions During Sexual Activity: Differences Between Sexually Functional and Dysfunctional Men and Women. Archives of Sexual Behavior, 35(4): 491-9.
  21. Nobre P.J., Pinto-Gouveia J. (2007). Cognitions, Emotions, and Sexual Response: Analysis of the Relationship among Automatic Thoughts, Emotional Responses, and Sexual Arousal. Archives of Sexual Behavior, 37: 652-61.
  22. Oliveira C., Nobre P.J. (2013). Cognitive Structures in Women with Sexual Dysfunction: The Role of Early Maladaptive Schemas. Journal of Sexual Medicine, 10(7): 1755-63.
  23. Purkayastha D., Venkateswaran C., Nayar K., Unnikrishnan U.G. (2017). Prevalence of Depression in Breast Cancer Patients and its Association with their Quality of Life: A Cross-sectional Observational Study. Indian Journal Palliative Care, 23(3): 268-73., DOI: 10.4103/IJPC.IJPC_6_1
  24. Taylor G.J., Bagby R.M., Parker J.D.A. (1992). The twenty item Toronto Alexithymia Scale. Convergent, Discriminant, and current validity. Journal of Psychosomatic Research, 38(1): 33-40., DOI: 10.1016/0022-3999(94)90006-
  25. Todarello O., La Pesa M.W., Zaka S., Martino V., Lattanzio E. (1989). Alexithymia and Breast Cancer. Survey of 200 Women Undergoing Mammography. Psychotherapy Psychosomatic, 51: 51-5., DOI: 10.1159/00028813
  26. World Health Organisation-WHO (2018). International Agency for Research on Cancer. Latest global cancer data: Cancer burden rises to 18.1 million new cases and 9.6 million cancer deaths in 2018. -- Testo disponibile al sito: (4 gennaio 2021)
  27. Zielińska M., Zarankiewicz N., Kosz K., Kuchnicka A., Aleksandrowicz J., Książek K., Mojsym-Korybska S. (2019). Sexuality and fertility of young women suffering from breast cancer. Journal of Education, Health and Sport, 9(7): 775-85.

Agnese Ruggiero, Stefano Magno, Laura Agostini, Annalisa Di Micco, Claudia Maggiore, Bianca Maria De Cesaris, Roberta Rossi, Chiara Simonelli, Filippo Maria Nimbi, Cognitive and emotional factors in sexuality of women with breast cancer: an ex-ploratory study in "RIVISTA DI SESSUOLOGIA CLINICA" 1/2021, pp. 5-22, DOI:10.3280/RSC2021-001001


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