Beyond Survival: Cultural Stigma, Silence, and the Forgotten Need of Sexual Quality of Life Among Indian Breast Cancer Survivors

Abstract

Introduction: With breast cancer survivorship steadily increasing, attention is now shifting from mere survival to quality of life. Among the most neglected dimensions is sexual health, a domain deeply affected by cancer and its treatment, yet rarely addressed in clinical practice, especially in conservative cultural contexts like India. We aimed to evaluate the sexual quality of life (SQL) among Indian breast cancer survivors. Methods: A cross-sectional, mixed-methods study was conducted at a tertiary teaching center in Central India. Fifty-five women who had undergone breast cancer treatment were assessed using the sexual activity questionnaire (SAQ). Quantitative data were supplemented with in-depth interviews among sexually inactive participants. Chi-square analysis was used to identify factors associated with sexual activity status. Results: Only 12 of 55 women (21.8%) reported being sexually active. Among them, over 90% experienced moderate to high satisfaction despite reduced frequency. The mean SAQ pleasure and discomfort scores were 0.92 and 0.54, respectively, with habit scores uniformly zero. Among the 43 sexually inactive women, key reasons for celibacy included body image issues, myths about cancer transmission, partner abandonment, and cultural silence. Age group was the only statistically significant factor associated with sexual activity (p = 0.011); menopausal status, education, surgery type, and hormonal therapy were not significant. Conclusion: Although sexual dysfunction post-breast cancer is globally prevalent, it is uniquely exacerbated in Indian patients by cultural silence, stigma, and systemic neglect. There is an urgent need for culturally sensitive communication training, patient education, and the inclusion of sexual rehabilitation in standard survivorship protocols.