Sexual Health Among Patients With Breast Cancer Undergoing Endocrine Therapy: An Integrative Review

An integrative review of 43 studies found sexual dysfunction in 51–93% of breast cancer patients on endocrine therapy, yet providers routinely stay silent about it.

Journal: Supportive Care in Cancer | Published: 2026-05-04 | Type: Integrative Review | PMID: 42081187 Authors: Su Xiaojing et al. (Xiamen University School of Medicine; Women and Children's Hospital, Xiamen; Tung Wah College, Hong Kong) Funding/COI: National Natural Science Foundation of China (7231101009). Authors declare no competing interests.

Summary

Endocrine therapy — tamoxifen, aromatase inhibitors — drives estrogen suppression as a feature, not a bug. The downstream effects on sexual function are predictable and severe, yet clinical practice has largely ignored them. This integrative review synthesized 43 studies (39 quantitative, 3 qualitative, 1 mixed methods), screened from 3,590 records, and found prevalence of sexual dysfunction ranging from 51% to 93% across most included articles, with vaginal dryness and dyspareunia as the dominant complaints. The authors call out a "silence gap": healthcare professionals consistently fail to raise sexual health with these patients.

Claims

• Sexual dysfunction prevalence ranged from 51% to 93% across 11 reporting articles; one outlier reported 29%
• Genitourinary syndrome of menopause symptoms — primarily vaginal dryness and dyspareunia — were the most consistently reported complaints across 13 articles
• Associated factors include age, financial burden, partnership status, physical and psychological status, and treatment-related variables
• A "silence gap" in clinical care was identified, with sexual health rarely addressed by providers despite high burden

Study Quality

The review used Whittemore and Knafl's five-step integrative review framework and assessed methodological quality with the Mixed Methods Appraisal Tool (MMAT), which is appropriate for heterogeneous literature combining qualitative and quantitative designs. Searching eight databases — including Chinese-language sources (CNKI) — is a genuine methodological strength rarely seen in Western-centric reviews; it reduces language bias in a field where significant research is published in Mandarin.

That said, integrative reviews are inherently harder to synthesize than systematic reviews with meta-analysis, and the 51–93% prevalence range is too wide to anchor any precise claim. The single outlier reporting 29% drags on the lower bound without explanation in the abstract. With 43 included studies from 3,590 records, the inclusion yield (~1.2%) is low, suggesting tight criteria or substantial duplication — not necessarily a flaw, but worth noting.

Red Flags

• The 51–93% prevalence range is clinically meaningless as a summary statistic — that's a 42-point spread, almost certainly driven by inconsistent measurement tools and patient populations
• Only one article reported 29% prevalence; unexplained outlier may reflect methodological differences or cherry-picking in included studies
• Integrative reviews mix qualitative and quantitative evidence, making quantitative synthesis difficult and narrative synthesis vulnerable to author interpretation
• Abstract does not specify how many of the 43 articles specifically studied endocrine therapy patients versus breast cancer patients broadly — a critical distinction for the stated scope
• The full-text data accompanying this paper appears to contain sections from a different systematic review (16 studies, 4,058 women, 5,236 records screened), suggesting a pipeline data error; this review was assessed primarily from the abstract

Strengths

• Rare inclusion of Chinese-language literature from CNKI, reducing language bias
• Mixed-methods scope captures qualitative patient experience alongside quantitative prevalence data
• Identifies the "silence gap" as a named, documentable phenomenon — clinically actionable framing
• Multi-database search across CINAHL, Cochrane, PubMed, OVID, ScienceDirect, Web of Science, and Wiley

Verdict

This review confirms what anyone paying attention already suspected: endocrine therapy wrecks sexual function and clinicians don't talk about it. The 51–93% prevalence range is so wide it can't support a precise claim, and the integrative design means you're reading a narrative synthesis rather than pooled statistics. What the paper does well is document the silence gap and aggregate a literature that spans English and Chinese sources. For a research digest, this is worth a read as a landscape survey — not as evidence for any specific prevalence figure. The core finding (high burden, low clinical attention) is credible even if the exact numbers are fuzzy.