Over the past thirteen years a great deal of effort has been expended to enhance the possibility of early diagnosis and improve the treatment of breast cancer, and problems related to the disease have been extensively investigated. It is now clear that the psychological problems most frequently observed in these patients are depression, body image-associated hypochondria and sexual dysfunction [
9,
10]. Our study, aimed to assess in treated breast cancer Moroccan women the subjective disturbance of sexual dysfunction that often is not expressed and that contributes to further lowering the quality of life. The interviews revealed a number of notable findings regarding sexuality after breast cancer in the Moroccan context. The sexual impact of having cancer and its treatments have long been a taboo topic in clinical settings in Morocco. The sexual aspects of having cancer have long been neglected in medical practice. There are a number of barriers to the discussion of sexual issues by patients and professionals. Difficulties related to sexuality and sexual functioning was common and occurred since their breast cancer diagnosis to treatment. The majority of informants revealed that they had experienced sexual dysfunction and physical discomfort caused by the breast cancer treatment. Patients reported worse sexual functioning, characterized by greater lack of sexual interest, inability to relax and enjoy sex, difficulty becoming aroused, and difficulty reaching the orgasm. Regarding personal and sexual relationships, 98% had an important personal relationship (partner) and 84% were effectively sexually active; following diagnosis and various treatments of breast cancer. 60% of the subjects had ceased sexual relations and 20% divorced. However, we were not able to compare the data from this study regarding sexual problems with those of other groups (normal population or samples of subjects with chronic disease) since to date no epidemiological studies of sexual behaviour and distribution of sexual dysfunctions in the normal population have been performed in Morocco. Nor was it possible to make a comparison between the data obtained from this study and that which had emerged from research carried out in other countries because of cultural, social, economic and moral variables which enormously condition sexual behaviour. Nevertheless, patients of this study had lower scores in the all body image subscales. This finding is comparable with other studies [
11‐
14]. Howighorst-Knapstein and al also found that, mastectomy resulted in lower sexual desire and changes in body image [
15]. Bakwell & Volker also showed that all types of treatment for breast cancer had a significant impact on body image and menopausal status and finally results in sexual problems [
16]. In Summary, breast cancer affects many aspects of a Moroccan woman's sexuality, including changes in physical functioning and in perception of femaleness but this study has some limitations. The first limitation of this study is the sample structure which was limited to breast cancer women and didn't study healthy women with these problems. The data obtained from this study must be interpreted with caution since they reflect the limited methodology with which the research was conducted. The sample seems to be small and not representative enough to allow us to extrapolate the data for a larger population. The second limitation of this study is the missing role of husband/partner in the study which can have a very important role in patient life. However, this study show that the onset of sexual dysfunctions in concomitance with and after treatment of breast cancer is frequent and that such dysfunctions noticeably compromise the quality of sex life and does sufficiently address a problem that needs to be investigated in greater depth. Although it is not possible to make distinctions, it appears that the most numerous dysfunctions are those which originate easily from compromises in physical state (dyspareunia and lubrication difficulties) while the fewest dysfunctions were of a psychological nature (the absence or reduction of sexual desire, difficulty to reach orgasm and brevity of intercourse). These disturbances, even though they noticeably reduce the quality of sex life, do not compromise it completely, as the majority of subjects remain sexually active.
Healthcare professionals should include an assessment of the effects of medical and surgical treatment on the sexuality of breast cancer survivors. Oncology nurses can recognize medical outcomes and sexual issues and they are best suited to offer specific and meaningful support that is adapted to the specific demands of the patients and that considers the specific characteristics of patients and their partners. Physician should pay more attention to discussing sexual dysfunctions with the patient as part of the side effects experienced during the programme of treatment for breast cancer. In order to deal with women's sexual issues appropriately, it is important to prepare a secure environment in the hospital to discuss sexual problems with patients. It is also necessary to promote understanding about sexual issues among health care providers in general as well as increasing the number of sex therapist and counsellors.