The Mediating Role of Sexual Satisfaction in the Relationships of Body Mass Index and Spiritual Well-being with Quality of Married Life in Women with Breast Cancer Quality of married life in women with BC

Shahin Tabarzan (1), Farzaneh Hooman (2), Saeed Bakhtiarpour (3)
(1) Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran, Iran, Islamic Republic of,
(2) Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran, Iran, Islamic Republic of,
(3) Department of Psychology, Ahvaz Branch, Islamic Azad University, Ahvaz, Iran, Iran, Islamic Republic of


Background: Breast cancer affects several aspects of a woman’s life. It can adversely affect a woman’s sexual function as well as her relationship with her spouse, which in turn can reduce the quality of her married life. The present study aimed to investigate the mediating role of sexual satisfaction in the relationships of body mass index (BMI) and spiritual well-being with the quality of married life in women with breast cancer.

Methods: This descriptive-correlational study used convenience sampling to enroll all 250 married women with breast cancer visiting specialized clinics in Tehran in 2022. The research instruments included the Revised Dyadic Adjustment Scale (RDAS), the Spiritual Well-Being Scale (SWBS), the Body Mass Index (BMI), and the Index of Sexual Satisfaction. The proposed model was evaluated using structural equation modeling (SEM).

Results: The direct paths from all variables (except for spiritual well-being) to quality of married life were significant (P<0.001). In addition, sexual satisfaction was found to mediate the relationships between BMI and spiritual well-being with the quality of married life in the participants (P<0.01).

Conclusion: The proposed model fitted the data well; therefore, the results may be used to help improve the quality of married life in women with breast cancer.

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Ganesh K, Massagué J. Targeting metastatic cancer. Nature Medicine. 2021;27(1):34-44. doi: 10.1038/s41591-020-01195-4.

Dorling L, Carvalho S, Allen J, González-Neira A, Luccarini C, Wahlström C, et al. Breast Cancer Risk Genes - Association Analysis in More than 113,000 Women. N Engl J Med. 2021;384(5):428-39. doi: 10.1056/NEJMoa1913948.

Tavakkoli L, Kalantari-Khandani B, Mirzaei M, Khanjani N, V. M. Breast Cancer Trend, Incidence, and Mortality in Kerman, Iran: A 14-Year Follow-up. Arch Breast Cancer. 2018;8(5):122-8. doi: 10.32768/abc.201853122-128.

Madic J, Kiialainen A, Bidard FC, Birzele F, Ramey G, Leroy Q, et al. Circulating tumor DNA and circulating tumor cells in metastatic triple negative breast cancer patients. Int J Cancer. 2015;136(9):2158-65. doi: 10.1002/ijc.29265.

Ebrahimi M, Haghighat S, Mehrdad N, Olfatbakhsh A, Azin A, S. N. Sexual Dysfunction in Breast Cancer: A Case-Control Study. Arch Breast Cancer. 2015;2(1):(1):15-20. doi: 10.19187/abc.20152115-20.

Kim J, Jang M. Stress, Social Support, and Sexual Adjustment in Married Female Patients with Breast Cancer in Korea. Asia Pac J Oncol Nurs. 2020;7(1):28-35. doi: 10.4103/apjon.apjon_31_19.

Hinz A, Zenger M, Schmalbach B, Brähler E, Hofmeister D, Petrowski K. Quality of Life Domains in Breast Cancer Survivors: The Relationship Between Importance and Satisfaction Ratings. Front Psychol. 2022;13:923537. doi: 10.3389/fpsyg.2022.923537.

Ruiz-Marin CM, Molina-Barea R, Slim M, Calandre EP. Marital Adjustment in Patients with Cancer: Association with Psychological Distress, Quality of Life, and Sleep Problems. Int J Environ Res Public Health. 2021;18(13). doi: 10.3390/ijerph18137089.

Odikpo L, Chiejina E. Practice and Outcome of Exercise Intervention on Breast Cancer-Specific Quality of Life of Breast Cancer Survivors in Nigeria. Arch Breast Cancer. 2021;8(3):174-82. doi: 10.32768/abc.202183174-182.

DeLongis A, Zwicker A. Marital satisfaction and divorce in couples in stepfamilies. Curr Opin Psychol. 2017;13:158-61. doi: 10.1016/j.copsyc.2016.11.003.

Harper C, Maher J, Grunseit A, Seimon RV, Sainsbury A. Experiences of using very low energy diets for weight loss by people with overweight or obesity: a review of qualitative research. Obes Rev. 2018;19(10):1412-23. doi: 10.1111/obr.12715.

Bot M, Brouwer IA, Roca M, Kohls E, Penninx B, Watkins E, et al. Effect of Multinutrient Supplementation and Food-Related Behavioral Activation Therapy on Prevention of Major Depressive Disorder Among Overweight or Obese Adults With Subsyndromal Depressive Symptoms: The MooDFOOD Randomized Clinical Trial. Jama. 2019;321(9):858-68. doi: 10.1001/jama.2019.0556.

Esfahani SB, Pal S. Obesity, mental health, and sexual dysfunction: A critical review. Health Psychol Open. 2018;5(2):2055102918786867. doi: 10.1177/2055102918786867.

Apple R, Samuels LR, Fonnesbeck C, Schlundt D, Mulvaney S, Hargreaves M, et al. Body mass index and health-related quality of life. Obes Sci Pract. 2018;4(5):417-26. doi: 10.1002/osp4.292.

Dinour L, Leung MM, Tripicchio G, Khan S, Yeh MC. The Association between Marital Transitions, Body Mass Index, and Weight: A Review of the Literature. J Obes. 2012;2012:294974. doi: 10.1155/2012/294974.

You H, Li XL, Jing KZ, Li ZG, Cao HM, Wang J, et al. Association between body mass index and health-related quality of life among Chinese elderly-evidence from a community-based study. BMC Public Health. 2018;18(1):1174. doi: 10.1186/s12889-018-6086-1.

Mosallanezhad Z, Honarmand F, Poornowrooz N, Jamali S. The relationship between body mass index, sexual function and quality of life in women of reproductive age in Iran. Sexual and Relationship Therapy. 2022;37(1):139-49. doi: 10.1080/14681994.2020.1724930.

Zare A, Bahia NJ, Eidy F, Adib N, Sedighe F. The relationship between spiritual well-being, mental health, and quality of life in cancer patients receiving chemotherapy. J Family Med Prim Care. 2019;8(5):1701-5. doi: 10.4103/jfmpc.jfmpc_131_19.

Büssing A, Waßermann U, Christian Hvidt N, Längler A, Thiel M. Spiritual needs of mothers with sick new born or premature infants-A cross sectional survey among German mothers. Women Birth. 2018;31(2):e89-e98. doi: 10.1016/j.wombi.2017.08.002.

Garduño-Ortega O, Morales-Cruz J, Hunter-Hernández M, Gany F, Costas-Muñiz R. Spiritual Well-Being, Depression, and Quality of Life Among Latina Breast Cancer Survivors. J Relig Health. 2021;60(3):1895-907. doi: 10.1007/s10943-020-01147-9.

Green C. Nurses and Patients' Perspectives on Spiritual Health Assessment. J Relig Health. 2021;60(1):122-33. doi: 10.1007/s10943-020-01113-5.

Zari Moin Z, Abolmaali Alhosseini K, MR. S. The Comparison of the Effectiveness of Acceptance and Commitment Therapy and Spirituality Therapy in Reducing Anxiety in Women with Breast Cancer. Arch Breast Cancer. 2022;9(4):1-7. doi: 10.32768/abc.202294497-504.

Nazoktabar H, Shetaban N. The Relationship between Spiritual Health with Social Adjustment and Quality of Life in Cancer Patients. Journal of Health and Care. 2019;21(4):283-92. doi: 10.29252/jhc.21.4.283.

Yilmaz M, Cengiz H. The relationship between spiritual well-being and quality of life in cancer survivors. Palliat Support Care. 2020;18(1):55-62. doi: 10.1017/s1478951519000464.

Javanmardifard S, Heidari S, Sanjari M, Yazdanmehr M, Shirazi F. The relationship between spiritual well-being and hope, and adherence to treatment regimen in patients with diabetes. J Diabetes Metab Disord. 2020;19(2):941-50. doi: 10.1007/s40200-020-00586-1.

Afzali M, Khani S, Hamzehgardeshi Z, Mohammadpour RA, Elyasi F. Investigation of the Social Determinants of Sexual Satisfaction in Iranian Women. Sex Med. 2020;8(2):290-6. doi: 10.1016/j.esxm.2020.02.002.

Park Y, Impett EA, MacDonald G. Singles' Sexual Satisfaction is Associated With More Satisfaction With Singlehood and Less Interest in Marriage. Pers Soc Psychol Bull. 2021;47(5):741-52. doi: 10.1177/0146167220942361.

Kizilay F, Gali HE, Serefoglu EC. Diabetes and Sexuality. Sex Med Rev. 2017;5(1):45-51. doi: 10.1016/j.sxmr.2016.07.002.

Mphaphuli M, Smuts L. “Give It to Him”: Sexual Violence in the Intimate Relationships of Black Married Women in South Africa. Signs: Journal of Women in Culture and Society. 2020;46(2):443-64. doi: 10.1086/710811.

Lee JT, Hu YL, Lin HH, Tseng HM. Sexual satisfaction and sexual function in women with gynecologic cancer: validation of the Sexual Satisfaction Scale for Women in Taiwan. Int J Gynecol Cancer. 2019;29(5):944-50. doi: 10.1136/ijgc-2018-000062.

Cao H, Zhou N, Fine MA, Li X, Fang X. Sexual Satisfaction and Marital Satisfaction During the Early Years of Chinese Marriage: A Three-Wave, Cross-Lagged, Actor-Partner Interdependence Model. J Sex Res. 2019;56(3):391-407. doi: 10.1080/00224499.2018.1463503

Jeanfreau MM, Wright L, Noguchi K. Marital Satisfaction and Sexting Behavior Among Individuals in Relationships. The Family Journal. 2018;27(1):17-21. doi: 10.1177/1066480718819868.

Ribas A, Wolchok JD. Cancer immunotherapy using checkpoint blockade. Science. 2018;359(6382):1350-5. doi: 10.1126/science.aar4060.

Kline R. Principels and practice of structural equation modeling. NY: Guilford Press; 1998.

Busby DM, Christensen C, Crane DR, Larson JH. A revision of the dyadic adjustment scale for use with distressed and nondistressed couples: construct hierarchy and multidimensional scales. Journal of Marital and Family Therapy. 1995;21(3):289-308. doi: 10.1111/j.1752-0606.1995.tb00163.x.

Maroufizadeh S, Omani-Samani R, Hosseini M, Almasi-Hashiani A, Sepidarkish M, Amini P. The Persian version of the revised dyadic adjustment scale (RDAS): a validation study in infertile patients. BMC Psychology. 2020;8(1):6. doi: 10.1186/s40359-020-0375-z.

Paloutzian RF, Agilkaya-Sahin Z, Bruce KC, Kvande MN, Malinakova K, Marques LF, et al. The Spiritual Well-Being Scale (SWBS): Cross-Cultural Assessment Across 5 Continents, 10 Languages, and 300 Studies. In: Ai AL, Wink P, Paloutzian RF, Harris KA, editors. Assessing Spirituality in a Diverse World. Cham: Springer International Publishing; 2021. p. 413-44.

Biglari Abhari MM, Fisher JWP, Kheiltash AM, Nojomi M Md MPH. Validation of the Persian Version of Spiritual Well-Being Questionnaires. Iran J Med Sci. 2018;43(3):276-85. doi: 10.30476/IJMS.2018.40539.

Hudson WW, Harrison DF, Crosscup PC. A short‐form scale to measure sexual discord in dyadic relationships. The Journal of Sex Research. 1981;17(2):157-74. doi: 10.1080/00224498109551110.

Talayizadeh F, Bakhtiyarpour S. The relationship between marital satisfaction and sexual satisfaction with couple mental health. Thoughts and Behavior in Clinical Psychology. 2016;11(40):37-46.

Gilbert-Diamond D, Baylin A, Mora-Plazas M, Villamor E. Correlates of obesity and body image in Colombian women. J Womens Health (Larchmt). 2009;18(8):1145-51. doi: 10.1089/jwh.2008.1179.

Zawisza K, Tobiasz-Adamczyk B, Galas A, Jabłońska K, Grodzicki T. Changes in Body Mass Index and Quality of Life—Population-Based Follow-up Study COURAGE and COURAGE-POLFUS, Poland. Applied Research in Quality of Life. 2021;16(2):501-26. doi: 10.1007/s11482-019-09776-3.


Shahin Tabarzan
Farzaneh Hooman (Primary Contact)
Saeed Bakhtiarpour
Shahin Tabarzan, Farzaneh Hooman, Saeed Bakhtiarpour. The Mediating Role of Sexual Satisfaction in the Relationships of Body Mass Index and Spiritual Well-being with Quality of Married Life in Women with Breast Cancer: Quality of married life in women with BC. Arch Breast Cancer [Internet]. 2022 Oct. 30 [cited 2024 Apr. 25];10(1):48-56. Available from:

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