Abstract Background: Sexual health symptoms are common and distressing in breast cancer survivors. There is limited data regarding the experience with sexual health among patients with metastatic breast cancer (MBC). Given the chronic nature of MBC and ongoing treatments, sexual health concerns may be especially complex and underrecognized in this population. We previously reported data from the WISH-BREAST study evaluating sexual health in breast cancer survivors. Here, we present findings from the WISH-BREAST MBC cohort. Methods: An anonymous online survey on sexual health in breast cancer survivors was distributed through a social media platform (Instagram) and e-mail. Questions included demographics, breast cancer history and treatment, sexual health symptoms and experience with medical care for sexual health symptoms. Results: There were a total of 1775 responses to the survey. 42 reported having MBC and 1420 reported Stage 0-III; these respondents were included in this analysis. The median age of MBC respondents was 44 years (range 39-53 years). Median age at diagnosis was 39 years (range 33-45 years) - younger than the non-MBC respondents. MBC respondents were more likely to report early menopause (57.1% vs 28.2%). 100% of respondents with MBC reported changes to sexual health. 95.2% reported a moderate to great deal of distress related to sexual health changes. The sexual health concerns reported are summarized in Table 1. Respondents with MBC were more likely to report painful sex (78.6% vs 58.8%), no sexual pleasure (52.4% vs 33.4%), and that sexual health concerns impacted relationships (85.7% vs 71.4%) than non-MBC respondents. The majority of respondents with MBC obtained information about sexual health from social media, although a lower percentage compared to those with non-MBC (66.7% vs 80.5%). While 95.2% of respondents with MBC reported vaginal dryness, 64.3% reported that treatment with vaginal hormones was not discussed. A similar proportion of respondents with MBC reported being prescribed vaginal estrogen compared to respondents with non-MBC (23.8% vs 22.7%). Conclusions: In this online survey, respondents with MBC reported high rates of sexual health concerns and distress. Despite the prevalence of symptoms such as vaginal dryness, painful sex and loss of sexual pleasure, conversations around management options, including vaginal hormones, remain limited. These findings underscore critical gaps in clinical care and patient-provider communication regarding sexual health in the metastatic setting and highlight the potential role of social media an information source. Integrating sexual health discussions into routine MBC care, improving access to evidence-based treatments and sexual health programs, and including patients with MBC in clinical trials focused on sexual health are essential steps toward enhancing quality of life for this population. Citation Format: L. S. Agrawal, T. Kluthe, C. Menn, E. Teplinsky. Women's Insights on Sexual Health After Breast Cancer (WISH-BREAST) Online Survey: Metastatic Breast Cancer Cohort abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS1-03-10.
Agrawal et al. (2026) studied this question.