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Purpose: The aims of the study were to investigate longitudinal changes in multiple domains of problems with sexual functioning in Korean breast cancer survivors in the first year after surgery for breast cancer and to determine which factor(s), including upper limb dysfunction, may influence sexual problems.Methods: Women diagnosed with breast cancer (n = 191) were initially assessed at baseline before surgery and completed follow-ups at 3, 6, and 12 months after surgery. Survey items included sexual interest, sexual activity, satisfaction with sex life, feeling sexually attractive, body image, medical history, symptoms, upper limb dysfunction, and sociodemographics.Results: The prevalence of sexually active women was 39.2% at 3 months, which increased to 48.2% at 6 months, and 50% at 12 months after surgery. Compared with pretreatment levels, considerably more women reported moderate or severe problems with sexual interest and sexual activity at 3, 6, and 12 months after surgery. Chemotherapy was related to sexual problems only early after treatment, and surgical procedure (extensive vs. conservative) had no significant effect on sexual problems. Low perceived sexual attractiveness in 3 months after surgery was related to greater overall sexual problems. Lymphedema was significantly related to sexual disinterest at all stages of follow-up and to sexual satisfaction at the 6 month follow-up after adjusting for other predicting factors.Conclusions: Although sexual activity gradually improved during the first year, more women reported moderate or severe problems with sexual interest and activity over time. Upper limb dysfunction, such as that caused by lymphedema, is a significant factor that may interfere with sexual functioning in breast cancer survivors. [ABSTRACT FROM AUTHOR]