Introduction

Cancer has been the primary cause of death in Japan since 1981 (Ministry of Health, Labour and Welfare, 2000). The Japanese word for cancer – gan – was once associated with the image of death, or with severe physical and psychological distress. However, thanks to the recent development of medical technology and treatment, patients’ survival rates have been dramatically improved and the diagnosis of cancer is no longer regarded as a virtual death sentence. This fact has directed people's attention from mere survival to how to achieve a better quality of life (QOL) following a cancer diagnosis (Osoba, 1991; Kawano, 1995).

In spite of the fact that cancer survival rates have increased, sexuality after having cancer remains a taboo topic in both the clinical and research setting of many countries. Research on sexuality after cancer in the context of psychosocial rehabilitation began in the 1980s (Andersen, 1985; Schain, 1988; Burbie and Polinski, 1992). In Japan, the reluctance to raise the topic seems to be even greater. There, sexuality was rarely included in cancer QOL scales. Also, when sexuality was discussed in the clinical setting, it was always related to pathological aspects, such as an infection route of sexually transmissible infections, or impotence as a complication of diabetes. Sex after having specific illnesses was rarely discussed in the context of pleasure or undergoing post-treatment rehabilitation.

This chapter focuses primarily on women's sexuality after having breast cancer, and discusses how this long-neglected issue is influenced by both the socio-cultural context and the health care system in Japan. However, the chapter first presents an overview of the health status of Japanese people and the Japanese health care system in general.

Overview of health status and health care system in Japan

Health status of people in Japan

The current life expectancy of people in Japan is the longest in the world. As of 1999, the average life expectancy at birth was 77.1 years for men and 84.0 years for women (Ministry of Health, Labour and Welfare, 2000). Figure 12.1 shows the changes in mortality rates according to the cause of death in Japan since 1950. After infectious diseases such as tuberculosis were successfully controlled in the 1920s and 1930s, cerebro-vascular diseases (CVD), heart diseases and malignant tumours have been the three major causes of death.