Ten couples, the women beginning treatment for carcinoma of the vulva, participated in a %year longitudinal study on sexual functioning before and after treatment. Sexual functioning was measured on admission and at 6,12, and 24 months posttreatment. Sexual functioning was made operational in terms of current sexual behavior, sexual motivation, sexual (dis)satisfaction, and the perception of genital sensations of sexual arousal. An age-matched nonpatient control group was added to the study and the impact of physical variables was also evaluated. Within 1 year, all women who were sexually active before the treatment had resumed their sexual activities. At the 6-month assessment an increase in relational sexual dissatisfaction could be detected. Over the remaining observation period the women's satisfaction with sexual interaction with the partner was not found to be different from their pretreatment satisfaction and not different from the satisfaction in the control group, in spite of the physical damage and persisting poor perception of genital symptoms of sexual arousal during lovemaking. Satisfaction with sexual interaction with the partner under these circumstances appears to be more an expression of satisfaction with the intimate aspects of the sexual relationship than of satisfaction with the physiologic arousal aspects of the sexual relationship. It is argued that psychological and social variables are more crucial for sexual rehabilitation than physical variables. Therefore, psychosocial issues constitute the most promising focus for intervention. Cancer 66: 402-407,1990. ANCER IS OFTEN LOOKED ON as a breaking point in C life because it leads to considerable changes in how people regard themselves and their future. Moreover, treatment frequently results in irreversible physical damage which, in turn, brings about changes in patterns of behavior.' One of these patterns of behavior involves sexual functioning. It is very likely that sexual function will From the