Women with breast cancer may have significant problems adjusting to the disease and therapy, due to the significant changes in body image and sexuality associated. The aim of this study was to 1) assess sexual functioning 3 months after surgical procedures for breast cancer, and 2) prospectively investigate the usefulness of a Sense of Coherence (SOC) and beauty treatment as predictors of sexual functioning. Methods: One hundred women with breast cancer were randomly assigned to a group receiving beauty treatments during hospitalization or a control group. SOC subscales were assessed the day before surgery. Psychological distress and body image were assessed on day 6 after surgery and sexual functioning was assessed at three months. Results: Patients with breast cancer seem to experience significant issues in sexual functioning 3 months after surgery. Half of them declared no sexual activity and 42% had no interest for sex. In terms of Sense of Coherence, only the perception that resources were available to face the disease (i.e. manageability) had a positive influence on sexual functioning. Beauty treatment was also associated, but the most statistically significant predictor of sexual functioning was a younger age. Conclusion: This study provides evidence that coping resources, and especially the perception that resources are available to face disease-related disturbances (i.e. manageability), have a positive influence on sexual functioning. Interventions aimed at improving patient perception of available resources might be useful to improve sexual functioning among patients with breast cancer.