PURPOSE: The purpose of this study was (1) to investigate the personal, interpersonal, social, and cultural factors related to sexual dissatisfaction in women with breast cancer and (2) to explore these differences regarding surgery (lumpectomy vs. mastectomy). METHODS: This cross-sectional study included women diagnosed with breast cancer (n = 87). Women were invited to complete questionnaires assessing sexual satisfaction, relationship satisfaction, conjugal support, quality of life, subjective health, anxiodepressive symptomatology, body image, self-esteem, and religiosity. Partial least squares path modeling (PLS‒PM) was used. RESULTS: No direct links were observed between resources (intraindividual and social) and sexual dissatisfaction (SD) or between vulnerability (physical and emotional) and SD. The quality of the conjugal relationship acted as a mediator between these different variables. Intraindividual resources are influenced directly by physical and emotional vulnerability. Age influenced only SD in women who had undergone a lumpectomy compared with those who had undergone a mastectomy. Finally, religiosity and the length of the couple relationship had no influence on SD. CONCLUSION: The results highlight the importance of considering different levels of variables when considering SD in women with breast cancer, particularly the role of the conjugal relationship. Hence, these results encourage the need to promote conjugal relationship quality to improve sexual satisfaction.