Sexual function outcomes in female patients with pelvic cancers treated with definitive chemoradiotherapy versus other combined modality therapies.

Background: Sexual health is an important aspect of survivorship for female patients with pelvic cancers, yet the specific impacts of radiation therapy (RT), surgery, and systemic treatments, alone or in combination, on sexual function remain underexplored. To provide tailored strategies to prevent or mitigate sexual dysfunction, our goal was to examine differences in sexual function outcomes between patients treated with definitive chemoradiotherapy (CRT) and those treated with other combined modality therapies. Methods: Adult female patients with pelvic cancers at least one year post-RT completion were recruited. Definitive CRT was defined as radiotherapy with concurrent chemotherapy as primary treatment for patients with anal or cervix cancer with an intact uterus. The combined modality therapy group included patients with cervix, rectal, or uterine cancer who underwent surgery followed by adjuvant RT, with or without chemotherapy. Sexual function was assessed using the PROMIS Sexual Function and Satisfaction questionnaire, which provides T-scores calibrated to the general population (mean = 50, SD = 10). Domains included sexual activity and interest, vaginal, clitoral, and labial discomfort, lubrication, orgasm pleasure, and satisfaction with sex. Therapeutic aid use, including vaginal moisturizers, dilators, and hormone therapy, was compared between groups. Statistical comparisons were performed using Mann-Whitney U tests, t-tests, Fisher’s exact tests, and chi-square tests, with a significance threshold of p < 0.05. Results: Of 31 patients, median age was 59.1 years (IQR: 48.7–69.6), and median follow-up was 2.1 years (IQR: 1.2–3.2). Overall, 9 (29.0%) received definitive CRT, and 18 (58.1%) were sexually active. There were no significant differences in sexual activity rates or interest between groups. Patients treated with CRT reported significantly higher vaginal discomfort (61.5 vs. 43.1, p = 0.03), clitoral discomfort (55.3 vs. 48.0, p = 0.04), and labial discomfort (61.3 vs. 47.1, p = 0.04) than those in the combined modality group. No significant differences were observed in lubrication (45.2 vs. 47.4, p = 0.30), orgasm-pleasure (47.7 vs. 48.7, p = 0.84), or satisfaction with sex life (42.9 vs. 45.7, vs. p = 0.48). Therapeutic aid use was similar between groups (all p > 0.05). Conclusions: Female patients with pelvic cancers who underwent definitive CRT experienced greater vaginal, clitoral, and labial discomfort than those treated with combined approaches. These findings highlight differences in sexual dysfunction likely driven by radiation exposure, surgical alterations, and/or chemotherapy effects, underscoring the need for better patient support to address treatment-related sexual dysfunction.