Sexual Toxicity After Chemoradiation for Anal Cancer Among Men Who Have Sex With Men: A Mixed-Methods Analysis

Chemoradiation (CRT) is the standard of treatment for localized anal squamous cell carcinoma (SCCA). Although cure rates are high, acute and late toxicities are common. There are increasing published data regarding vaginal stenosis and erectile dysfunction; however, the nature and impact of holistic sexual dysfunction after pelvic radiation, particularly among men who have sex with men (MSM), remains poorly characterized. This study aimed to: (1) explore patient-reported sexual health outcomes among MSM as measured by existing patient-reported outcome tools, and (2) assess the applicability of these existing tools for this population.

MSM who are at least 6 months out from completion of CRT for SCCA were recruited via fliers and online platforms. Participants completed a sexual patient-reported outcome questionnaire that included previously validated instruments assessing symptom burden, sexual function and satisfaction, erectile function, and pain with receptive anal intercourse. This was followed by a semistructured interview. Descriptive statistics were used to report demographics and survey data. McNemar's test compared sexual activities pre- and post-CRT. Interview data were thematically analyzed using inductive coding.

Of the 23 participants who completed the questionnaire, 19 completed an interview. The median (IQR) time since completing CRT was 3.1 (1.2-4.8) years. Approximately half (N = 11) had moderate to severe erectile dysfunction (median International Index of Erectile Function [IIEF-5] = 12; IQR, 6-20). Since completing treatment, 9 (39.1%) had attempted receptive anal penetration. Of those who had attempted receptive anal penetration, 66.7% experienced pain, and an equal percentage reported moderate-severe distress and interpersonal/relationship difficulty as a result. In general, patients reported participating in fewer sexual activities after CRT. Emergent themes from interviews included the need for patient education, the interplay between other radiation side effects and sexual side effects, and positive reactions to the survey measures.

Sexual dysfunction is common among MSM following CRT for SCCA. Erectile dysfunction and/or pain with receptive anal intercourse often lead to distress and interpersonal relationship challenges. Improved patient education and targeted interventions are needed to support sexual function and quality of life in this population.