Prevalence, risk factors, and interventions for female sexual dysfunction after radiotherapy for anal cancer: a...

Despite high survival after radiotherapy (RT) for anal cancer (AC), its impact on female sexual dysfunction (FSD) and vaginal toxicity remains poorly defined.

We systematically searched MEDLINE, EMBASE, CENTRAL, and CINAHL for studies on women treated with curative-intent RT for anal cancer, addressing prevalence, risk factors, and interventions. Eligibility criteria were defined a priori; prevalence was restricted to studies using modern techniques (IMRT/VMAT), whereas studies of risk factors and interventions were included regardless of modality. Data were extracted using a Cochrane-adapted form, and risk of bias assessed with AXIS. Due to heterogeneity, evidence was synthesized using a narrative approach.

Of 3764 records, 32 reported prevalence estimates, 23 examined risk factors, and 8 evaluated interventions. FSD prevalence ranged from 0.9 to 85%. Dyspareunia (0.3-79%), vaginal stenosis (1-88%), and dryness (up to 98%) were frequent and persistent. Higher vaginal doses were associated with worse outcomes, though thresholds varied. Intervention evidence was limited: two studies linked dilator use to less stenosis, and nurse-led or multidisciplinary programs showed promise.

FSD is a prevalent, long-term consequence of RT for AC. This review provides symptom-specific evidence for patient counseling. It underscores the need for standardized assessment, dose optimization, and integrated follow-up strategies for female AC survivors.

PROSPERO CRD42024592088.