(643) Bridging the Silence: A Qualitative Exploration of Sexual Health Communication in Gynecologic Cancer Care

Introduction Gynecologic cancers account for roughly 16% of cancer diagnoses worldwide and 12.5% of cases in the United States. Between 40% and 100% of survivors report sexual difficulties following treatment, including pain, loss of desire, diminished arousal, reduced satisfaction, and changes in body image or identity. Although research and guidelines emphasize that early, proactive sexual health discussions improve survivorship outcomes, these conversations remain rare in clinical care. In prior surveys, 98% of gynecologic oncology providers agreed that sexual health should be addressed, yet only one in five routinely raise the topic. Objective This project examined the experiences and perspectives of both gynecologic cancer survivors and oncology providers to understand how sexual health communication unfolds in practice. The goal was to identify points of disconnect and highlight opportunities to improve the integration of sexual health into routine oncology and survivorship care. Methods Two qualitative studies were conducted using semi-structured interviews and focus groups. Survivor participants (n = 30) were recruited through existing research registries, online cancer communities, and social media. Provider participants (n = 21) included gynecologic oncologists, nurse practitioners, and physician assistants representing academic and community settings. Interviews were analyzed thematically using a reflexive, inductive approach to identify patterns within and across survivor and provider narratives. Results Survivors described six core themes: experiences of provider communication, preferences for communication, changes in sexual function, expanding views of intimacy, partner and relationship factors, and changes to sense of self. Many survivors felt that sexuality was overlooked or dismissed, with medical discussions limited to fertility or survival rather than sexual wellbeing. Participants reported frustration about the absence of anticipatory guidance for changes in desire, arousal, or vaginal anatomy, and several mourned losses related to femininity, attractiveness, or bodily trust. Survivors consistently expressed a desire for providers to initiate conversations early, normalize sexual changes, and offer practical tools and referrals for recovery. Provider interviews revealed both empathy and constraint. Most reported that sexual health concerns arise late in survivorship, often during exams or at patient initiation. Barriers included limited time, lack of formal training, and discomfort about discussing sexuality-especially with older or single patients and LGBTQ+ individuals. Several providers described feeling equipped to address physical symptoms (e.g., dryness, dyspareunia) but less confident discussing emotional or relational concerns. Many delegated these discussions to advanced practice providers who had longer follow-up appointments. Conclusions Survivors and providers share an understanding that sexual health matters, yet persistent gaps in communication, confidence, and time prevent it from becoming standard practice. Survivors interpret silence as invalidation; providers cite discomfort, competing demands, and limited resources. Integrating structured sexual health assessments, multidisciplinary training, and clear referral pathways into oncology care could bridge this gap. Recognizing sexual wellbeing as a central component of survivorship is essential, not an optional conversation, but a measure of comprehensive, person-centered cancer care. Disclosure No