Exploring the aesthetic and sexual health impacts of reported lower extremity lymphedema-related symptoms in 174 patients following inguinal lymphadenectomy

Background Inguinal lymph node dissection (ILND) is associated with physical changes that extend beyond functional impairment. The psychosocial sequelae, particularly alterations in body image and sexual health, remain poorly characterized despite their profound impact on cancer survivors' well-being. Understanding these outcomes is essential for comprehensive patient counseling and identifying candidates who may benefit from reconstructive interventions. Methods This cross-sectional study was conducted and reported in accordance with the STROBE guidelines. Body image and sexual health outcomes were assessed in 174 patients who underwent ILND between 1990 and 2022 across three Dutch medical centers. Body image was assessed using the Body Image Scale (BIS), while sexual health was evaluated with the EORTC Sexual Health Questionnaire (SHQ-22). Clinical and surgical data were abstracted from medical records. Multivariate linear regression identified predictors of aesthetic and sexual health impairments. Results Body image dissatisfaction and sexual health impairments were significantly more pronounced among patients with reported lymphedema-related symptoms. Patients who were female, of younger age, and who had postoperative complications including seroma requiring excision independently predicted worse body image outcomes. Female patients and those of older age were associated with reduced sexual function. Advanced malignancy stage for which surgery was indicated significantly increased sexual health-related morbidity. Conclusion Body image disturbance and sexual dysfunction represent substantial yet under-recognized burdens following ILND. These findings underscore the need to consider psychosocial factors that may help identify high-risk patients who could benefit from interventions, such as reconstructive microsurgery.