Long-term sexual health and post-treatment issues among female survivors of anal cancer.

8 Background: Data on sexual health outcomes and quality of life in long-term female survivors of anal cancer are limited. This study aimed to characterize sexual dysfunction, treatment-related morbidity, and healthcare utilization patterns in this population. Methods: A cross-sectional survey of adults who had completed definitive treatment was conducted using institutional registries, patient advocacy groups, and nonprofit organizations. Respondents completed a one-time survey on sexual function, quality of life, healthcare access, and sociodemographic and clinical characteristics. Analyses assessed the prevalence and severity of sexual function and dyspareunia in the overall cohort as well as stratified by age (<50, 50+ years). Results: A total of 308 females participated (mean age 66.1 years; 94.8% White; median year of treatment 2020). Substantial morbidity was observed: 73.9% reported no sexual activity in the prior 4 weeks, 66.2% reported complete absence of sexual interest, and 57.0% indicated their sex life was "very much" affected for the worse. Only 13.8% reported no adverse impact. Among sexually active participants, dyspareunia was common, affecting 64.2% with moderate to severe pain, with 42.8% reporting severe pain during intercourse. Additional post-treatment symptoms included moderate-severe vaginal dryness (60.5%), vaginal tightness/narrowing (69.2%), diarrhea (55.8%), stool leakage (70.2%), and frequent anxiety (24.2%). Despite the high symptom burden, only 43.6% were offered pelvic physical therapy. In age-stratified analyses, sexual inactivity was numerically lower in women <50 years (59% vs 74% ≥50; p=0.155), sexual interest was similar (64% vs 67%; p=0.537), and dyspareunia (67% vs 38%; p=0.146) and vaginal pain (19% vs 13%; p=0.131) were numerically higher in younger women, although none of these differences reached statistical significance. Conclusions: Female survivors of anal cancer experience persistent sexual morbidity, including high rates of sexual inactivity, dyspareunia, and other treatment-related dysfunction. These findings emphasize the lasting sexual health consequences of treatment and reveal critical gaps in post-treatment care and rehabilitation. There is an urgent need for targeted sexual health interventions and expanded supportive care resources to address the needs of this vulnerable survivor population. Sexual Health Outcome N (%) No sexual activity (4 weeks) 226 (73.9) Absent sexual interest 200 (66.2) Severe treatment impact on sex life 170 (57.0) Severe dyspareunia* 98 (42.8) Communication difficulties with partner** 97 (38.6) No negative sexual impact 41 (13.8) *Among sexually active participants (n=229). **Among partnered participants (n=251).