A Systematic Review of Patient-Reported Outcomes on the Impact of Radiotherapy on Sexual Health in Gynecologic Cancer Patients

To evaluate the impact of radiotherapy on sexual health in women with gynecological cancers. A comprehensive search of PubMed, Cochrane CENTRAL, Embase, CINAHL, APA PsycInfo, Scopus, and Web of Science was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published from 01/2000 to 08/2025 were screened using MeSH terms and keywords related to "gynecological cancer and radiotherapy and sexual health." Inclusion criteria required studies assessing the impact of radiotherapy on sexual health in women with endometrial, cervical, and vulvar cancers using validated patient-reported outcome (PRO) questionnaires with baseline data. Reviews and studies on ovarian cancer were excluded. Two independent reviewers (LH, IV) performed data extraction. Of 1,402 records identified, 1,049 were screened, 26 studies met the inclusion criteria, comprising a total of 5,646 patients. Eleven studies focused on cervical cancer, seven on endometrial cancer, and eight included mixed gynecologic malignancies. The majority were prospective in design (n = 25), with one retrospective study identified. Commonly used patient-reported outcome (PRO) instruments included the EORTC QLQ-C30, QLQ-CX24, FSFI, LENT-SOMA, and SAQ. Radiation was consistently associated with long-term sexual dysfunction, including vaginal dryness, dyspareunia, and diminished sexual satisfaction. While sexual activity declined following treatment, it improved over time and then stabilized. Regular vaginal dilation was associated with maintained vaginal length and enhanced sexual function but had no effect on vaginal elasticity. Psychological, social, and cultural factors also influenced outcomes. Radiotherapy for gynecologic cancers has enduring adverse effects on sexual health, shaped by both physical and psychosocial dimensions. Interventions like vaginal dilation and nurse-led programs may help preserve vaginal health, though adherence is low and benefits modest. Future research should prioritize diverse, longitudinal studies with standardized PRO tools, while clinical care should incorporate sexual health counseling, early pelvic rehabilitation, and psychosocial support into survivorship programs.