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This research aims to define the prevalence and risk factors for female sexual dysfunction following radiotherapy for anal cancer, as well as identify potential interventions.

April 11, 2026Open Access

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

JSJ SteffensenAarhus University LSLise K SchouAarhus University AJA. V. JakobsenAarhus University

Key Points

This research aims to define the prevalence and risk factors for female sexual dysfunction following radiotherapy for anal cancer, as well as identify potential interventions.
Systematic search of MEDLINE, EMBASE, CENTRAL, and CINAHL for studies on female patients treated with radiotherapy for anal cancer.
Inclusion criteria focused on prevalence, risk factors, and interventions addressing female sexual dysfunction.
Data extraction utilized a Cochrane-adapted form, assessing risk of bias with AXIS.
FSD prevalence ranged from 0.9% to 85%, showing significant variation among studies.
Common symptoms included dyspareunia (0.3–79%), vaginal stenosis (1–88%), and vaginal dryness (up to 98%).
Higher vaginal radiotherapy doses were correlated with worse sexual outcomes, though dosage thresholds differed by study.
Limited intervention evidence indicated that dilator use may reduce stenosis, and nurse-led or multidisciplinary programs showed potential benefits.

Abstract

Abstract Background Despite high survival after radiotherapy (RT) for anal cancer (AC), its impact on female sexual dysfunction (FSD) and vaginal toxicity remains poorly defined. Methods 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. Results 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. Conclusions 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. Registration: PROSPERO CRD42024592088.

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