A Systematic Review of Patient-Reported Outcomes on the Impact of Radiation Therapy on Sexual Health in Patients With Gynecologic Cancer.

Abstract

<h4>Purpose</h4>To evaluate the impact of radiation therapy (RT) on sexual health in women with gynecologic cancers.<h4>Methods and materials</h4>A comprehensive search of PubMed, Cochrane CENTRAL, Embase, Cumulative Index to Nursing and Health Literature, APA PsycInfo, Scopus, and Web of Science was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies published from January 2000 to August 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 RT 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 (L.H. and I.V.) performed data extraction.<h4>Results</h4>Of 1402 records identified, 1049 were screened, 26 studies met the inclusion criteria, comprising a total of 5646 patients. Eleven studies focused on cervical cancer, 7 on endometrial cancer, and 8 included mixed gynecologic malignancies. The majority were prospective in design (n = 25), with one retrospective study identified. Commonly used PRO instruments included the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30, Quality of Life Questionnaire-CX24, Female Sexual Function Index, Late Effects on Normal Tissues-Subjective, Objective, Management, and Analytic, and Sex Adjustment Questionnaire. Radiation was consistently associated with long-term sexual dysfunction, including vaginal dryness, dyspareunia, and diminished sexual satisfaction. Although sexual activity declined after 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.<h4>Conclusions</h4>RT for gynecologic cancers has enduring adverse effects on sexual health, shaped by both physical and psychosocial dimensions. Interventions such as 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, whereas clinical care should incorporate sexual health counseling, early pelvic rehabilitation, and psychosocial support into survivorship programs.