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Female Sexual Dysfunction Following Radiation Therapy for Anal Canal Cancer

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Concurrent chemotherapy and radiation therapy is often an effective primary method of treatment for anal canal cancers. Due to the high treatment success rate, there is a growing population of survivors experiencing late side effects of the radiation, including sexual dysfunction. This can significantly  impact their quality of life (QOL)1. Sexual dysfunction is characterized by any disturbances in sexual  relations both physical and psychological.


The purpose of this review is to identify the prevalence of sexual dysfunction, different causes of sexual dysfunction, and intervention strategies for female anal canal cancer survivors. 


A literature review was conducted on the Google Scholar and Pubmed database.


Searches were conducted using the keywords: anal canal cancer, radiation therapy side effects, interventions, and female sexual dysfunction.


Thirty-four studies were selected for this review and included literature on female sexual dysfunction (FSD) following pelvic radiotherapy and intervention strategies for female sexual dysfunction.




Causes of sexual dysfunction:

The causes of sexual dysfunction are multifactorial.

Physical (Resulting directly from radiation treatment):

•Epithelial cell radio-sensitivity (dryness)
•Vaginal fibrosis (adhesions)
•Vaginal stenosis (narrowing) (Figure 1)


•Body image (vaginal changes)
•Relationship changes with their partners
•Patient-Physician relationship: 62% of gynaecological cancer patients reported never speaking to their doctors about FSD3

FSD is a common side effect for anal canal cancer patients following radiotherapy.


Most prevalent FSD symptoms:

•Changes in vaginal size, dryness, dyspareunia, and sexual interest 
•Anal cancer patients reported higher percentages of FSD than other pelvic radiotherapy patients.
•Vaginal size more troublesome in anal cancer patients than other pelvic radiotherapy patients.
•Body image is an important factor in FSD.
•Psychotherapeutic interventions proved to benefit patients, enforcing the importance of education and discussion of FSD.



•Limited and smaller anal canal cancer studies
•Lack of consistency with data collection methods (various questionnaires) 

FSD is a significant long term side effect of radiotherapy for anal canal cancer and requires further research in order to have a more comprehensive knowledge on the topic.


•Sexual functioning assessment should be standardized by using a validated questionnaire (ex. SVQ)
•Current anal canal cancer studies of FSD are limited
•Health care professionals should be mindful to discuss FSD with pelvic radiotherapy patients to offer proper interventions, education, and support
•Intervention strategies for FSD are limited and require more research in order to determine efficacy of lesser known interventions
•It is important to understand the radiation dose relationship with the vagina in regards to FSD. The higher rate of FSD in anal canal cancer patients compared to the patients who have pelvic radiation may suggest a difference in vaginal dose received between groups.
•A retrospective study of pelvic radiotherapy plans analyzing FSD as it relates to vaginal radiation dose delivered should be conducted. 
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