# Sexual Dysfunction in Female Rectal and Anal Cancer Survivors: Pathophysiology, Clinical Management, and Integration into Survivorship Care

## TL;DR

This review highlights how rectal and anal cancer treatments often lead to sexual dysfunction in women, which is under-recognized and poorly addressed in survivorship care.

## Contribution

The paper emphasizes the need for better assessment tools and multidisciplinary care to address sexual health in female cancer survivors.

## Key findings

- Over 60% of female survivors experience sexual dysfunction, including pain during sex and loss of desire.
- Current tools like the FSFI lack specificity for this population, and care access is limited in low- and middle-income countries.
- Emerging therapies like immunotherapy may help reduce sexual dysfunction risk, but evidence is limited.

## Abstract

This review looks at how treatments for rectal and anal cancers affect women’s sexual health, a topic that is often ignored in cancer care. While survival rates are improving, many women experience lasting problems such as pain during sex, loss of desire, and changes in intimacy. These issues are caused not only by physical effects of treatment, like tissue damage and hormonal changes, but also by emotional factors, including low self-esteem, body image concerns, and relationship difficulties. Current ways of measuring sexual health do not always reflect the real experiences of female survivors, and support services remain limited. We highlight the need for better tools, more consistent care, and greater attention to sexual well-being as an essential part of life after cancer.

Background: Female Sexual dysfunction (FSD) is a common but under-recognized outcome of rectal and anal cancer treatment. While survival has improved, sexual health remains insufficiently addressed in survivorship care, warranting a multidisciplinary perspective. Methods: A narrative review of studies published between 2000 and 2025 was conducted, including clinical trials, cohort studies, and guideline documents addressing female sexual dysfunction after anorectal cancer treatment. Articles that were not pertinent to the research topic, outdated, or methodologically inadequate were excluded from the analysis. Results: Over 60% of female survivors experience FSD, including decreased libido, vaginal dryness, dyspareunia, and arousal difficulties. Causes include hormonal deficiency, nerve injury, and radiation fibrosis, compounded by psychological distress, altered body image, stoma-related stigma, and communication issues. The FSFI is commonly applied but lacks specificity for this population. Geographic disparities persist, with greater stigma and limited care access in low- and middle-income countries. Emerging therapies, such as immunotherapy, may mitigate FSD risk, though evidence is scarce. Conclusions: FSD after anorectal cancer is highly prevalent and significantly impacts quality of life, yet remains under-assessed in follow-up care. Multidisciplinary, culturally sensitive strategies integrating screening, psychosexual support, and tailored rehabilitation are urgently needed. Future research should address sexual outcomes more systematically, particularly in novel treatment contexts.