# More than just “vaginal dryness”: sexual dysfunction correlates with genitourinary anatomy changes in female cancer survivors

## TL;DR

This study shows that sexual dysfunction in female cancer survivors is linked to changes in genitourinary anatomy, which can cause pain and reduce sexual satisfaction.

## Contribution

The study identifies previously unreported genitourinary anatomy changes associated with sexual dysfunction in female cancer survivors.

## Key findings

- Patients with more abnormal GU exams had significantly lower sexual function scores in lubrication, orgasm, satisfaction, and pain domains.
- Endocrine therapy, especially aromatase inhibitors, was associated with worse GU exam scores.
- Low sexual satisfaction scores were nearly three times more likely in patients with abnormal GU exams.

## Abstract

To correlate genitourinary exam (GU) findings to patient-reported sexual dysfunction in female cancer survivors.

This retrospective cohort study included female cancer patients seen at a South Florida sexual health after cancer program. GU anatomy abnormalities and patient-reported sexual dysfunction were evaluated by Adapted Vulvovaginal Exam Score (AVES) and the Female Sexual Function Index (FSFI), respectively. Multivariate analyses compared, FSFI scores between patients with AVES > 3 vs. 0–3, (AVES > 3 corresponds to more abnormal GU exam). Adjusted odds ratio (aOR) and 95% confidence intervals (95% CI) were calculated.

AVES was calculated for 162 female patients treated between 2020–2022. Median age was 46; 57% were Hispanic, and 79% had breast cancer. Common symptoms included vaginal dryness (55%) and dyspareunia (45%). Of 108 women with FSFI scores, 97% met criteria for female sexual dysfunction (FSD). 23% were found to have vaginal stenosis, and 42% had a narrowed vaginal introitus. Those with AVES > 3 had significantly lower FSFI lubrication, orgasm, satisfaction, and pain domain scores. Any endocrine therapy use was associated with worse AVES scores (aOR 0.20, 95% CI 0.05–0.80, p = 0.024), an association strongest with aromatase inhibitor (AIs) use. Low satisfaction scores < 3.6 were nearly three times more likely to have abnormal GU exams (aOR = 2.81; 95% CI: 1.03–7.65; p = 0.044).

FSD in female cancer survivors is associated with previously unreported GU exam changes that can limit or prevent sexual activity through pain and worsened sexual satisfaction. Ongoing work evaluates targeted interventions to improve symptoms and quality of life for this growing survivor population.

The online version contains supplementary material available at 10.1007/s00520-025-10046-2.