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

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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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