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Vaginal and sexual function is an important, yet often neglected, survivorship issue for cervical cancer patients. Our objective was to evaluate patient-reported sexual outcomes (PROs) and physician-assessed vaginal toxicity (VT) after chemo-radiation (CRT) and brachytherapy (BT) for locally advanced cervical cancer.

This was a single-centre prospective cross-sectional study. Stage IB-IVA cervical cancer patients treated with definitive CRT and MR-guided BT who were disease-free for >3 months were eligible. Consenting patients completed the following validated PRO measures: Female Sexual Distress Scale-Revised (FSDS-R; cut-off for distress ≥11)), Female Sexual Function Index (FSFI; cut-off for risk of sexual dysfunction ≤26), EuroQol Group EQ-5D (index value range: 0 (death) to 1 (perfect health)), and Menopause Rating Scale (MRS; 0 (asymptomatic) to 44 (highest symptoms)), as well as a socio-demographics questionnaire. During the clinical encounter, physicians assessed VT using the CTCAE v4.0. Sociodemographic, PROs, VT, and clinical data were summarized using descriptive statistics. Univariate associations of PROs with VT (grouped 0/1 vs 2+) were explored using the Wilcoxon-rank sum (Mann-Whitney) test for continuous PRO variables and Fisher’s exact test for categorical PRO variables.

Between August 2018 and April 2022, 74 patients were eligible for analysis. Median age at diagnosis was 49.5 (range: 25-81), 51% were FIGO cT2b, 61% had vaginal involvement at diagnosis, 77% were partnered and 87% reported using a vaginal dilator post-treatment. Median time from treatment was 19.8 months (3.3-57.1). Median CTVHR D90% was 92.1Gy (81-106.4), ICRU recto-vaginal (RV) point was 63.1Gy (52.6-85.8) and vaginal D2cm3 was 76.3Gy (54.5-133). Median FSDS-R score was 12.5 (0-52) with 55% meeting criteria for sexual distress, median FSFI score was 12.6 (0-33.6) with 85% meeting criteria for sexual dysfunction, median EQ-5D index value was 0.8 (0.4-1), and median MRS score was 13 (0-44). Grade 2+ VT was documented in 31.1% (23/74) of patients. Younger age (<50 years old, p<0.001) and marital status (being partnered, p=0.004) were associated with higher rates of sexual distress, whereas there were no associations for sexual orientation, ethnicity, or religion. Vaginal dilator use was associated with less sexual dysfunction (p=0.04). Patient-reported sexual distress and menopausal symptoms were associated with physician-reported VT for dryness (p=0.01 FSDS-R, p-0.02 MRS), dyspareunia (p=0.01 FSDS-R, p=0.01 MRS) and vaginismus (p=0.004 FSDS-R, p=0.005 MRS).

Cervical cancer patients self-report high rates of sexual distress, sexual dysfunction and menopausal symptoms after CRT and BT. Clinical identification of VT should prompt physicians to discuss sexual health and to assess the downstream impact on functioning and quality of life.