Background: Treatment for gynecologic cancer is associated with side effects including sexual dysfunction, that present during and after treatment, and can be long lasting. The aim of this study was to investigate the frequency and the risk of sexual dysfunction among gynecologic cancer survivors compared to cancer-free women in a population-based cohort study.

Methods: We identified a cohort of 4,889 endometrial, ovarian and cervical cancer survivors diagnosed between 1997-2012 in the Utah Cancer Registry. Up to five cancer-free women were matched to cancer survivors on birth year and birth state from the Utah Population Database (N=22,809). We used ICD-9 codes to identify sexual dysfunction including dyspareunia, vaginal dryness/atrophic vaginitis, decreased libido, and lack of arousal/orgasm. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for sexual dysfunction with adjustment for potential confounders, including race/ethnicity, baseline body mass index (BMI), and baseline Charlson Comorbidity Index (CCI).

Results: Gynecologic cancer survivors had higher risks of sexual dysfunction (HR: 2.52, 95% CI: 2.16, 2.93) compared to a general population of women 1-5 years after cancer diagnosis. Sexual dysfunction was associated with advance cancer stage (HRRegional vs. Localized: 1.59, 95% CI:1.19, 2.12), radiation therapy (HR: 1.65, 95% CI: 1.26, 2.16), and chemotherapy (HR: 1.53, 95% CI: 1.17, 2.01).

Conclusions: Although this large cohort study confirms an increased risk of sexual dysfunction among gynecologic cancer survivors, the proportion of cases documented with diagnosis codes was lower than those commonly reported by gynecologic cancer survivors (6% vs. 10-85%). Further investigation into this discrepancy is important in improving survivorship issues for gynecological cancer patients.

Sexual dysfunction among gynecologic cancer survivors and women from the general population**

Gynecologic cancer survivorsOvarian cancer survivorsEndometrial cancer survivorsCervical cancer survivors
HR (95% CI)bHR (95% CI)bHR (95% CI)bHR (95% CI)b
Sexual dysfunctiona 2.52 (2.16, 2.93)* 2.76 (2.02, 3.76)* 2.35 (1.88, 2.92) 2.62 (1.83, 3.74)* 
Dyspareunia 3.25 (2.62, 4.04)* 3.20 (2.10, 4.88)* 3.03 (2.16, 4.24) 3.24 (2.04, 5.14)* 
Vaginal Dryness/Atrophic Vaginitis 2.62 (2.21, 3.11)* 3.43 (2.26, 5.22) 2.49 (2.00, 3.09)* 2.90 (1.77, 4.76) 
Gynecologic cancer survivorsOvarian cancer survivorsEndometrial cancer survivorsCervical cancer survivors
HR (95% CI)bHR (95% CI)bHR (95% CI)bHR (95% CI)b
Sexual dysfunctiona 2.52 (2.16, 2.93)* 2.76 (2.02, 3.76)* 2.35 (1.88, 2.92) 2.62 (1.83, 3.74)* 
Dyspareunia 3.25 (2.62, 4.04)* 3.20 (2.10, 4.88)* 3.03 (2.16, 4.24) 3.24 (2.04, 5.14)* 
Vaginal Dryness/Atrophic Vaginitis 2.62 (2.21, 3.11)* 3.43 (2.26, 5.22) 2.49 (2.00, 3.09)* 2.90 (1.77, 4.76) 

Abbreviation: HR, hazard ratio; CI, confidence interval. a. Sexual dysfunction included dyspareunia, vaginal dryness/atrophic vaginitis, decreased libido, lack of arousal/orgasm. b. Models adjusted for matching factors (birth year and birth state), race/ethnicity, baseline body mass index, baseline Charlson Comorbidity Index.

*Proportional hazards assumption not met; flexible model was used.

**1 to 5 years after cancer diagnosis

Citation Format: Chun-Pin Chang, Christina M. Wilson, Kerry Rowe, John Snyder, Mark Dodson, Vikrant Deshmukh, Michael Newman, Alison Fraser, Ken Smith, Ankita Date, Joseph B. Stanford, David Gaffney, Kathi Mooney, Mia Hashibe. Sexual dysfunction among gynecologic cancer survivors in a population-based cohort study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 899.