Comparison of Sexual Function in Women with Endometrial Cancer and Their Partners Following Surgery versus Brachytherapy: A Cross-Sectional Study from a Tertiary Care Center

Comparison of Sexual Function in Women with Endometrial Cancer and Their Partners Following Surgery versus Brachytherapy: A Cross-Sectional Study from a Tertiary Care Center | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of Sexual Function in Women with Endometrial Cancer and Their Partners Following Surgery versus Brachytherapy: A Cross-Sectional Study from a Tertiary Care Center Gazi Güner, Can Tercan, Emrah Dağdeviren, Ayşe Bacaksız¹, Erdem Kiray, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7004113/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Endometrial cancer is the most common malignancy of the female reproductive tract, with a globally increasing incidence and mortality rate. Standard treatment includes surgery, with adjuvant radiotherapy and/or chemotherapy based on factors such as myometrial invasion and histological grade. Among these, the physical and psychological impact of radiotherapy, particularly brachytherapy on sexual health, is often underestimated. This study aimed to compare female sexual dysfunction and male partner sexual satisfaction in endometrial cancer patients who received surgery alone versus those who received additional brachytherapy. To our knowledge, this is the first study to comprehensively assess sexual function in both patients and their partners in this context. Methods Sixty-nine patients were included. Group 1 (n = 34) received adjuvant brachytherapy after surgery; Group 2 (n = 35) underwent surgery only. Participants completed a structured questionnaire including socio-demographic and clinical data, along with validated instruments: the Female Sexual Function Index and the New Sexual Satisfaction Scale for partners. Results The mean age was significantly higher in the brachytherapy group (61.71 ± 7.88 vs. 56.54 ± 8.74 years; p = 0.012). Gravidity (p = 0.029) and parity (p = 0.013) were also higher in this group, while body mass index was similar (p = 0.118). Female sexual function index scores [2 (2–20.3) vs. 2 (2–19.6); p = 0.459] and new sexual satisfaction scale scores [20 (20–83) vs. 20 (20–90); p = 0.492] showed no significant differences. Female sexual function index subdomain scores were also comparable. Tumor grade and stage significantly differed between groups, as did surgical approach and lymphadenectomy rates. Conclusion Sexual function was negatively affected in all endometrial cancer patients, with a more pronounced impact among those receiving brachytherapy and their partners. These findings highlight the need to consider sexual health in treatment planning and to implement supportive interventions such as psychosexual counseling, particularly for patients undergoing adjuvant radiotherapy. Endometrial cancer Brachytherapy Sexual function Female Sexual Function Index (FSFI) New Sexual Satisfaction Scale (NSSS) Partner satisfaction Gynecologic oncology Quality of life Radiotherapy side effects Figures Figure 1 Figure 2 BACKGROUND Endometrial cancer is the most common cancer of the female reproductive system and its incidence is increasing due to the aging and the obesity epidemic. About 85% are usually diagnosed in the early stage and has a excellent prognosis [ 1 ]. The first step in the treatment is laparoscopic or laparotomic hysterectomy and salpingoooferectomy [ 2 ]. Using the Mayo criteria [ 3 ] or based on sentinel lymph node status [ 4 ] a decision is made regarding lymphadenectomy. In order to determine the extent of lymphovascular invasion and also accurately stage the disease, pelvic and para-aortic lymph node dissection is added [ 5 ]. The use of adjuvant radiotherapy is determined by the risk of disease recurrence after surgery. Factors that increase the risk of recurrence include advanced age, advanced stage, depth of myometrial invasion, presence of lymphovascular invasion, histological type of tumor (e.g. serous or clear cell) and grade [ 6 – 10 ]. The ideal timing for initiating radiotherapy is within 6 to 8 weeks after surgery, depending on the patient’s postoperative recovery. As part of adjuvant treatment, in the absence of residual macroscopic tumor, three-dimensional endocavitary brachytherapy is applied for better dose distribution and protection of organs at risk [ 6 ]. The target area is the first third of the vagina and the vaginal cuff, applied to a depth of 5 mm. Depending on pathology results, the dose depth may be increased toward the paravaginal region or parametrium [ 7 ]. Organ-sparing dose limitations are based on the limitations defined for cervical cancer treatments. Bladder, rectum and bowel toxicities have been identified during the development of dose optimization in general, and the vagina has been limitedly included among the organs at risk in radiotherapy planning [ 8 – 11 ]. Vaginal dryness, vaginal stenosis and loss of elasticity, fibrosis, inflammation, mucosal damage and ulceration are among the negative side effects of brachytherapy on the vagina. These physical effects can make sexual intercourse unpleasant or painful. Also, changes in the function and structure of the genitals can lead to feelings of inadequacy, emotional detachment and guilt [ 12 ]. In addition to the physical changes, these psychosexual effects result in anxiety, depression and aversion. More than 40% of women want to receive sexual counselling after treatment, yet these side effects are ignored and under-treated in patient management [ 13 ]. In our study, we aimed to evaluate the impact of the surgical procedure and brachytherapy used in the treatment of endometrial cancer on the sexual life of couples. METHODS A total of 69 patients receiving or not adjuvant treatment for endometrial cancer at Istanbul Başakşehir Çam and Sakura City Hospital and their partners were included in the study. The participants were divided into two groups: 35 patients in the surgery group and 34 patients in the brachytherapy group. Female participants completed the FSFI (Female Sexual Function Index) scale, while their partners completed the NSSS (New Sexual Satisfaction Scale). In addition, a follow-up form containing sociodemographic information was completed for each patient. This form included information about the patient's age, obstetric history, educational status, method of contraception, smoking and alcohol use, presence of chronic diseases, stage of endometrial cancer, the surgical procedure performed, and whether the patient received chemotherapy and/or brachytherapy. Female Sexual Function Index FSFI is a multidimensional scale developed to assess women's sexual functioning, with proven validity and reliability. This scale, which consists of a total of 19 questions, examines female sexuality under six main headings: sexual desire, arousal, lubrication, orgasm, sexual satisfaction and pain during sexual intercourse. Each sub-dimension is assessed with specific questions and the scores of these sub-dimensions are summed to obtain an overall sexual function score. The total score varies between 2 and 36. A total score below 26.55 suggests that the woman has sexual dysfunction in general. New Sexual Satisfaction Scale The NSSS is a comprehensive and multidimensional scale developed to assess individuals' overall satisfaction with their sexual life. This scale, which can be applied to both men and women, takes into account not only the physical but also the emotional and psychological aspects of sexual satisfaction. The NSSS provides a holistic assessment of sexual satisfaction by focusing on various areas such as the quality of the sexual relationship, communication with the partner, emotional intimacy, sexual desire and performance. Participants respond to specific statements on a Likert-type scale and a total score is calculated based on these responses; higher scores indicate higher sexual satisfaction. This scale consists of a total of 20 questions and the total score is 100. Sexual function scores obtained from the FSFI and NSSS were compared between the brachytherapy and surgery groups. Their distributions are presented using box plots (Fig. 1 ). Additionally, education level was recorded as a key sociodemographic factor. The distribution of education levels by treatment group is shown in Fig. 2 , indicating that the majority of patients in both groups were primary school graduates, with no university graduates in the brachytherapy group. Statistical analysis The data obtained from the study were analyzed using Jamovi software and SPSS version 26. Descriptive statistics, were used to summarize the sociodemographic and clinical characteristics of the participants. The normality of the data distribution was assessed using skewness, kurtosis and the Shapiro-Wilk test. For comparisons between the two independent groups (brachytherapy vs. surgery), the Independent Samples t-test was used for normally distributed continuous variables, while the Mann-Whitney U test was applied for non-normally distributed variables. Categorical variables were compared using the Chi-square test or Fisher’s exact test, as appropriate. A p-value of less than 0.05 was considered statistically significant. RESULTS A total of 69 patients were included in the study, although the number of patients analyzed per variable varied slightly due to missing data (Table 1 ). The mean age was 61,71 ± 7,88 years in the brachytherapy group and 56,54 ± 8,74 years in the surgery group (p = 0,012). The mean BMI was 33,94 ± 6,14 in the brachytherapy group and 31,61 ± 6,04 in the surgery group (p = 0,118). The median gravidity was 3,5 (0–9) in the brachytherapy group and 3 (0–5) in the surgery group (p = 0,029), while the median parity was 3 (0–6) versus 2 (0–5), respectively (p = 0,013). Table 1 Baseline Demographic and Obstetric Characteristics by Treatment Group Variable Brachytherapy Surgery p-value Age (years)* (n = 34 / n = 35) 61,71 ± 7,88 56,54 ± 8,74 0,012 BMI (kg/m²)* (n = 34 / n = 35) 33,94 ± 6,14 31,61 ± 6,04 0,118 Gravidity** (n = 34 / n = 35) 3,5 (0–9) 3 (0–5) 0,029 Parity** (n = 34 / n = 35) 3 (0–6) 2 (0–5) 0,013 Education Level*** (n = 34 / n = 32) No education 5 (15,2%) 5 (15,6%) 0,300 Primary school 22 (66,7%) 14 (43,8%) Middle school 2 (6,1%) 4 (12,5%) High school 4 (12,1%) 8 (25,0%) University 0 (0,0%) 1 (3,1%) Contraceptive Use*** (n = 33 / n = 35) None 31 (93,9%) 35 (100,0%) 0,232 Condom 2 (6,1%) 0 (0,0%) Smoking Status*** (n = 33 / n = 35) No 32 (97,0%) 33 (94,3%) 0,590 Yes 1 (3,0%) 2 (5,7%) Alcohol Use*** (n = 34 / n = 35) No 34 (100,0%) 35 (100,0%) NA Chronic Disease*** (n = 34 / n = 35) No 5 (14,7%) 12 (34,3%) 0,059 Yes 29 (85,3%) 23 (65,7%) Abbreviations: NA; Non Applicable, * Normally distributed data presented as mean ± standard deviation; compared by independent samples t-test, ** Non-normally distributed data presented as median (minimum–maximum); compared by Mann–Whitney U test, *** Categorical variables presented as n (%); compared using the Chi-square or Fisher’s exact test, as appropriate In terms of education, no education was reported in 15,2% vs. 15,6%; primary school in 66,7% vs. 43,8%; middle school in 6,1% vs. 12,5%; high school in 12,1% vs. 25,0%; and university in 0,0% vs. 3,1% of the brachytherapy and surgery groups, respectively (p = 0,300). Regarding contraceptive use, 93,9% in the brachytherapy group and 100,0% in the surgery group reported no use, while condom use was reported in 6,1% and 0,0%, respectively (p = 0,232). Most patients were nonsmokers (97,0% vs. 94,3%; p = 0,590), and none reported alcohol use (100,0% vs. 100,0%; NA). Chronic disease was present in 85,3% of the brachytherapy group and 65,7% of the surgery group (p = 0,059). Sexual function and pain assessments are presented in Table 2 . The median Female Sexual Function Index (FSFI) score was 2 (2–20,3) versus 2 (2–19,6) in the brachytherapy and surgery groups, respectively (p = 0,459). Male sexual satisfaction scores were 20 (20–83) versus 20 (20–90) (p = 0,492). Sexual desire scores were 1,2 (1,2–3,6) versus 1,2 (0–3,0) (p = 0,442), arousal scores were 0 (0–3,9) versus 0 (0–3,9) (p = 0,881), lubrication scores were 0 (0–3,9) versus 0 (0–4,2) (p = 0,234), orgasm scores were 0 (0–4,0) versus 0 (0–3,2) (p = 0,336), satisfaction scores were 0,8 (0,8–4,4) versus 0,8 (0,8–3,6) (p = 0,513), and pain scores were 0 (0–6) versus 0 (0–6) (p = 0,310). Table 2 Sexual Function Scores and Pain Assessment by Treatment Group Variable Brachytherapy Surgery p-value Female FSFI Score** (n = 32 / n = 32) 2 (2–20,3) 2 (2–19,6) 0,459 Male Sexual Satisfaction** (n = 25 / n = 28) 20 (20–83) 20 (20–90) 0,492 Sexual Desire** (n = 31 / n = 32) 1,2 (1,2–3,6) 1,2 (0–3) 0,442 Arousal** (n = 31 / n = 32) 0 (0–3,9) 0 (0–3,9) 0,881 Lubrication** (n = 31 / n = 32) 0 (0–3,9) 0 (0–4,2) 0,234 Orgasm** (n = 31 / n = 32) 0 (0–4) 0 (0–3,2) 0,336 Satisfaction** (n = 31 / n = 32) 0,8 (0,8–4,4) 0,8 (0,8–3,6) 0,513 Pain** (n = 31 / n = 32) 0 (0–6) 0 (0–6) 0,310 Abbreviations: FSFI = Female Sexual Function Index; **Non-normally distributed data presented as median (minimum–maximum); compared by Mann–Whitney U test, Pathology and surgical characteristics are presented in Table 3 . Among patients with available data (n = 33 vs. 35), Grade 1 tumors were observed in 6,1% vs. 62,9%; Grade 2 in 87,9% vs. 34,3%; and Grade 3 in 6,1% vs. 2,9% (p < 0,001). The distribution of tumor stage (n = 34 vs. 35) was as follows: Stage 1A, 73,5% vs. 97,1%; Stage 1B, 17,6% vs. 0,0%; and Stage 2, 8,8% vs. 2,9% (p = 0,005). The surgical approach varied between groups (n = 27 vs. 35): laparotomy was performed in 51,9% vs. 14,3%; laparoscopy in 44,4% vs. 82,9%; and robotic surgery in 3,7% vs. 2,9% (p = 0,002). Table 3 Pathological Grade, Stage, and Lymph Node Dissection by Treatment Group Variable Brachytherapy Surgery p-value Tumor Grade*** (n = 33 / n = 35) Grade 1 2 a (6,1%) 22 b (62,9%) < 0,001 Grade 2 29 a (87,9%) 12 b (34,3%) Grade 3 2 a (6,1%) 1 a (2,9%) Tumor Stage*** (n = 34 / n = 35) Stage 1A 25 a (73,5%) 34 b (97,1%) 0,005 Stage 1B 6 a (17,6%) 0 b (0,0%) Stage 2 3 a (8,8%) 1 a (2,9%) Surgical Method*** (n = 27 / n = 35) Laparotomy 14 a (51,9%) 5 b (14,3%) 0,002 Laparoscopy 12 a (44,4%) 29 b (82,9%) Robotic 1 a (3,7%) 1 a (2,9%) Pelvic LND*** (n = 27 / n = 35) Yes 24 a (88,9%) 35 b (100,0%) 0,043 No 3 a (11,1%) 0 b (0,0%) Paraaortic LND*** (n = 27 / n = 35) Yes 15 a (55,6%) 6 b (17,1%) 0,002 No 12 a (44,4%) 29 b (82,9%) Sentinel LND*** (n = 27 / n = 35) Yes 4 (14,8%) 7 (20,0%) 0,742 No 23 (85,2%) 28 (80,0%) Abbreviations: LND = Lymph Node Dissection; NS = Not Significant (p > 0,05) ***Categorical variables presented as n (%); compared using the Chi-square or Fisher’s exact test, as appropriate Categories with the same subscript letter are not significantly different in terms of column proportions (p > 0,05), Pelvic lymph node dissection was performed in 88,9% vs. 100,0% of patients (p = 0,043), paraaortic lymph node dissection in 55,6% vs. 17,1% (p = 0,002), and sentinel lymph node dissection in 14,8% vs. 20,0% (p = 0,742). DISCUSSION This study is the first to examine both male and female sexual function specifically in the context of endometrial cancer. We analyzed the demographic characteristics of patients diagnosed with endometrial cancer and compared sexual function in both the patients and their partners across two treatment groups: those who underwent surgery alone and those who received additional brachytherapy. To our knowledge, this is the first study to comprehensively assess sexual function in both partners following treatment for endometrial cancer. Our research differs from previous studies, including the most comparable work by Nowesieski et al. (2023), which evaluated sexual function in the broader context of gynecologic cancers. In contrast, our study focuses exclusively on endometrial cancer and includes a larger, more targeted sample of 69 patient-partner pairs. Additionally, it uniquely evaluates sexual function in both female patients and their partners following either surgery alone or adjuvant brachytherapy. In this regard, our study provides a more comprehensive and focused assessment across a broader range of parameters and patient profiles. In our cohort, the brachytherapy group consisted of 34 patients, while 35 received only surgical treatment. When examining demographic characteristics, we found that the majority of participants in both groups were primary school graduates. This finding contrasts with the study by Aygın and Eti Aslan, which involved the Turkish adaptation of the Female Sexual Function Index (FSFI) and reported that most participants were employed and had completed secondary education [ 14 ]. Despite these differences in educational background, both studies yielded similar findings in terms of parity, with most women having two or three children. This suggests that parity may be a more consistent demographic variable across different populations studied for sexual function, while education level and employment status may vary depending on the clinical setting and population characteristics. Tugut et al. (2016) examined the validity and reliability of the New Sexual Satisfaction Scale in a sample of adults in Turkey. The study found that the two-factor structure of the scale was preserved in the Turkish adult sample and that it demonstrated a high level of reliability. However, the majority of participants consisted of unemployed women with primary school education and employed men with university degrees [ 15 ]. In our study, while most participants were similarly primary school graduates, the distribution of educational status by gender was not clearly distinguished. Variables such as education and employment status need to be examined in more detail regarding their impact on sexual satisfaction. Our study investigated both female and male sexual function in endometrial cancer patients who underwent either surgery alone or additional brachytherapy. Despite slight demographic differences between the group such as age, parity, and educational status, our results revealed no statistically significant differences in overall sexual function or pain scores between treatment modalities. The median Female Sexual Function Index (FSFI) scores were equally low in both groups, suggesting that sexual dysfunction is common regardless of the addition of brachytherapy. Similarly, male partners reported comparable levels of sexual satisfaction in both groups, indicating that the presence of brachytherapy did not significantly influence partner sexual experience. In our study, pelvic lymph node dissection was performed in the majority of patients in both groups (88.9% vs. 100.0%; p = 0.043), while paraaortic lymph node dissection was significantly more frequent in the brachytherapy group (55.6% vs. 17.1%; p = 0.002). Although no significant difference was observed in overall FSFI or NSSS scores between groups, the higher rate of paraaortic dissection in the brachytherapy group may partially contribute to the more pronounced sexual dysfunction observed in this cohort. This aligns with findings by Fujii et al. (2008), [ 16 ] who demonstrated that extensive lymphadenectomy, particularly involving paraaortic regions, may lead to autonomic nerve injury, thereby negatively impacting bladder, bowel, and sexual function in gynecologic oncology patients. While our study did not specifically assess nerve preservation, the higher incidence of sexual dysfunction in patients undergoing brachytherapy, combined with more extensive lymph node dissection, suggests a possible cumulative effect on pelvic autonomic innervation. These findings support the need for further research into nerve-sparing surgical approaches, particularly in patients likely to require adjuvant radiotherapy. In contrast, the study by Nowosielski et al. (2023), which included 30 gynecologic cancer survivors and their male partners, found more nuanced gender differences in sexual adaptation following treatment. Specifically, while female survivors reported a decline in sexual frequency, male partners paradoxically reported an increase Moreover, women in that study demonstrated higher sexual inhibitory tone and more body image concerns than their partners, revealing a potential divergence in sexual recovery trajectories within couples after cancer treatment [ 17 ]. Unlike the findings of Nowosielski et al., where inter-partner discrepancies in sexual interest and perception were clearly documented, our study observed no significant difference in sexual function between genders or between treatment arms. This could be due to differences in sample characteristics, cancer types, or cultural factors, including conservative attitudes toward sexuality, as the majority of our participants were primary school graduates and did not use contraceptives, indicating a potentially lower baseline level of sexual activity and openness. Additionally, in our study population, none of the patients reported alcohol use and over 95% were nonsmokers, which may also reflect more traditional lifestyle patterns and potentially contribute to sexual conservatism. In our study, female sexual dysfunction was prevalent in both the brachytherapy and surgery-only groups, with equally low median FSFI scores. This aligns with the findings of Damast et al., who reported sexual dysfunction in 81% of endometrial cancer survivors treated with high-dose-rate intravaginal brachytherapy, with impaired scores across all FSFI domains [ 18 ]. Notably, our data suggest that the addition of brachytherapy did not further worsen sexual outcomes, possibly due to already low baseline sexual activity and sociocultural factors, such as limited education and conservative sexual behavior. While Damast et al. identified laparotomy as a predictor of poorer sexual function, in our cohort, the higher laparotomy rate in the brachytherapy group did not translate into statistically worse FSFI scores, highlighting the complex interplay of treatment and demographic influences on sexual health. These findings underscore the importance of contextualizing sexual health outcomes in oncology not only by treatment modality but also by sociocultural background, gender dynamics, and relationship factors. In a study reported by Datta et al. in 2023, which included 132 patients who underwent surgery alone, surgery followed by brachytherapy, or surgery followed by chemoradiotherapy, 89% of participants continued to report low sexual function scores one year after treatment. Being over the age of 50 and having an education level below a university degree were identified as significant predictors of impaired sexual function. The study also emphasized that women who underwent surgery alone reported better quality of life compared to those who received adjuvant therapy, with the lowest quality of life scores observed in women who received chemoradiotherapy [ 19 ]. In contrast, in our study, sexual function remained similarly low across all treatment groups, with no statistically significant differences found between them. This suggests that factors beyond treatment modality such as age, partner relationship quality, communication levels, and psychological adaptationn may play a more critical role in determining post-treatment sexual health outcomes. Our results align partially with a recent study comparing early-stage endometrial cancer patients who received intravaginal brachytherapy (IVB) with those treated by surgery alone, which reported similar outcomes in terms of quality of life and female sexual function, although male partner function was not evaluated [ 20 ]. In contrast, another study focusing on high-dose-rate (HDR) IVB involving treatment of a ≥ 6 cm vaginal cuff found significantly higher rates of sexual dysfunction among brachytherapy patients compared to those who had surgery alone [ 21 ]. The discrepancy may stem from differences in radiation dose, vaginal length irradiated, and inclusion criteria. Notably, our cohort had relatively short vaginal cuff targets, and sociocultural characteristics such as low educational attainment and conservative sexual practices may have contributed to universally low FSFI scores, thus diminishing the observable difference between treatment arms. This study has several limitations. The study population was characterized by low educational attainment, limited contraceptive use, and conservative sexual behavior, which may have led to universally low FSFI scores and potentially masked more subtle treatment-related effects. Sexual function was assessed at a single time point post-treatment, precluding evaluation of longitudinal changes. Additionally, validated sexual function questionnaires for male partners were not employed; instead, partner sexual satisfaction was self-reported in a simplified manner. Finally, psychological factors, hormonal status, and relationship quality which are known to influence sexual function were not systematically evaluated. CONCLUSIONS This study is the first to comprehensively evaluate both female and male sexual function in endometrial cancer patients, comparing outcomes between those treated with surgery alone and those who received additional brachytherapy. Our findings indicate that female sexual dysfunction is highly prevalent in both groups, with no significant difference attributable to the addition of brachytherapy. Importantly, male partner sexual satisfaction also did not differ between treatment arms, highlighting that radiotherapy may not further impair sexual outcomes in this context. The inclusion of male partners adds a unique dimension to this research, offering insight into the dynamics of sexual health within couples affected by gynecologic malignancies. These findings underscore the need to consider both partners in survivorship care, particularly in cultural contexts where sexual conservatism and lower baseline sexual activity may obscure the impact of treatment. Further studies with more diverse populations are warranted to better understand the interplay between oncologic therapy, relationship dynamics, and cultural factors in sexual recovery. Abbreviations BMI Body Mass Index FSFI Female Sexual Function Index HDR High-Dose Rate IVB Intravaginal Brachytherapy NSSS New Sexual Satisfaction Scale Declarations Ethics approval and consent to participate: This study was approved by the Ethics Committee of Başakşehir Çam and Sakura City Hospital (Approval Number: E-96317207-514.10-262311282, Date: 16 December 2024). Written informed consent was obtained from all participants prior to enrollment. All procedures involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Consent for publication: Written informed consent for publication was obtained from all participants. Availability of data and materials: The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors’ contributions: Conceptualization: G.G.; Methodology: G.G., C.T.; Data curation: E.D., S.N.E., İ.T.Y.; Formal analysis: A.B., C.T., E.T.; Investigation: Y.Ö.Ö., S.Ö.K.; Resources: N.A.V., Ç.E.; Visualization: E.K.; Writing – original draft: G.G.; Writing – review & editing: C.T., Z.Z.S., F.E.Ç.; Supervision: A.Y.B., E.T. All authors read and approved the final version of the manuscript. Acknowledgements: Not applicable. References Colombo N, Creutzberg C, Amant F, Bosse T, Gonzalez-Martin A, Ledermann J, Marth C, Nout R, Querleu D, Mirza MR et al. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up. International Journal of Gynecological Cancer 2016, 26(1):2–30. Corr B, Erickson B, Barber E, Fisher C, Slomovitz B. Advances in the management of endometrial cancer. BMJ (Clinical Res ed). 2025;388:e080978. Ferreiro JA, Myers JL, Bostwick DG. 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Güner","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIiWNgGAWjYDCCA2BSAsJJMLABkoyNB4jX8qEgDaSlgRgtEMA448NhDEEMwHf7APOLH38s7Dbcbj72mcfgvN3a9sNAW2psonFpkTyXwGbZwyORvOHOseTZPAa3k7edSQRqOZaW24BDi8EZBjYDHgmJZIMbOcbMIC1mB4BaGBsO49Vi+McApCX/M1DLuWSz8w8JamF+zJMgYQe0hZlxhsEBO7MbBGyRPMPYxixzQCJB8kaaMcMHg+QEsxtAWxLw+IXvDPPhj2/+1Nnz3Uh+zJDwx87e7Hz6wwcfamxwagFGRhsoHhNhCiCMBJzKwYD5A5Cwh/Hs8agcBaNgFIyCEQoAmHllGjtRsZwAAAAASUVORK5CYII=","orcid":"","institution":"Başakşehir Çam and Sakura City Hospital","correspondingAuthor":true,"prefix":"","firstName":"Gazi","middleName":"","lastName":"Güner","suffix":""},{"id":478440193,"identity":"ce37f94b-4c86-450c-b752-4e2c1de293d3","order_by":1,"name":"Can Tercan","email":"","orcid":"","institution":"Başakşehir Çam and Sakura City 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Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ayben","middleName":"Yentek","lastName":"Balkanay","suffix":""},{"id":478440206,"identity":"a7e0be6a-b205-4378-aab3-4a757c196a7f","order_by":14,"name":"İlkbal Temel Yüksel¹","email":"","orcid":"","institution":"Başakşehir Çam and Sakura City Hospital","correspondingAuthor":false,"prefix":"","firstName":"İlkbal","middleName":"Temel","lastName":"Yüksel¹","suffix":""}],"badges":[],"createdAt":"2025-06-29 17:23:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7004113/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7004113/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85837838,"identity":"365dc281-b6ea-48e2-9066-bdf9a55c3575","added_by":"auto","created_at":"2025-07-02 08:33:44","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":114439,"visible":true,"origin":"","legend":"\u003cp\u003eBox plots of women FSFI score and male sexual satisfaction score in the bracytherapy and surgery groups.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7004113/v1/973b60a6b4b00fd1a7b3c673.jpeg"},{"id":85837484,"identity":"2e20b184-f4fa-49ad-8d4f-260b292532b9","added_by":"auto","created_at":"2025-07-02 08:25:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":7679,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of education levels by treatment group in endometrial cancer patients.\u003cbr\u003e\nThe figure shows the number of patients in each education category for the brachytherapy group (blue) and the surgery-only group (green).\u003c/p\u003e","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7004113/v1/f2240c95b7b7bdd6ab908ead.png"},{"id":93533254,"identity":"51bb8ed6-3fd6-4cfe-bb27-4530994455d2","added_by":"auto","created_at":"2025-10-14 23:16:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1010895,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7004113/v1/d7a16324-47a7-4f1e-8577-feac258694ec.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of Sexual Function in Women with Endometrial Cancer and Their Partners Following Surgery versus Brachytherapy: A Cross-Sectional Study from a Tertiary Care Center","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eEndometrial cancer is the most common cancer of the female reproductive system and its incidence is increasing due to the aging and the obesity epidemic. About 85% are usually diagnosed in the early stage and has a excellent prognosis [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The first step in the treatment is laparoscopic or laparotomic hysterectomy and salpingoooferectomy [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Using the Mayo criteria [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] or based on sentinel lymph node status [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] a decision is made regarding lymphadenectomy. In order to determine the extent of lymphovascular invasion and also accurately stage the disease, pelvic and para-aortic lymph node dissection is added [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The use of adjuvant radiotherapy is determined by the risk of disease recurrence after surgery. Factors that increase the risk of recurrence include advanced age, advanced stage, depth of myometrial invasion, presence of lymphovascular invasion, histological type of tumor (e.g. serous or clear cell) and grade [\u003cspan additionalcitationids=\"CR7 CR8 CR9\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The ideal timing for initiating radiotherapy is within 6 to 8 weeks after surgery, depending on the patient\u0026rsquo;s postoperative recovery. As part of adjuvant treatment, in the absence of residual macroscopic tumor, three-dimensional endocavitary brachytherapy is applied for better dose distribution and protection of organs at risk [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The target area is the first third of the vagina and the vaginal cuff, applied to a depth of 5 mm. Depending on pathology results, the dose depth may be increased toward the paravaginal region or parametrium [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Organ-sparing dose limitations are based on the limitations defined for cervical cancer treatments. Bladder, rectum and bowel toxicities have been identified during the development of dose optimization in general, and the vagina has been limitedly included among the organs at risk in radiotherapy planning [\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Vaginal dryness, vaginal stenosis and loss of elasticity, fibrosis, inflammation, mucosal damage and ulceration are among the negative side effects of brachytherapy on the vagina. These physical effects can make sexual intercourse unpleasant or painful. Also, changes in the function and structure of the genitals can lead to feelings of inadequacy, emotional detachment and guilt [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In addition to the physical changes, these psychosexual effects result in anxiety, depression and aversion. More than 40% of women want to receive sexual counselling after treatment, yet these side effects are ignored and under-treated in patient management [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In our study, we aimed to evaluate the impact of the surgical procedure and brachytherapy used in the treatment of endometrial cancer on the sexual life of couples.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eA total of 69 patients receiving or not adjuvant treatment for endometrial cancer at Istanbul Başakşehir \u0026Ccedil;am and Sakura City Hospital and their partners were included in the study. The participants were divided into two groups: 35 patients in the surgery group and 34 patients in the brachytherapy group. Female participants completed the FSFI (Female Sexual Function Index) scale, while their partners completed the NSSS (New Sexual Satisfaction Scale). In addition, a follow-up form containing sociodemographic information was completed for each patient. This form included information about the patient's age, obstetric history, educational status, method of contraception, smoking and alcohol use, presence of chronic diseases, stage of endometrial cancer, the surgical procedure performed, and whether the patient received chemotherapy and/or brachytherapy.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eFemale Sexual Function Index\u003c/h2\u003e \u003cp\u003eFSFI is a multidimensional scale developed to assess women's sexual functioning, with proven validity and reliability. This scale, which consists of a total of 19 questions, examines female sexuality under six main headings: sexual desire, arousal, lubrication, orgasm, sexual satisfaction and pain during sexual intercourse. Each sub-dimension is assessed with specific questions and the scores of these sub-dimensions are summed to obtain an overall sexual function score. The total score varies between 2 and 36. A total score below 26.55 suggests that the woman has sexual dysfunction in general.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eNew Sexual Satisfaction Scale\u003c/h3\u003e\n\u003cp\u003eThe NSSS is a comprehensive and multidimensional scale developed to assess individuals' overall satisfaction with their sexual life. This scale, which can be applied to both men and women, takes into account not only the physical but also the emotional and psychological aspects of sexual satisfaction. The NSSS provides a holistic assessment of sexual satisfaction by focusing on various areas such as the quality of the sexual relationship, communication with the partner, emotional intimacy, sexual desire and performance. Participants respond to specific statements on a Likert-type scale and a total score is calculated based on these responses; higher scores indicate higher sexual satisfaction. This scale consists of a total of 20 questions and the total score is 100.\u003c/p\u003e \u003cp\u003eSexual function scores obtained from the FSFI and NSSS were compared between the brachytherapy and surgery groups. Their distributions are presented using box plots (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Additionally, education level was recorded as a key sociodemographic factor. The distribution of education levels by treatment group is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e, indicating that the majority of patients in both groups were primary school graduates, with no university graduates in the brachytherapy group.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe data obtained from the study were analyzed using Jamovi software and SPSS version 26. Descriptive statistics, were used to summarize the sociodemographic and clinical characteristics of the participants. The normality of the data distribution was assessed using skewness, kurtosis and the Shapiro-Wilk test. For comparisons between the two independent groups (brachytherapy vs. surgery), the Independent Samples t-test was used for normally distributed continuous variables, while the Mann-Whitney U test was applied for non-normally distributed variables. Categorical variables were compared using the Chi-square test or Fisher\u0026rsquo;s exact test, as appropriate. A p-value of less than 0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 69 patients were included in the study, although the number of patients analyzed per variable varied slightly due to missing data (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The mean age was 61,71\u0026thinsp;\u0026plusmn;\u0026thinsp;7,88 years in the brachytherapy group and 56,54\u0026thinsp;\u0026plusmn;\u0026thinsp;8,74 years in the surgery group (p\u0026thinsp;=\u0026thinsp;0,012). The mean BMI was 33,94\u0026thinsp;\u0026plusmn;\u0026thinsp;6,14 in the brachytherapy group and 31,61\u0026thinsp;\u0026plusmn;\u0026thinsp;6,04 in the surgery group (p\u0026thinsp;=\u0026thinsp;0,118). The median gravidity was 3,5 (0\u0026ndash;9) in the brachytherapy group and 3 (0\u0026ndash;5) in the surgery group (p\u0026thinsp;=\u0026thinsp;0,029), while the median parity was 3 (0\u0026ndash;6) versus 2 (0\u0026ndash;5), respectively (p\u0026thinsp;=\u0026thinsp;0,013).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Demographic and Obstetric Characteristics by Treatment Group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBrachytherapy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)*\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;34 / n\u0026thinsp;=\u0026thinsp;35)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61,71\u0026thinsp;\u0026plusmn;\u0026thinsp;7,88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56,54\u0026thinsp;\u0026plusmn;\u0026thinsp;8,74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,012\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBMI (kg/m\u0026sup2;)*\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;34 / n\u0026thinsp;=\u0026thinsp;35)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33,94\u0026thinsp;\u0026plusmn;\u0026thinsp;6,14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31,61\u0026thinsp;\u0026plusmn;\u0026thinsp;6,04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0,118\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGravidity**\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;34 / n\u0026thinsp;=\u0026thinsp;35)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,5 (0\u0026ndash;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (0\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,029\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParity**\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;34 / n\u0026thinsp;=\u0026thinsp;35)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (0\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0,013\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eEducation Level***\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;34 / n\u0026thinsp;=\u0026thinsp;32)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (15,2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (15,6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0,300\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (66,7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (43,8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMiddle school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6,1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (12,5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (12,1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (25,0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0,0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (3,1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eContraceptive Use***\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;33 / n\u0026thinsp;=\u0026thinsp;35)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (93,9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (100,0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,232\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCondom\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (6,1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0,0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSmoking Status***\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;33 / n\u0026thinsp;=\u0026thinsp;35)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (97,0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33 (94,3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,590\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (3,0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (5,7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcohol Use***\u003c/b\u003e \u003cem\u003e(n\u0026thinsp;=\u0026thinsp;34 / n\u0026thinsp;=\u0026thinsp;35)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (100,0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (100,0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eChronic Disease***\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;34 / n\u0026thinsp;=\u0026thinsp;35)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (14,7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (34,3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,059\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (85,3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (65,7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAbbreviations: NA; Non Applicable,\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e* Normally distributed data presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation; compared by independent samples t-test,\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e** Non-normally distributed data presented as median (minimum\u0026ndash;maximum); compared by Mann\u0026ndash;Whitney U test,\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*** Categorical variables presented as n (%); compared using the Chi-square or Fisher\u0026rsquo;s exact test, as appropriate\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn terms of education, no education was reported in 15,2% vs. 15,6%; primary school in 66,7% vs. 43,8%; middle school in 6,1% vs. 12,5%; high school in 12,1% vs. 25,0%; and university in 0,0% vs. 3,1% of the brachytherapy and surgery groups, respectively (p\u0026thinsp;=\u0026thinsp;0,300). Regarding contraceptive use, 93,9% in the brachytherapy group and 100,0% in the surgery group reported no use, while condom use was reported in 6,1% and 0,0%, respectively (p\u0026thinsp;=\u0026thinsp;0,232). Most patients were nonsmokers (97,0% vs. 94,3%; p\u0026thinsp;=\u0026thinsp;0,590), and none reported alcohol use (100,0% vs. 100,0%; NA). Chronic disease was present in 85,3% of the brachytherapy group and 65,7% of the surgery group (p\u0026thinsp;=\u0026thinsp;0,059).\u003c/p\u003e \u003cp\u003eSexual function and pain assessments are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The median Female Sexual Function Index (FSFI) score was 2 (2\u0026ndash;20,3) versus 2 (2\u0026ndash;19,6) in the brachytherapy and surgery groups, respectively (p\u0026thinsp;=\u0026thinsp;0,459). Male sexual satisfaction scores were 20 (20\u0026ndash;83) versus 20 (20\u0026ndash;90) (p\u0026thinsp;=\u0026thinsp;0,492). Sexual desire scores were 1,2 (1,2\u0026ndash;3,6) versus 1,2 (0\u0026ndash;3,0) (p\u0026thinsp;=\u0026thinsp;0,442), arousal scores were 0 (0\u0026ndash;3,9) versus 0 (0\u0026ndash;3,9) (p\u0026thinsp;=\u0026thinsp;0,881), lubrication scores were 0 (0\u0026ndash;3,9) versus 0 (0\u0026ndash;4,2) (p\u0026thinsp;=\u0026thinsp;0,234), orgasm scores were 0 (0\u0026ndash;4,0) versus 0 (0\u0026ndash;3,2) (p\u0026thinsp;=\u0026thinsp;0,336), satisfaction scores were 0,8 (0,8\u0026ndash;4,4) versus 0,8 (0,8\u0026ndash;3,6) (p\u0026thinsp;=\u0026thinsp;0,513), and pain scores were 0 (0\u0026ndash;6) versus 0 (0\u0026ndash;6) (p\u0026thinsp;=\u0026thinsp;0,310).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSexual Function Scores and Pain Assessment by Treatment Group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBrachytherapy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFemale FSFI Score**\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;32 / n\u0026thinsp;=\u0026thinsp;32)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (2\u0026ndash;20,3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2\u0026ndash;19,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,459\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMale Sexual Satisfaction**\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;25 / n\u0026thinsp;=\u0026thinsp;28)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (20\u0026ndash;83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (20\u0026ndash;90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,492\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSexual Desire**\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;31 / n\u0026thinsp;=\u0026thinsp;32)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1,2 (1,2\u0026ndash;3,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,2 (0\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,442\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eArousal**\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;31 / n\u0026thinsp;=\u0026thinsp;32)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0\u0026ndash;3,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0\u0026ndash;3,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,881\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLubrication**\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;31 / n\u0026thinsp;=\u0026thinsp;32)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0\u0026ndash;3,9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0\u0026ndash;4,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,234\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOrgasm**\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;31 / n\u0026thinsp;=\u0026thinsp;32)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0\u0026ndash;3,2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,336\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSatisfaction**\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;31 / n\u0026thinsp;=\u0026thinsp;32)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0,8 (0,8\u0026ndash;4,4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0,8 (0,8\u0026ndash;3,6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,513\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePain**\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;31 / n\u0026thinsp;=\u0026thinsp;32)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0,310\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eAbbreviations: FSFI\u0026thinsp;=\u0026thinsp;Female Sexual Function Index;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e**Non-normally distributed data presented as median (minimum\u0026ndash;maximum); compared by Mann\u0026ndash;Whitney U test,\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePathology and surgical characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Among patients with available data (n\u0026thinsp;=\u0026thinsp;33 vs. 35), Grade 1 tumors were observed in 6,1% vs. 62,9%; Grade 2 in 87,9% vs. 34,3%; and Grade 3 in 6,1% vs. 2,9% (p\u0026thinsp;\u0026lt;\u0026thinsp;0,001). The distribution of tumor stage (n\u0026thinsp;=\u0026thinsp;34 vs. 35) was as follows: Stage 1A, 73,5% vs. 97,1%; Stage 1B, 17,6% vs. 0,0%; and Stage 2, 8,8% vs. 2,9% (p\u0026thinsp;=\u0026thinsp;0,005). The surgical approach varied between groups (n\u0026thinsp;=\u0026thinsp;27 vs. 35): laparotomy was performed in 51,9% vs. 14,3%; laparoscopy in 44,4% vs. 82,9%; and robotic surgery in 3,7% vs. 2,9% (p\u0026thinsp;=\u0026thinsp;0,002).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePathological Grade, Stage, and Lymph Node Dissection by Treatment Group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBrachytherapy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eTumor Grade***\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;33 / n\u0026thinsp;=\u0026thinsp;35)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003csub\u003ea\u003c/sub\u003e (6,1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22\u003csub\u003eb\u003c/sub\u003e (62,9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0,001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003csub\u003ea\u003c/sub\u003e (87,9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003csub\u003eb\u003c/sub\u003e (34,3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrade 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003csub\u003ea\u003c/sub\u003e (6,1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003csub\u003ea\u003c/sub\u003e (2,9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eTumor Stage***\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;34 / n\u0026thinsp;=\u0026thinsp;35)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage 1A\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003csub\u003ea\u003c/sub\u003e (73,5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34\u003csub\u003eb\u003c/sub\u003e (97,1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e0,005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage 1B\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003csub\u003ea\u003c/sub\u003e (17,6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003csub\u003eb\u003c/sub\u003e (0,0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003csub\u003ea\u003c/sub\u003e (8,8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003csub\u003ea\u003c/sub\u003e (2,9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eSurgical Method***\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;27 / n\u0026thinsp;=\u0026thinsp;35)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLaparotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003csub\u003ea\u003c/sub\u003e (51,9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003csub\u003eb\u003c/sub\u003e (14,3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e0,002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLaparoscopy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003csub\u003ea\u003c/sub\u003e (44,4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003csub\u003eb\u003c/sub\u003e (82,9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRobotic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003csub\u003ea\u003c/sub\u003e (3,7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003csub\u003ea\u003c/sub\u003e (2,9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePelvic LND***\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;27 / n\u0026thinsp;=\u0026thinsp;35)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003csub\u003ea\u003c/sub\u003e (88,9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35\u003csub\u003eb\u003c/sub\u003e (100,0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0,043\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003csub\u003ea\u003c/sub\u003e (11,1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003csub\u003eb\u003c/sub\u003e (0,0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eParaaortic LND***\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;27 / n\u0026thinsp;=\u0026thinsp;35)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003csub\u003ea\u003c/sub\u003e (55,6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003csub\u003eb\u003c/sub\u003e (17,1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0,002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003csub\u003ea\u003c/sub\u003e (44,4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29\u003csub\u003eb\u003c/sub\u003e (82,9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSentinel LND***\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;27 / n\u0026thinsp;=\u0026thinsp;35)\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (14,8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (20,0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0,742\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (85,2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (80,0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eAbbreviations: LND\u0026thinsp;=\u0026thinsp;Lymph Node Dissection; NS\u0026thinsp;=\u0026thinsp;Not Significant (p\u0026thinsp;\u0026gt;\u0026thinsp;0,05)\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e***Categorical variables presented as n (%); compared using the Chi-square or Fisher\u0026rsquo;s exact test, as appropriate\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eCategories with the same subscript letter are not significantly different in terms of column proportions (p\u0026thinsp;\u0026gt;\u0026thinsp;0,05),\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePelvic lymph node dissection was performed in 88,9% vs. 100,0% of patients (p\u0026thinsp;=\u0026thinsp;0,043), paraaortic lymph node dissection in 55,6% vs. 17,1% (p\u0026thinsp;=\u0026thinsp;0,002), and sentinel lymph node dissection in 14,8% vs. 20,0% (p\u0026thinsp;=\u0026thinsp;0,742).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study is the first to examine both male and female sexual function specifically in the context of endometrial cancer. We analyzed the demographic characteristics of patients diagnosed with endometrial cancer and compared sexual function in both the patients and their partners across two treatment groups: those who underwent surgery alone and those who received additional brachytherapy. To our knowledge, this is the first study to comprehensively assess sexual function in both partners following treatment for endometrial cancer.\u003c/p\u003e \u003cp\u003eOur research differs from previous studies, including the most comparable work by Nowesieski et al. (2023), which evaluated sexual function in the broader context of gynecologic cancers. In contrast, our study focuses exclusively on endometrial cancer and includes a larger, more targeted sample of 69 patient-partner pairs. Additionally, it uniquely evaluates sexual function in both female patients and their partners following either surgery alone or adjuvant brachytherapy. In this regard, our study provides a more comprehensive and focused assessment across a broader range of parameters and patient profiles.\u003c/p\u003e \u003cp\u003eIn our cohort, the brachytherapy group consisted of 34 patients, while 35 received only surgical treatment. When examining demographic characteristics, we found that the majority of participants in both groups were primary school graduates. This finding contrasts with the study by Aygın and Eti Aslan, which involved the Turkish adaptation of the Female Sexual Function Index (FSFI) and reported that most participants were employed and had completed secondary education [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Despite these differences in educational background, both studies yielded similar findings in terms of parity, with most women having two or three children. This suggests that parity may be a more consistent demographic variable across different populations studied for sexual function, while education level and employment status may vary depending on the clinical setting and population characteristics.\u003c/p\u003e \u003cp\u003eTugut et al. (2016) examined the validity and reliability of the New Sexual Satisfaction Scale in a sample of adults in Turkey. The study found that the two-factor structure of the scale was preserved in the Turkish adult sample and that it demonstrated a high level of reliability. However, the majority of participants consisted of unemployed women with primary school education and employed men with university degrees [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In our study, while most participants were similarly primary school graduates, the distribution of educational status by gender was not clearly distinguished. Variables such as education and employment status need to be examined in more detail regarding their impact on sexual satisfaction.\u003c/p\u003e \u003cp\u003eOur study investigated both female and male sexual function in endometrial cancer patients who underwent either surgery alone or additional brachytherapy. Despite slight demographic differences between the group such as age, parity, and educational status, our results revealed no statistically significant differences in overall sexual function or pain scores between treatment modalities. The median Female Sexual Function Index (FSFI) scores were equally low in both groups, suggesting that sexual dysfunction is common regardless of the addition of brachytherapy. Similarly, male partners reported comparable levels of sexual satisfaction in both groups, indicating that the presence of brachytherapy did not significantly influence partner sexual experience.\u003c/p\u003e \u003cp\u003eIn our study, pelvic lymph node dissection was performed in the majority of patients in both groups (88.9% vs. 100.0%; p\u0026thinsp;=\u0026thinsp;0.043), while paraaortic lymph node dissection was significantly more frequent in the brachytherapy group (55.6% vs. 17.1%; p\u0026thinsp;=\u0026thinsp;0.002). Although no significant difference was observed in overall FSFI or NSSS scores between groups, the higher rate of paraaortic dissection in the brachytherapy group may partially contribute to the more pronounced sexual dysfunction observed in this cohort. This aligns with findings by Fujii et al. (2008), [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] who demonstrated that extensive lymphadenectomy, particularly involving paraaortic regions, may lead to autonomic nerve injury, thereby negatively impacting bladder, bowel, and sexual function in gynecologic oncology patients. While our study did not specifically assess nerve preservation, the higher incidence of sexual dysfunction in patients undergoing brachytherapy, combined with more extensive lymph node dissection, suggests a possible cumulative effect on pelvic autonomic innervation. These findings support the need for further research into nerve-sparing surgical approaches, particularly in patients likely to require adjuvant radiotherapy.\u003c/p\u003e \u003cp\u003eIn contrast, the study by Nowosielski et al. (2023), which included 30 gynecologic cancer survivors and their male partners, found more nuanced gender differences in sexual adaptation following treatment. Specifically, while female survivors reported a decline in sexual frequency, male partners paradoxically reported an increase Moreover, women in that study demonstrated higher sexual inhibitory tone and more body image concerns than their partners, revealing a potential divergence in sexual recovery trajectories within couples after cancer treatment [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUnlike the findings of Nowosielski et al., where inter-partner discrepancies in sexual interest and perception were clearly documented, our study observed no significant difference in sexual function between genders or between treatment arms. This could be due to differences in sample characteristics, cancer types, or cultural factors, including conservative attitudes toward sexuality, as the majority of our participants were primary school graduates and did not use contraceptives, indicating a potentially lower baseline level of sexual activity and openness. Additionally, in our study population, none of the patients reported alcohol use and over 95% were nonsmokers, which may also reflect more traditional lifestyle patterns and potentially contribute to sexual conservatism.\u003c/p\u003e \u003cp\u003eIn our study, female sexual dysfunction was prevalent in both the brachytherapy and surgery-only groups, with equally low median FSFI scores. This aligns with the findings of Damast et al., who reported sexual dysfunction in 81% of endometrial cancer survivors treated with high-dose-rate intravaginal brachytherapy, with impaired scores across all FSFI domains [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Notably, our data suggest that the addition of brachytherapy did not further worsen sexual outcomes, possibly due to already low baseline sexual activity and sociocultural factors, such as limited education and conservative sexual behavior. While Damast et al. identified laparotomy as a predictor of poorer sexual function, in our cohort, the higher laparotomy rate in the brachytherapy group did not translate into statistically worse FSFI scores, highlighting the complex interplay of treatment and demographic influences on sexual health.\u003c/p\u003e \u003cp\u003eThese findings underscore the importance of contextualizing sexual health outcomes in oncology not only by treatment modality but also by sociocultural background, gender dynamics, and relationship factors.\u003c/p\u003e \u003cp\u003eIn a study reported by Datta et al. in 2023, which included 132 patients who underwent surgery alone, surgery followed by brachytherapy, or surgery followed by chemoradiotherapy, 89% of participants continued to report low sexual function scores one year after treatment. Being over the age of 50 and having an education level below a university degree were identified as significant predictors of impaired sexual function. The study also emphasized that women who underwent surgery alone reported better quality of life compared to those who received adjuvant therapy, with the lowest quality of life scores observed in women who received chemoradiotherapy [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In contrast, in our study, sexual function remained similarly low across all treatment groups, with no statistically significant differences found between them. This suggests that factors beyond treatment modality such as age, partner relationship quality, communication levels, and psychological adaptationn may play a more critical role in determining post-treatment sexual health outcomes.\u003c/p\u003e \u003cp\u003eOur results align partially with a recent study comparing early-stage endometrial cancer patients who received intravaginal brachytherapy (IVB) with those treated by surgery alone, which reported similar outcomes in terms of quality of life and female sexual function, although male partner function was not evaluated [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In contrast, another study focusing on high-dose-rate (HDR) IVB involving treatment of a\u0026thinsp;\u0026ge;\u0026thinsp;6 cm vaginal cuff found significantly higher rates of sexual dysfunction among brachytherapy patients compared to those who had surgery alone [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The discrepancy may stem from differences in radiation dose, vaginal length irradiated, and inclusion criteria. Notably, our cohort had relatively short vaginal cuff targets, and sociocultural characteristics such as low educational attainment and conservative sexual practices may have contributed to universally low FSFI scores, thus diminishing the observable difference between treatment arms.\u003c/p\u003e \u003cp\u003eThis study has several limitations. The study population was characterized by low educational attainment, limited contraceptive use, and conservative sexual behavior, which may have led to universally low FSFI scores and potentially masked more subtle treatment-related effects. Sexual function was assessed at a single time point post-treatment, precluding evaluation of longitudinal changes. Additionally, validated sexual function questionnaires for male partners were not employed; instead, partner sexual satisfaction was self-reported in a simplified manner. Finally, psychological factors, hormonal status, and relationship quality which are known to influence sexual function were not systematically evaluated.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThis study is the first to comprehensively evaluate both female and male sexual function in endometrial cancer patients, comparing outcomes between those treated with surgery alone and those who received additional brachytherapy. Our findings indicate that female sexual dysfunction is highly prevalent in both groups, with no significant difference attributable to the addition of brachytherapy. Importantly, male partner sexual satisfaction also did not differ between treatment arms, highlighting that radiotherapy may not further impair sexual outcomes in this context.\u003c/p\u003e \u003cp\u003eThe inclusion of male partners adds a unique dimension to this research, offering insight into the dynamics of sexual health within couples affected by gynecologic malignancies. These findings underscore the need to consider both partners in survivorship care, particularly in cultural contexts where sexual conservatism and lower baseline sexual activity may obscure the impact of treatment. Further studies with more diverse populations are warranted to better understand the interplay between oncologic therapy, relationship dynamics, and cultural factors in sexual recovery.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody Mass Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFSFI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFemale Sexual Function Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHDR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHigh-Dose Rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIVB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntravaginal Brachytherapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNSSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNew Sexual Satisfaction Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e This study was approved by the Ethics Committee of Başakşehir \u0026Ccedil;am and Sakura City Hospital (Approval Number: E-96317207-514.10-262311282, Date: 16 December 2024). Written informed consent was obtained from all participants prior to enrollment. All procedures involving human participants were conducted in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Written informed consent for publication was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e Conceptualization: G.G.; Methodology: G.G., C.T.; Data curation: E.D., S.N.E., İ.T.Y.; Formal analysis: A.B., C.T., E.T.; Investigation: Y.\u0026Ouml;.\u0026Ouml;., S.\u0026Ouml;.K.; Resources: N.A.V., \u0026Ccedil;.E.; Visualization: E.K.; Writing \u0026ndash; original draft: G.G.; Writing \u0026ndash; review \u0026amp; editing: C.T., Z.Z.S., F.E.\u0026Ccedil;.; Supervision: A.Y.B., E.T. All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eColombo N, Creutzberg C, Amant F, Bosse T, Gonzalez-Martin A, Ledermann J, Marth C, Nout R, Querleu D, Mirza MR et al. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up. \u003cem\u003eInternational Journal of Gynecological Cancer\u003c/em\u003e 2016, 26(1):2\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCorr B, Erickson B, Barber E, Fisher C, Slomovitz B. Advances in the management of endometrial cancer. BMJ (Clinical Res ed). 2025;388:e080978.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerreiro JA, Myers JL, Bostwick DG. Accuracy of frozen section diagnosis in surgical pathology: review of a 1-year experience with 24,880 cases at Mayo Clinic Rochester. Mayo Clin Proc. 1995;70(12):1137\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClark C, Loizzi V, Cormio G, Lopez S. Sentinel Lymph Node Assessment in Endometrial Cancer: A Review. Cancers (Basel) 2024, 16(18).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrost JA, Webster KE, Bryant A, Morrison J. Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev. 2015;2015(9):Cd007585.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChargari C, Peignaux K, Escande A, Renard S, Lafond C, Petit A, Hannoun-L\u0026eacute;vi JM, Durdux C. Haie-M\u0026eacute;der C: Radiotherapy for endometrial cancer. Cancer Radiother. 2022;26(1\u0026ndash;2):309\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan den Heerik A, Horeweg N, Creutzberg CL, Nout RA. Vaginal brachytherapy management of stage I and II endometrial cancer. Int J Gynecol Cancer. 2022;32(3):304\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParsons MW, Huang YJ, Burt L, Suneja G, Gaffney D. Vaginal cuff brachytherapy for endometrial cancer: a review of major clinical trials with a focus on fractionation. Int J Gynecol Cancer. 2022;32(3):311\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim J, Lee KJ, Park KR, Ha B, Kim YJ, Jung W, Lee R, Kim SC, Moon HS, Ju W, et al. Treatment outcomes after adjuvant radiotherapy following surgery for patients with stage I endometrial cancer. Radiat Oncol J. 2016;34(4):265\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan den Heerik A, Horeweg N, de Boer SM, Bosse T, Creutzberg CL. Adjuvant therapy for endometrial cancer in the era of molecular classification: radiotherapy, chemoradiation and novel targets for therapy. Int J Gynecol Cancer. 2021;31(4):594\u0026ndash;604.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJensen PT, Froeding LP. Pelvic radiotherapy and sexual function in women. Transl Androl Urol. 2015;4(2):186\u0026ndash;205.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWarring S, Yost KJ, Cheville AL, Dowdy SC, Faubion SS, Kumar A, Lemens MA, Van Oort CC, Fought AJ, Mc Gree ME, et al. The Quality of Life after Endometrial Cancer Study: Baseline Characteristics and Patient-Reported Outcomes. Curr Oncol. 2024;31(9):5557\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarcellini A, Dominoni M, Dal Mas F, Biancuzzi H, Venturini S, Gardella B, Orlandi E, B\u0026oslash; K. Sexual Health Dysfunction After Radiotherapy for Gynecological Cancer: Role of Physical Rehabilitation Including Pelvic Floor Muscle Training. Front Med. 2022;8:813352.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAygin D, Aslan F. The Turkish adaptation of the Female Sexual Function Index. Turkiye Klinikleri J Med Sci. 2005;25:393\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTugut N. Yeni Cinsel Doyum \u0026Ouml;l\u0026ccedil;eği\u0026rsquo;nin T\u0026uuml;rk\u0026ccedil;e versiyonu: Ge\u0026ccedil;erlik ve g\u0026uuml;venirlik \u0026ccedil;alışması. Yeni Cinsel Doyum \u0026Ouml;l\u0026ccedil;eği\u0026rsquo;nin T\u0026uuml;rk\u0026ccedil;e versiyonu: Ge\u0026ccedil;erlik ve g\u0026uuml;venirlik \u0026ccedil;alışması 2016, 4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFujii S. Anatomic identification of nerve-sparing radical hysterectomy: a step-by-step procedure. Gynecol Oncol. 2008;111(2 Suppl):S33\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNowosielski K, Pałka A. Couples' sexual health after gynaecological cancer diagnosis - an unexplored area for further research. Contemp Oncol (Pozn). 2023;27(1):47\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDamast S, Alektiar KM, Goldfarb S, Eaton A, Patil S, Mosenkis J, Bennett A, Atkinson T, Jewell E, Leitao M, et al. Sexual functioning among endometrial cancer patients treated with adjuvant high-dose-rate intra-vaginal radiation therapy. Int J Radiat Oncol Biol Phys. 2012;84(2):e187\u0026ndash;193.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDatta A, Ram TS, Karuppusami R, Thomas A, Sebastian A, Thomas V, Chandy RG, Peedicayil A. A longitudinal study of sexual health and quality of life in endometrial carcinoma survivors. Int J Gynecol Cancer. 2023;33(6):890\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNout RA, Putter H, J\u0026uuml;rgenliemk-Schulz IM, Jobsen JJ, Lutgens LC, van der Steen-Banasik EM, Mens JW, Slot A, Stenfert Kroese MC, Nijman HW, et al. Five-year quality of life of endometrial cancer patients treated in the randomised Post Operative Radiation Therapy in Endometrial Cancer (PORTEC-2) trial and comparison with norm data. Eur J Cancer. 2012;48(11):1638\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSorbe B, Nordstr\u0026ouml;m B, M\u0026auml;enp\u0026auml;\u0026auml; J, Kuhelj J, Kuhelj D, Okkan S, Delaloye J-F, Frankendal B. Intravaginal Brachytherapy in FIGO Stage I Low-Risk Endometrial Cancer: A Controlled Randomized Study. Int J Gynecol Cancer. 2009;19(5):873\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Endometrial cancer, Brachytherapy, Sexual function, Female Sexual Function Index (FSFI), New Sexual Satisfaction Scale (NSSS), Partner satisfaction, Gynecologic oncology, Quality of life, Radiotherapy side effects","lastPublishedDoi":"10.21203/rs.3.rs-7004113/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7004113/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eEndometrial cancer is the most common malignancy of the female reproductive tract, with a globally increasing incidence and mortality rate. Standard treatment includes surgery, with adjuvant radiotherapy and/or chemotherapy based on factors such as myometrial invasion and histological grade. Among these, the physical and psychological impact of radiotherapy, particularly brachytherapy on sexual health, is often underestimated. This study aimed to compare female sexual dysfunction and male partner sexual satisfaction in endometrial cancer patients who received surgery alone versus those who received additional brachytherapy. To our knowledge, this is the first study to comprehensively assess sexual function in both patients and their partners in this context.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eSixty-nine patients were included. Group 1 (n\u0026thinsp;=\u0026thinsp;34) received adjuvant brachytherapy after surgery; Group 2 (n\u0026thinsp;=\u0026thinsp;35) underwent surgery only. Participants completed a structured questionnaire including socio-demographic and clinical data, along with validated instruments: the Female Sexual Function Index and the New Sexual Satisfaction Scale for partners.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe mean age was significantly higher in the brachytherapy group (61.71\u0026thinsp;\u0026plusmn;\u0026thinsp;7.88 vs. 56.54\u0026thinsp;\u0026plusmn;\u0026thinsp;8.74 years; p\u0026thinsp;=\u0026thinsp;0.012). Gravidity (p\u0026thinsp;=\u0026thinsp;0.029) and parity (p\u0026thinsp;=\u0026thinsp;0.013) were also higher in this group, while body mass index was similar (p\u0026thinsp;=\u0026thinsp;0.118). Female sexual function index scores [2 (2\u0026ndash;20.3) vs. 2 (2\u0026ndash;19.6); p\u0026thinsp;=\u0026thinsp;0.459] and new sexual satisfaction scale scores [20 (20\u0026ndash;83) vs. 20 (20\u0026ndash;90); p\u0026thinsp;=\u0026thinsp;0.492] showed no significant differences. Female sexual function index subdomain scores were also comparable. Tumor grade and stage significantly differed between groups, as did surgical approach and lymphadenectomy rates.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eSexual function was negatively affected in all endometrial cancer patients, with a more pronounced impact among those receiving brachytherapy and their partners. These findings highlight the need to consider sexual health in treatment planning and to implement supportive interventions such as psychosexual counseling, particularly for patients undergoing adjuvant radiotherapy.\u003c/p\u003e","manuscriptTitle":"Comparison of Sexual Function in Women with Endometrial Cancer and Their Partners Following Surgery versus Brachytherapy: A Cross-Sectional Study from a Tertiary Care Center","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-02 08:25:39","doi":"10.21203/rs.3.rs-7004113/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0dd97fde-cad5-4fb8-b1fe-f4122f81a494","owner":[],"postedDate":"July 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-14T23:08:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-02 08:25:39","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7004113","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7004113","identity":"rs-7004113","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}