Breaking the sexual silence of cancer survivors: exploration of sexual distress and health communication paths after cervical cancer surgery based on qualitative interviews

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Methods : A total of 12 cervical cancer patients who attended the outpatient department of a tertiary hospital in Jiangnan, were selected for participation in semi-structured in-depth interviews. The collected interview data were analyzed using Braun and Clarke’s thematic analysis approach, supported by the use of Nvivo 12 software. Results : The study identified five major themes: sexual function injury (encompassing physical dysfunction and female role trauma), which is deeply intertwined with biological, psychological, and sociocultural factors; disrupted intimate relationships (characterized by misaligned needs and the paradox of silent protection); systemic silence (manifested through medical aphasia and social stigma); communication pathways (including personalized medical communication, as well as peer and media-based empowerment); and the recognition of sexual health as a critical social issue. Conclusions: Sexual dysfunction in patients following cervical cancer surgery arises from the combined effects of physiological damage and sociocultural norms. To address the issue of "sexual silence," it is essential to establish a patient-centered, multi-disciplinary health communication system that facilitates the reclassification of sexual health from a "taboo subject" to an essential component of rehabilitation. Healthcare professionals should proactively offer comprehensive medical guidance, psychological support, and interventions aimed at reducing social stigma. These measures can help improve patients' sexual function, enhance intimate relationships with their partners, and ultimately elevate their overall quality of life. Cervical cancer Radical resection of cervical cancer Sexual dysfunction Qualitative research Health information dissemination Figures Figure 1 Introduction Cervical cancer is one of the most common gynecological malignancies, originating from cervical epithelial neoplasia [1] . According to data released by the International Agency for Research on Cancer (IARC), cervical cancer ranks as the leading cause of cancer in women in 23 countries and the primary cause of cancer-related mortality among women in 36 countries. It is the fourth most prevalent and lethal female malignancy in terms of both incidence and mortality. The average age at diagnosis is 49 years, with a noticeable trend toward younger onset [2-4] . With advancements in medical treatment, the five-year survival rate for cervical cancer has improved [5] , and the World Health Organization emphasizes the importance of enhancing the long-term quality of life for cancer survivors [6] . However, the treatment of cervical cancer—particularly radical surgical interventions—often results in significant sexual dysfunction. Patients may experience vaginal dryness or shortening, dyspareunia, decreased libido, orgasmic disorders, and pelvic pain [7-10] . These complications can negatively impact patients' mental health and overall quality of life, and in severe cases, may impair their intimate relationships with partners. In Asia, for example, a meta-analysis conducted in China reported that the prevalence of sexual dysfunction among cervical cancer patients was as high as 76%, with 72% of those who underwent radical surgery experiencing such issues [11] . Sexual dysfunction may persist for two years or even longer following radical treatment [12-14] . Despite its high prevalence, influenced by traditional cultural norms, many Asian patients tend to remain silent due to feelings of shame, embarrassment, and concerns about their partners’ reactions [8-10] . Communication between healthcare providers and patients regarding sexual function remains significantly inadequate. Studies have indicated that as many as 82.4% of cervical cancer patients choose not to discuss these issues due to cultural taboos [15] . The lack of effective communication channels and insufficient doctor-patient interaction further prevent patients from seeking assistance for sexual health improvement [16] . Current research has primarily focused on the incidence and classification of sexual dysfunction, with limited in-depth exploration of patients' subjective experiences, coping strategies, informational needs, and preferred modes of communication and support. This study aims to explore the specific manifestations, impacts, and emotional experiences related to sexual function among female cervical cancer survivors through in-depth interviews. It also seeks to identify the barriers these women face when seeking information and support regarding sexual health, examine their perspectives on current doctor-patient communication practices and unmet needs, and investigate the pathways they perceive as effective for delivering health-related information and support. Methods 1.1 Research Design: This study adopted a descriptive qualitative approach to investigate patients who had undergone radical surgery for cervical cancer. Data were primarily collected through semi-structured in-depth interviews, and the reporting adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ). 1.2 Study Sites and Participant Recruitment: 1.2.1 This study will be conducted from December 2024 to April 2025 at the Oncology Department and Gynecological Oncology Outpatient and Follow-up Center of a large tertiary hospital in Wuxi, Jiiangsu Province. The study has been approved under ethics number LS2024294. 1.2.2 A purposive sampling approach combined with maximum variation sampling was employed to ensure diversity across key demographic characteristics, including age, time since radical cervical cancer surgery, educational background, occupation, and place of residence (urban vs. rural). 1.2.3 Criteria for Patient Inclusion and Exclusion: Inclusion criteria: Patients diagnosed with cervical cancer who had undergone major surgical treatment at least six months prior to enrollment; Age≥18 years; A history of sexual activity before surgery; Ability to communicate clearly and willingness to participate in the interview; Provision of informed consent by the patient. Exclusion criteria included cancer recurrence or metastasis, preoperative sexual dysfunction, a history of psychological sexual dysfunction, and severe cognitive or mental impairment that prevented the patient from cooperating with the interview. 1.3 The recruitment process involved initial screening of eligible patients by medical staff for follow-up. Researchers then introduced the study to the patients and obtained their informed consent. During this stage, participants were informed that the interview would cover topics related to sexual health, and their understanding and voluntary participation were confirmed. The plan was to recruit between 10 and 20 participants, with data saturation serving as the criterion for stopping recruitment—defined as the point at which no new significant themes or insights emerged from subsequent interviews. 1.4 Interview Outline: The interview outline was developed based on a comprehensive literature review and the research objectives. Following expert consultation and a pilot interview with two patients, the outline was revised accordingly. The final interview outline consists of 8 dimensions, as shown in Table 1. Table 1. Summary of Interviews on Patients' Sexual Function Following Radical Hysterectomy for Cervical Cancer 1. Postoperative Physical Changes and Sensations (with Particular Attention to Sexual Function) A.What physical changes following your surgery have had the most significant impact on your sexual health or intimate relationships? Could you please share your feelings and experiences regarding these changes? B.Do these physical changes give you new concerns about intimacy? 2. Specific Experiences of Sexual Distress (Physical, Psychological, and Relational Dimensions) C.What is the most troubling physical problem you have encountered during sexual or intimate interactions? How does (e.g. location of pain, dryness, changes in pleasure, etc.) affect daily life? D.Does this change make you feel anxious or frustrated? E.What are the significant changes in intimate relationships (e.g., the frequency and style of interactions with partners) after surgery? What specific effects have these changes had on your relationship? 3.Experiences and Challenges in Communicating with Partners Regarding Sexual Issues F.Have you talked to your partner about sexual distress or changes in intimacy after surgery? G.What is the biggest difficulty in communication? (such as difficult to speak, partner does not understand, fear of conflict, etc.) do you choose to avoid it for a while? H.If your partner actively cares about your sexual health, how would you most like him to support you? (such as listening, seeking help together, adjusting intimacy, etc.) 4.Experiences and Challenges in Communicating with Partners Regarding Sexual Issues I.Did the medical staff (doctor/nurse) initiate conversations with you about sexual health or intimacy after surgery? If so, what are the main contents? If not, have you thought about asking? J.When and how would you like your health care provider to discuss sexual health with you? What information do you most want from them? 5.Access to and experience of sexual health information K.Through what channels have you learned about postoperative sexual health? (such as medical care, patients, Internet, science materials, etc.) What sources of information do you find most useful/least trustworthy? L.Does the information currently available meet your needs? What would you like to know more about? 6. Unmet needs for information and support M.What needs regarding sexual health or intimacy have you had that have not been addressed since your surgery? How have you been affected by these unmet needs? N.Have you ever felt "alone" in this regard? Where does this loneliness mainly come from? (such as family avoidance, medical neglect, social taboo, etc.) 7.Suggestions for ideal support/communication paths O.If there is a dedicated support service, who do you think would be most helpful to you by participating? (e.g., doctors, nurses, rehabilitators, patients, partners, etc.) what forms of help do they want? (One-on-one consultation, group activities, online platforms, etc.) P.What specific content would you like to see included in such support services? (can be specific to medical guidance, psychological counseling, communication skills, emotional support, etc.) in which stage would you prefer to intervene after surgery? 8. Emotional connection Q.What do you think is the biggest significance of breaking the "sexual silence" for cancer survivors? If you had the opportunity to say a word to a patient who had the same experience, what would you say 1.5 Interview implementation: One-to-one interviews were conducted in a private and quiet setting by trained female interviewers with strong communication skills and empathetic dispositions. Each session lasted approximately 45 to 60 minutes. The entire interview process was audio-recorded, and brief field notes were taken concurrently. Participants’ confidentiality was strictly maintained, and access to emotional support resources, including psychological counseling hotlines, was provided. 1.6 Data Analysis: Interview data were anonymized and stored on encrypted hard drives. The data were transcribed and verified by the participants. Thematic analysis was conducted using Braun and Clarke’s six-step method with the support of NVivo 12, a qualitative data analysis software. To ensure reliability, two researchers independently coded and analyzed a portion of the interview transcripts, and any discrepancies were resolved through discussion. Result 1.1 Participant Characteristics: This study ultimately included a total of 12 patients diagnosed with cervical cancer who had undergone radical hysterectomy. The demographic and clinical characteristics of the participants are summarized in Table 2. Table 2 General Characteristics of Patients Participating in Qualitative Interviews Following Radical Cervical Cancer Surgery Age (years) Marital status Type of surgery Duration of surgery Pathological staging Degree of education Place of residence Occupations P1 32 Married Radical hysterectomy and pelvic lymph node dissection were performed 18 Ⅱ Undergraduate Cities Enterprise administrative director P2 45 Married Radical hysterectomy 24 Ⅰ Junior college Cities Primary school teacher P3 28 Unmarried Cervical conization 12 Ⅰ Master's degree Cities Internet Company programmer P4 50 Get divorced Radical hysterectomy 30 Ⅱ High school Cities Individual clothing store owner P5 38 Married Laparoscopic hysterectomy was performed 20 Ⅰ Undergraduate Cities Accounting P6 42 Married Hysterectomy plus bilateral adnexectomy 26 Ⅱ Technical secondary school Rural areas A supermarket cashier P7 35 Married Radical hysterectomy 16 Ⅰ Junior college Cities Customer Service Specialist P8 48 Married Radical hysterectomy 22 Ⅱ Junior high school Rural areas Farmer P9 30 Unmarried Cervical cold knife conization 14 Ⅱ Undergraduate Cities Marketing Specialist P10 43 Married Radical hysterectomy 28 Ⅱ Technical secondary school Cities Factory worker P11 36 Married Radical hysterectomy 18 Ⅱ Junior high school Rural areas Domestic service staff P12 40 Married Abdominal hysterectomy and double adnexectomy were performed 24 Ⅱ Junior college Urban and rural settlements Reporter 1.2 Theme refinement 1.2.1 Biopsychosocial Aspects of Sexual Dysfunction 1.2.1.1 Physical dysfunction and uncertainty regarding rehabilitation following radical resection of cervical cancer: The procedure often disrupts the anatomical structure and neural integrity of the vaginal region, resulting in persistent physiological complications such as pain and dryness. These complications are the primary contributors to impaired sexual health among patients. Such somatic symptoms not only diminish the comfort associated with sexual activity but also provoke prolonged anxiety due to the unpredictable nature of recovery timelines. P1 : "The first time after surgery, I felt that the vagina was as hard as stone; going a little deeper caused tearing pain … I still feel sick." (Persistent anxiety related to physical pain) . P2 : "The vagina is very dry, and lubricants are ineffective; I have gradually lost the desire for sexual activity." (Dual impact on sexual desire due to physiological impairment). 1.2.1.2 Female Role Trauma and Self-Identity Crisis: The alteration in physical appearance and the loss of reproductive organs due to surgical trauma lead patients to deeply question their gender roles and sexual attractiveness. This disruption in body image not only affects self-perception but also undermines sexual confidence through psychological internalization, potentially resulting in sexual avoidance behaviors. P3 : "The postoperative scar on my body is unattractive, and my abdomen has become loose and enlarged. I no longer wish to look at my own body." (Scarring provokes a sense of diminished self-worth.) P5 : "After the hysterectomy, my body feels hollow. Am I still considered a complete woman?" (Organ loss contributes to uncertainty in gender identity.) 1.2.2 Communication Breakdown and Emotional Disconnection in Close Relationships 1.2.2.1 The imbalance in demand-response dynamics within partner interactions arises from a misalignment in sexual needs and emotional expression between postoperative patients and their partners. This mismatch perpetuates a vicious cycle of mutual misunderstanding and communication avoidance in intimate relationships. Partners’ limited understanding of the patient’s physiological changes, coupled with the patient’s emotional suppression, further widens the relational divide. P5: "He believed that I refused intimacy because I thought he was unclean, but in reality, I was concerned that bleeding from the wound might distress him. I was thinking about his feelings. Why can't he see that?" (Emotional dislocation) P6 : "At night, when his hand casually moved toward my waist, I couldn ’ t help tensing up involuntarily. He sighed and turned over to sleep. ... It feels as though he no longer cares for me as much as before." (Trust cracks in nonverbal interactions). 1.2.2.2 The paradox of silence as a relationship protection mechanism lies in the fact that although patients perceive silence as a strategy to preserve relational harmony, this form of "protective avoidance" ultimately exacerbates emotional detachment between partners. Social and cultural taboos surrounding sexuality, combined with patients' internalized stigma, render silence the default norm within intimate relationships. P7 : "When he wanted to talk about it, I immediately said, 'I'm tired today.' In reality, I was afraid that discussing it would force us to confront the reality of 'what if we can't be cured?' Pretending to be normal allows us to maintain at least an appearance of harmony." (This illustrates the use of silence to avoid deeper communication.) P8 : "From childhood onward, people have consistently avoided using the word 'sex', and now no one dares to mention it since my illness. It seems that as long as I don ’ t speak about it, my sexual concerns simply do not exist." (This reflects a culturally ingrained silence regarding sexual needs.) 1.2.3 The Dual Constraints of Systematic Silence: Medical Avoidance and Social Stigma 1.2.3.1 Sexual health "aphasia" in the medical field: The current medical system tends to overlook issues related to sexual health, making it difficult for patients to access professional support. The avoidance behaviors of healthcare professionals, the absence of standardized diagnostic and treatment protocols, and inappropriate communication styles further exacerbate patients' feelings of helplessness and stigma. P6 : "After the surgery, the nurse was very attentive to my general health, but no one addressed how to manage marital life post-operation. They simply advised me to avoid sexual activity as much as possible within the first six months, without providing any detailed guidance." (This highlights the lack of a standardized care process.) P9 : "When I consulted with a male doctor, I hesitated to mention 'vaginal dryness' and only described it as 'discomfort below.' It was not until I spoke with a female nurse that I felt comfortable enough to ask about it directly. She recommended trying an over-the-counter lubricant suppository. That was the first time I truly felt supported." (This illustrates the significant influence of gender on patients' willingness to communicate openly.) 1.2.3.2 The "sexless" construction within social discourse: Social culture persistently reinforces the stigmatization of the sexual needs of cancer patients through familial, media, and public discourses. This form of "non-sexual" regulation not only deprives patients of their right to self-expression but also marginalizes sexual health concerns into a societal taboo. P11 : "After I left the hospital, my relatives came to visit, and I overheard them advising my husband not to engage in sexual activity with me, as if my illness could be transmitted to him through intercourse." (Stigmatization and linguistic violence at the familial level) . P12 : "I have read numerous posts regarding cervical cancer rehabilitation and comments addressing sexual issues. Most responses are along the lines of 'why do you want to preserve your sex life?' or 'sexual activity will only drain your energy', yet few truly acknowledge our actual needs." (Invisible regulation within public discourse space). 1.2.4 Desire to Break the Status Quo: Calls for Health Communication through Multi-Subject Participation 1.2.4.1 The core expectation of individualized medical communication lies in patients’ emphasis on three key dimensions: timeliness, professionalism, and humanization. Patients expect healthcare providers to bridge the information gap by delivering targeted health guidance in a more proactive, confidential, and comprehensible manner. P3 : "I would like a photo book illustrating potential sexual issues that may arise after surgery, preferably with a QR code linking to a doctor for immediate consultation at any time." (The irreplaceability of non-verbal communication tools). P11: "Every time doctors or nurses check on my wound healing, if a nurse could take me to a safe and private space to ask about how I ’ ve been getting along with my husband recently, whether there ’ s any discomfort, and allow me to share my concerns and emotional distress, it would make a big difference." (The significant impact of communication timing and style on patients). 1.2.4.2 Dual empowerment effects of peer and media: Peer experience sharing and health communication through the media were recognized as crucial forces in breaking the silence surrounding sensitive health issues. Patients expressed a strong desire to achieve emotional resonance and obtain practical advice through peer narratives. They also urged the media to address sexual health topics in a more open, scientific, and responsible manner in order to reduce social stigma. P4 : "In the patient group, I saw someone share 'using warm saline sitz bath to relieve sexual pain,' and after trying it for two weeks, I found it effective. ... I am not alone in experiencing this pain, nor should I be expected to endure it silently." (Practical value and emotional comfort derived from peer experience sharing) . P10 : "If there was a media program — even just a short video of a few minutes — in which doctors explained that sexual recovery is as important as wound healing, I would have experienced less psychological pressure, and more people would have become aware of this issue." (Mass media as a tool for knowledge-based empowerment). 1.2.5 From Silence to Voice: Sexual Health as a Critical Social Issue 1.2.5.1 The ontological significance of breaking silence: Patients challenge societal norms and elevate their sexual health needs to the level of quality of life and personal integrity. They emphasize that sexual health is not an optional "add-on," but a core component that must be addressed throughout the recovery process. P3 : "I didn't want to get cancer, nor did I wish for my life to revolve around chemotherapy and healing. Isn't it natural to experience sexual difficulties? I desire greater physical respect." (Sexual health rises to the level of human dignity). P12 : "The surgery removed my uterus; however, why does society continue to perceive cancer patients solely as medical cases to be reassessed in hospital beds? We deserve to live full lives after discharge. This aspect is undeniably part of who I am. I want to be more courageous in expressing my sexual needs and hope that more people will join me in speaking out." (The desire to break the silence and assert bodily autonomy). Discussion Through qualitative interviews, this study elucidated the multidimensional complexity of sexual health challenges faced by patients following cervical cancer surgery. By integrating perspectives from nursing and journalism, the research identified that societal public opinion and the absence of discourse within the medical field collectively form systemic barriers to expressing sexual health needs. Furthermore, it highlighted that health communication interventions represent a critical pathway to addressing this issue. The conceptual framework of this study is shown in Figure 1. 1.1 Multi-Dimensional Impacts on Sexual Function at the Biopsychosocial Level: The Dual Burden of Physiological Impairment and Sociocultural Norms Vaginal stenosis, dryness, and other forms of physical functional impairment resulting from radical cervical cancer surgery create a vicious cycle in conjunction with postoperative depression and female role disruption [15] . Importantly, this study reveals that social attitudes further intensify patients' self-imposed restrictions through stigmatizing language within family settings and implicit societal norms in public discourse. The underlying nature of this "neutralizing" mechanism is to redefine cancer survivors primarily as "bodies requiring medical intervention," thereby denying them the recognition and legitimacy to express their emotional and psychological needs as whole individuals. According to Erving Goffman's theory of stigma, individuals with chronic or socially sensitive illnesses often face social exclusion and marginalization [17] . Cervical cancer survivors, in particular, may be viewed as "deviant" or "incomplete" in terms of their social identity due to the disease's association with sexual health. At the societal level, insufficient public education has led to widespread misconceptions, wherein cervical cancer is frequently equated with behaviors such as promiscuity or poor personal hygiene. These misperceptions can heighten barriers to social interaction [18-19] . When patients encounter sexual dysfunction, they may internalize these external negative judgments, which in turn exacerbates their psychological distress. The prolonged neglect of cancer-related sexual health by the media has resulted in the public’s perception of postoperative sexual rehabilitation remaining at the level of "contraindication." Patients consequently struggle to develop appropriate confidence in seeking medical guidance, which not only exacerbates their sense of isolation but also impedes the allocation of medical resources to the field of sexual health [20-22] . Therefore, it is essential for the media to move beyond the traditional narrative that portrays cancer patients solely as 'tragic heroes' and instead adopt a 'holistic rehabilitation' perspective. By integrating sexual health into routine cancer education and science communication, the media can play a pivotal role in reshaping public understanding and promoting comprehensive patient care. 1.2 Communication Breakdowns in Intimate Relationships: The Paradox of Silence as a Protective Mechanism The decline in the frequency of sexual communication between couples following surgery was characterized by a "demand-response" imbalance and the adoption of a "silent protection" strategy in this study. The underlying causes of this communication breakdown extend beyond the physiological anxiety associated with surgical trauma to include the influence of "sexual shame" rooted in traditional social norms [23-24] . Notably, nonverbal forms of avoidance, such as reduced physical intimacy, may undermine mutual trust and potentially lead to emotional distance within the relationship. The "spiral of silence" theory [25] in journalism research holds particular significance in this context: when prevailing social opinion deems the sexual needs of cancer patients as "inappropriate," individuals may opt for self-censorship to avoid social ostracization, thereby reinforcing a more pronounced culture of silence. The core of sexual silence lies in the dual internalization of stigma driven by cultural shame [26] , and the "family sexual taboo" frequently reported by patients further intensifies this negative internalization. Therefore, it is imperative for the media to disrupt this cycle of silence through diverse narrative strategies—such as interviews with survivors and their partners, as well as providing guidelines on resuming intimate relationships after surgery—and to help reshape public perceptions toward a more normalized understanding of sexual health among cancer patients. 1.3 The Dual Shackles of Systemic Silence: The Interplay of Medical Avoidance and Social Stigma Consistent with findings from most previous studies [23] , sexual health "aphasia" within the medical field remains prominently evident in this research. Patients are not routinely consulted by physicians or nurses regarding their sexual health, and the use of "non-standardized" lubricants provided by female medical staff underscores the systemic deficiencies in the current diagnostic and treatment framework for sexual function rehabilitation among cancer patients [27] . At the societal level, the "secondary stigma" experienced by patients—such as ridicule from relatives and online harassment—reflects a narrow interpretation of the "patient role." This form of stigma originates from public misconceptions, which are largely perpetuated by the media's long-standing reluctance to address such issues [25] . Many young cancer patients choose to conceal their medical history due to concerns that disclosure may negatively affect their close relationships, thereby exacerbating communication barriers [25-28] . Therefore, it is essential for the media to address the prevailing misconception linking "sex with shame" through authoritative science communication initiatives, such as expert interviews and animated educational content on post-treatment sexual health. Simultaneously, efforts should be made to encourage the healthcare system to implement standardized sexual health assessment protocols. 1.4 Interdisciplinary Approaches to the Realization of Health Communication Requirements This study identified peer narrative (experience sharing among patients) and media empowerment (effective science communication through media channels) as the two key drivers in breaking the silence surrounding sensitive health issues [29-31] . Peer-based storytelling facilitates the transformation of abstract rehabilitation processes into actionable experiences through a mechanism of "empathy-imitation-practice" [28] . As a public opinion amplifier for "social cognitive reconstruction," the media can enable multi-stakeholder collaborative interventions by initiating thematic breakthroughs (e.g., reporting on postoperative sexual health clinics), introducing innovative formats (e.g., cross-disciplinary medical-documentary productions), and establishing resource linkages (e.g., integrating counseling hotlines into media content) [30-31] . It is noteworthy that patients' strong demand for "progressive medical communication" (e.g., anticipated postoperative follow-up inquiries) and "non-verbal tools" (e.g., visual aids and textual guides) offers practical opportunities for interdisciplinary collaboration between nursing and journalism [29-31] . For instance, the development of a "doctor-media collaborative training module" aimed at teaching healthcare providers how to convey sexual health information through short video formats, as well as engaging survivors as "sexual health ambassadors" in media content creation, can significantly enhance the credibility and accessibility of health interventions. 1.5 The Significance of Sexual Health as a Social Issue Sexual well-being is a crucial component of public health, serving as an indicator of health equity, a significant demographic measure of overall well-being, a distinct lens for understanding demographic trends beyond traditional sexual health, and an avenue to reorient public health ethics, frameworks, and practices [32] . This study revealed that patients regard sexual health issues as matters of physical autonomy and human dignity. With economic progress and cultural exchange in contemporary society, the awareness of patient subjectivity has introduced a new ethical dimension to media studies—the media not only functions as an information conduit but also acts as a promoter of social justice. For instance, by highlighting the issue of "medical silence," the media can encourage the development of clinical guidelines addressing sexual health after tumor surgery. By showcasing diverse survivor narratives—such as those involving non-sexual intimate relationship reconstruction—the media can help reduce individual stigmatization and ultimately foster a positive cycle of "knowing-understanding-acting." This communicative approach, where dissemination equates to intervention, not only enhances the quality of life for patients but also contributes to the broader societal recognition and protection of cancer survivors' rights [33-36] . Conclusion This study explored the multi-dimensional complexity of sexual function-related dilemmas experienced by cervical cancer survivors through qualitative interviews, offering a systematic perspective to understand the phenomenon of "sexual silence" among cancer survivors. Existing research has confirmed that sexual distress stems not only from physical impairments caused by medical treatments—such as vaginal dryness and dyspareunia—but also from the dual pressures of sociocultural norms and the lack of institutional support within healthcare systems. This creates an interactive disorder involving physiological, psychological, and social dimensions. Survivors often encounter a paradox in intimate relationships characterized by an imbalance between sexual desire and response, alongside a tendency toward emotional withdrawal as a protective mechanism. Furthermore, the absence of open discourse on sexual health within clinical settings—such as insufficient patient-provider communication and inadequate follow-up care—exacerbates barriers to seeking help. The study revealed that health communication serves as a key strategy to address the current challenges. Patients demonstrate a preference for multi-agent interventions that incorporate personalized medical communication (e.g., private consultations during postoperative follow-up), peer-based experience sharing (e.g., patient support groups), and media-driven science education (e.g., short videos on sexual health). These findings offer important insights for clinical practice: it is essential to integrate standardized health assessment tools into the processes of tumor rehabilitation, including diagnosis, treatment, and follow-up. Additionally, healthcare professionals should receive training in effectively communicating sensitive topics. Furthermore, reconstructing public understanding through media narratives can help challenge the societal stigma associated with sexuality. Additionally, patients have elevated sexual health to the level of physical autonomy and personal dignity, underscoring its broader social significance. In the future, our research team will further refine the "3C (Clinical+Couple+Community) intervention protocol," expand the sample coverage, and explore the effectiveness of digital intervention tools, such as online support platforms, with the aim of integrating sexual health from a previously marginalized issue into the comprehensive cancer rehabilitation system. This approach will ultimately contribute to the realization of holistic health care for cancer survivors. Declarations Funding None. Availability of data and materials The data used to support the findings of this study are available from the corresponding author upon request. Ethics approval and consent to participate All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the Declaration of Helsinki. The study was approved by the Medical Ethics Committee of the Affiliated Hospital of Jiangnan University (Wuxi, Jiangsu, China) (Ethics acceptance number: LS2024294, IRB approval number: WXSY-YXLL-AF/SC-11/02.0). All subjects provided written informed consent before enrollment. The approval period is from September 11, 2024, to September 11, 2025. Contributions from authors Chen Huang(First author) : Analyze data, participate in the formulation of intervention plans, contribute to methods and designs, conduct software analysis, manage data, and draft original manuscripts. Yanru Qiu: Data management, survey administration, verification processes, data visualization, and initial draft composition; Hong Tang and Xuan Huang(Corresponding author) : Conceptualized the study, developed the methodology, supervised it throughout, participated in the review and editing of the manuscript, and all the authors read and approved the final manuscript. Acknowledgements We thank the colleagues of the Medical Department of the Affiliated Hospital of Jiangnan University and the patients involved in the study for their cooperation, and the School of Literature and Art of Shihezi University for their research and cooperation. Conflict of interest The authors declare that they have no conflict of Interest. References Lokich E. Gynecologic Cancer Survivorship. Obstet Gynecol Clin North Am. 2019 Mar;46(1):165-178. doi: 10.1016/j.ogc.2018.10.002. PMID: 30683262. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. 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McKinney-Prupis E, Chiu YJ, Grov C, Tsui EK, Duke SI. Psychosocial and Health-Related Behavioral Outcomes of a Work Readiness HIV Peer Worker Training Program. Int J Environ Res Public Health. 2023 Feb 28;20(5):4322. doi: 10.3390/ijerph20054322. PMID: 36901333; PMCID: PMC10001842. Zamora GT. Social Media and the Patient - on Education and Empowerment. Rheumatol Immunol Res. 2022 Dec 31;3(4):156-159. doi: 10.2478/rir-2022-0028. PMID: 36879840; PMCID: PMC9984928. Good MM, Tanouye S. Social Media Superpowers in Obstetrics and Gynecology. Obstet Gynecol Clin North Am. 2021 Dec;48(4):787-800. doi: 10.1016/j.ogc.2021.07.007. PMID: 34756297. Mitchell KR, Lewis R, O'Sullivan LF, Fortenberry JD. What is sexual wellbeing and why does it matter for public health? Lancet Public Health. 2021 Aug;6(8):e608-e613. doi: 10.1016/S2468-2667(21)00099-2. Epub 2021 Jun 22. Erratum in: Lancet Public Health. 2023 Mar;8(3):e172. doi: 10.1016/S2468-2667(23)00031-2. PMID: 34166629; PMCID: PMC7616985. Sewak A, Yousef M, Deshpande S, Seydel T, Hashemi N. The effectiveness of digital sexual health interventions for young adults: a systematic literature review (2010-2020). Health Promot Int. 2023 Feb 1;38(1):daac104. doi: 10.1093/heapro/daac104. PMID: 36757346. Tazinya RMA, El-Mowafi IM, Hajjar JM, Yaya S. Sexual and reproductive health and rights in humanitarian settings: a matter of life and death. Reprod Health. 2023 Mar 10;20(1):42. doi: 10.1186/s12978-023-01594-z. PMID: 36899344; PMCID: PMC9999057. Uhawenimana TC, Musabwasoni MGS, Nsengiyumva R, Mukamana D. Sexuality and Sexual and Reproductive Health Depiction in Social Media: Content Analysis of Kinyarwanda YouTube Channels. J Med Internet Res. 2023 Sep 27;25:e46488. doi: 10.2196/46488. PMID: 37756040; PMCID: PMC10568387. McCashin D, Murphy CM. Using TikTok for public and youth mental health - A systematic review and content analysis. Clin Child Psychol Psychiatry. 2023 Jan;28(1):279-306. doi: 10.1177/13591045221106608. Epub 2022 Jun 10. PMID: 35689365; PMCID: PMC9902978 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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14:09:56","extension":"html","order_by":11,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":143895,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7063690/v1/d208bf253d84e5e4dc0bfcec.html"},{"id":93338152,"identity":"054b9f7b-eda1-4689-a5c4-167e6af53fe5","added_by":"auto","created_at":"2025-10-12 14:17:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":137492,"visible":true,"origin":"","legend":"\u003cp\u003eThematic logic diagram\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7063690/v1/96dd0c72a07c16cbe42cfc4d.png"},{"id":95526458,"identity":"9a7a8d11-b07c-4a3d-aa3b-7f68f7fc7394","added_by":"auto","created_at":"2025-11-10 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According to data released by the International Agency for Research on Cancer (IARC), cervical cancer ranks as the leading cause of cancer in women in 23 countries and the primary cause of cancer-related mortality among women in 36 countries. It is the fourth most prevalent and lethal female malignancy in terms of both incidence and mortality. The average age at diagnosis is 49 years, with a noticeable trend toward younger onset\u003csup\u003e[2-4]\u003c/sup\u003e. With advancements in medical treatment, the five-year survival rate for cervical cancer has improved\u003csup\u003e[5]\u003c/sup\u003e, and the World Health Organization emphasizes the importance of enhancing the long-term quality of life for cancer survivors\u003csup\u003e[6]\u003c/sup\u003e. However, the treatment of cervical cancer—particularly radical surgical interventions—often results in significant sexual dysfunction. Patients may experience vaginal dryness or shortening, dyspareunia, decreased libido, orgasmic disorders, and pelvic pain\u003csup\u003e[7-10]\u003c/sup\u003e. These complications can negatively impact patients' mental health and overall quality of life, and in severe cases, may impair their intimate relationships with partners.\u003c/p\u003e\n\u003cp\u003eIn Asia, for example, a meta-analysis conducted in China reported that the prevalence of sexual dysfunction among cervical cancer patients was as high as 76%, with 72% of those who underwent radical surgery experiencing such issues\u003csup\u003e[11]\u003c/sup\u003e. Sexual dysfunction may persist for two years or even longer following radical treatment\u003csup\u003e[12-14]\u003c/sup\u003e. Despite its high prevalence, influenced by traditional cultural norms, many Asian patients tend to remain silent due to feelings of shame, embarrassment, and concerns about their partners’\u0026nbsp;reactions\u003csup\u003e[8-10]\u003c/sup\u003e. Communication between healthcare providers and patients regarding sexual function remains significantly inadequate. Studies have indicated that as many as 82.4% of cervical cancer patients choose not to discuss these issues due to cultural taboos\u003csup\u003e[15]\u003c/sup\u003e. The lack of effective communication channels and insufficient doctor-patient interaction further prevent patients from seeking assistance for sexual health improvement\u003csup\u003e[16]\u003c/sup\u003e. Current research has primarily focused on the incidence and classification of sexual dysfunction, with limited in-depth exploration of patients' subjective experiences, coping strategies, informational needs, and preferred modes of communication and support.\u003c/p\u003e\n\u003cp\u003eThis study aims to explore the specific manifestations, impacts, and emotional experiences related to sexual function among female cervical cancer survivors through in-depth interviews. It also seeks to identify the barriers these women face when seeking information and support regarding sexual health, examine their perspectives on current doctor-patient communication practices and unmet needs, and investigate the pathways they perceive as effective for delivering health-related information and support.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e1.1 Research Design: This study adopted a descriptive qualitative approach to investigate patients who had undergone radical surgery for cervical cancer. Data were primarily collected through semi-structured in-depth interviews, and the reporting adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ).\u003c/p\u003e\n\u003cp\u003e1.2 Study Sites and Participant Recruitment:\u003c/p\u003e\n\u003cp\u003e1.2.1 This study will be conducted from December 2024 to April 2025 at the Oncology Department and Gynecological Oncology Outpatient and Follow-up Center of a large tertiary hospital in Wuxi, Jiiangsu Province. The study has been approved under ethics number LS2024294.\u003c/p\u003e\n\u003cp\u003e1.2.2 A purposive sampling approach combined with maximum variation sampling was employed to ensure diversity across key demographic characteristics, including age, time since radical cervical cancer surgery, educational background, occupation, and place of residence (urban vs. rural).\u003c/p\u003e\n\u003cp\u003e1.2.3 Criteria for Patient Inclusion and Exclusion:\u003c/p\u003e\n\u003cp\u003eInclusion criteria: Patients diagnosed with cervical cancer who had undergone major surgical treatment at least six months prior to enrollment; Age\u0026ge;18 years; A history of sexual activity before surgery; Ability to communicate clearly and willingness to participate in the interview; Provision of informed consent by the patient.\u003c/p\u003e\n\u003cp\u003eExclusion criteria included cancer recurrence or metastasis, preoperative sexual dysfunction, a history of psychological sexual dysfunction, and severe cognitive or mental impairment that prevented the patient from cooperating with the interview.\u003c/p\u003e\n\u003cp\u003e1.3 The recruitment process involved initial screening of eligible patients by medical staff for follow-up. Researchers then introduced the study to the patients and obtained their informed consent. During this stage, participants were informed that the interview would cover topics related to sexual health, and their understanding and voluntary participation were confirmed. The plan was to recruit between 10 and 20 participants, with data saturation serving as the criterion for stopping recruitment\u0026mdash;defined as the point at which no new significant themes or insights emerged from subsequent interviews.\u003c/p\u003e\n\u003cp\u003e1.4 Interview Outline: The interview outline was developed based on a comprehensive literature review and the research objectives. Following expert consultation and a pilot interview with two patients, the outline was revised accordingly. The final interview outline consists of 8 dimensions, as shown in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1. Summary of Interviews on Patients\u0026apos; Sexual Function Following Radical Hysterectomy for Cervical Cancer\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003e1. Postoperative Physical Changes and Sensations (with Particular Attention to Sexual Function)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eA.What physical changes following your surgery have had the most significant impact on your sexual health or intimate relationships? Could you please share your feelings and experiences regarding these changes?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eB.Do these physical changes give you new concerns about intimacy?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003e2. Specific Experiences of Sexual Distress (Physical, Psychological, and Relational Dimensions)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eC.What is the most troubling physical problem you have encountered during sexual or intimate interactions? How does (e.g. location of pain, dryness, changes in pleasure, etc.) affect daily life?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eD.Does this change make you feel anxious or frustrated?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eE.What are the significant changes in intimate relationships (e.g., the frequency and style of interactions with partners) after surgery? What specific effects have these changes had on your relationship?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003e3.Experiences and Challenges in Communicating with Partners Regarding Sexual Issues\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eF.Have you talked to your partner about sexual distress or changes in intimacy after surgery?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eG.What is the biggest difficulty in communication? (such as difficult to speak, partner does not understand, fear of conflict, etc.) do you choose to avoid it for a while?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eH.If your partner actively cares about your sexual health, how would you most like him to support you? (such as listening, seeking help together, adjusting intimacy, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003e4.Experiences and Challenges in Communicating with Partners Regarding Sexual Issues\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eI.Did the medical staff (doctor/nurse) initiate conversations with you about sexual health or intimacy after surgery? If so, what are the main contents? If not, have you thought about asking?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eJ.When and how would you like your health care provider to discuss sexual health with you? What information do you most want from them?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003e5.Access to and experience of sexual health information\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eK.Through what channels have you learned about postoperative sexual health? (such as medical care, patients, Internet, science materials, etc.) What sources of information do you find most useful/least trustworthy?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eL.Does the information currently available meet your needs? What would you like to know more about?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003e6. Unmet needs for information and support\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eM.What needs regarding sexual health or intimacy have you had that have not been addressed since your surgery? How have you been affected by these unmet needs?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eN.Have you ever felt \u0026quot;alone\u0026quot; in this regard? Where does this loneliness mainly come from? (such as family avoidance, medical neglect, social taboo, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003e7.Suggestions for ideal support/communication paths\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eO.If there is a dedicated support service, who do you think would be most helpful to you by participating? (e.g., doctors, nurses, rehabilitators, patients, partners, etc.) what forms of help do they want? (One-on-one consultation, group activities, online platforms, etc.)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eP.What specific content would you like to see included in such support services? (can be specific to medical guidance, psychological counseling, communication skills, emotional support, etc.) in which stage would you prefer to intervene after surgery?\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003e8. Emotional connection\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 568px;\"\u003e\n \u003cp\u003eQ.What do you think is the biggest significance of breaking the \u0026quot;sexual silence\u0026quot; for cancer survivors? If you had the opportunity to say a word to a patient who had the same experience, what would you say\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e1.5 Interview implementation: One-to-one interviews were conducted in a private and quiet setting by trained female interviewers with strong communication skills and empathetic dispositions. Each session lasted approximately 45 to 60 minutes. The entire interview process was audio-recorded, and brief field notes were taken concurrently. Participants\u0026rsquo;\u0026nbsp;confidentiality was strictly maintained, and access to emotional support resources, including psychological counseling hotlines, was provided.\u003c/p\u003e\n\u003cp\u003e1.6 Data Analysis: Interview data were anonymized and stored on encrypted hard drives. The data were transcribed and verified by the participants. Thematic analysis was conducted using Braun and Clarke\u0026rsquo;s six-step method with the support of NVivo 12, a qualitative data analysis software. To ensure reliability, two researchers independently coded and analyzed a portion of the interview transcripts, and any discrepancies were resolved through discussion.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003e1.1 Participant Characteristics: This study ultimately included a total of 12 patients diagnosed with cervical cancer who had undergone radical hysterectomy. The demographic and clinical characteristics of the participants are summarized in Table 2.\u003c/p\u003e\n\u003cp\u003eTable 2 General Characteristics of Patients Participating in Qualitative Interviews Following Radical Cervical Cancer Surgery\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"878\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003cp\u003e(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eType of surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003eDuration of surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003ePathological staging\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eDegree of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003ePlace of residence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eOccupations\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eP1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eRadical hysterectomy and pelvic lymph node dissection were performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eⅡ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eCities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eEnterprise administrative director\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eP2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eRadical hysterectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eⅠ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eCities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003ePrimary school teacher\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eP3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eCervical conization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eⅠ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eMaster\u0026apos;s degree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eCities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eInternet Company programmer\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eP4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eGet divorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eRadical hysterectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eⅡ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eHigh school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eCities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eIndividual clothing store owner\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eP5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eLaparoscopic hysterectomy was performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eⅠ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eCities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eAccounting\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eP6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eHysterectomy plus bilateral adnexectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eⅡ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eTechnical secondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eRural areas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eA supermarket cashier\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eP7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eRadical hysterectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eⅠ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eCities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eCustomer Service Specialist\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eP8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eRadical hysterectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eⅡ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eJunior high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eRural areas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eP9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eUnmarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eCervical cold knife conization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eⅡ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eCities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eMarketing Specialist\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eP10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eRadical hysterectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eⅡ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eTechnical secondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eCities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eFactory worker\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eP11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eRadical hysterectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eⅡ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eJunior high school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eRural areas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eDomestic service staff\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 42px;\"\u003e\n \u003cp\u003eP12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 154px;\"\u003e\n \u003cp\u003eAbdominal hysterectomy and double adnexectomy were performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 88px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003eⅡ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003eJunior college\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eUrban and rural settlements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003eReporter\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e1.2 Theme refinement\u003c/p\u003e\n\u003cp\u003e1.2.1 Biopsychosocial Aspects of Sexual Dysfunction\u003c/p\u003e\n\u003cp\u003e1.2.1.1 Physical dysfunction and uncertainty regarding rehabilitation following radical resection of cervical cancer: The procedure often disrupts the anatomical structure and neural integrity of the vaginal region, resulting in persistent physiological complications such as pain and dryness. These complications are the primary contributors to impaired sexual health among patients. Such somatic symptoms not only diminish the comfort associated with sexual activity but also provoke prolonged anxiety due to the unpredictable nature of recovery timelines. \u003cstrong\u003e\u003cem\u003eP1\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: \u0026quot;The first time after surgery, I felt that the vagina was as hard as stone; going a little deeper caused tearing pain\u003c/em\u003e\u003cem\u003e\u0026hellip;\u003c/em\u003e\u003cem\u003e\u0026nbsp;I still feel sick.\u0026quot;\u0026nbsp;\u003c/em\u003e(Persistent anxiety related to physical pain) .\u003cstrong\u003e\u003cem\u003eP2\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: \u0026quot;The vagina is very dry, and lubricants are ineffective; I have gradually lost the desire for sexual activity.\u0026quot;\u0026nbsp;\u003c/em\u003e(Dual impact on sexual desire due to physiological impairment).\u003c/p\u003e\n\u003cp\u003e1.2.1.2 Female Role Trauma and Self-Identity Crisis: The alteration in physical appearance and the loss of reproductive organs due to surgical trauma lead patients to deeply question their gender roles and sexual attractiveness. This disruption in body image not only affects self-perception but also undermines sexual confidence through psychological internalization, potentially resulting in sexual avoidance behaviors. \u003cstrong\u003e\u003cem\u003eP3\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: \u0026quot;The postoperative scar on my body is unattractive, and my abdomen has become loose and enlarged. I no longer wish to look at my own body.\u0026quot;\u003c/em\u003e (Scarring provokes a sense of diminished self-worth.) \u003cstrong\u003e\u003cem\u003eP5\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: \u0026quot;After the hysterectomy, my body feels hollow. Am I still considered a complete woman?\u0026quot;\u0026nbsp;\u003c/em\u003e(Organ loss contributes to uncertainty in gender identity.)\u003c/p\u003e\n\u003cp\u003e1.2.2 Communication Breakdown and Emotional Disconnection in Close Relationships\u003c/p\u003e\n\u003cp\u003e1.2.2.1 The imbalance in demand-response dynamics within partner interactions arises from a misalignment in sexual needs and emotional expression between postoperative patients and their partners. This mismatch perpetuates a vicious cycle of mutual misunderstanding and communication avoidance in intimate relationships. Partners\u0026rsquo;\u0026nbsp;limited understanding of the patient\u0026rsquo;s physiological changes, coupled with the patient\u0026rsquo;s emotional suppression, further widens the relational divide. \u003cstrong\u003e\u003cem\u003eP5:\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026nbsp;\u0026quot;He believed that I refused intimacy because I thought he was unclean, but in reality, I was concerned that bleeding from the wound might distress him. I was thinking about his feelings. Why can\u0026apos;t he see that?\u0026quot;\u0026nbsp;\u003c/em\u003e(Emotional dislocation) \u003cstrong\u003e\u003cem\u003eP6\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: \u0026quot;At night, when his hand casually moved toward my waist, I couldn\u003c/em\u003e\u003cem\u003e\u0026rsquo;\u003c/em\u003e\u003cem\u003et help tensing up involuntarily. He sighed and turned over to sleep. ... It feels as though he no longer cares for me as much as before.\u0026quot;\u0026nbsp;\u003c/em\u003e(Trust cracks in nonverbal interactions).\u003c/p\u003e\n\u003cp\u003e1.2.2.2 The paradox of silence as a relationship protection mechanism lies in the fact that although patients perceive silence as a strategy to preserve relational harmony, this form of \u0026quot;protective avoidance\u0026quot; ultimately exacerbates emotional detachment between partners. Social and cultural taboos surrounding sexuality, combined with patients\u0026apos; internalized stigma, render silence the default norm within intimate relationships. \u003cstrong\u003e\u003cem\u003eP7\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: \u0026quot;When he wanted to talk about it, I immediately said, \u0026apos;I\u0026apos;m tired today.\u0026apos; In reality, I was afraid that discussing it would force us to confront the reality of \u0026apos;what if we can\u0026apos;t be cured?\u0026apos; Pretending to be normal allows us to maintain at least an appearance of harmony.\u0026quot;\u003c/em\u003e (This illustrates the use of silence to avoid deeper communication.) \u003cstrong\u003e\u003cem\u003eP8\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: \u0026quot;From childhood onward, people have consistently avoided using the word \u0026apos;sex\u0026apos;, and now no one dares to mention it since my illness. It seems that as long as I don\u003c/em\u003e\u003cem\u003e\u0026rsquo;\u003c/em\u003e\u003cem\u003et speak about it, my sexual concerns simply do not exist.\u0026quot;\u003c/em\u003e (This reflects a culturally ingrained silence regarding sexual needs.)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1.2.3 The Dual Constraints of Systematic Silence: Medical Avoidance and Social Stigma\u003c/p\u003e\n\u003cp\u003e1.2.3.1 Sexual health \u0026quot;aphasia\u0026quot; in the medical field: The current medical system tends to overlook issues related to sexual health, making it difficult for patients to access professional support. The avoidance behaviors of healthcare professionals, the absence of standardized diagnostic and treatment protocols, and inappropriate communication styles further exacerbate patients\u0026apos; feelings of helplessness and stigma. \u003cstrong\u003e\u003cem\u003eP6\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: \u0026quot;After the surgery, the nurse was very attentive to my general health, but no one addressed how to manage marital life post-operation. They simply advised me to avoid sexual activity as much as possible within the first six months, without providing any detailed guidance.\u0026quot;\u003c/em\u003e (This highlights the lack of a standardized care process.) \u003cstrong\u003e\u003cem\u003eP9\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: \u0026quot;When I consulted with a male doctor, I hesitated to mention \u0026apos;vaginal dryness\u0026apos; and only described it as \u0026apos;discomfort below.\u0026apos; It was not until I spoke with a female nurse that I felt comfortable enough to ask about it directly. She recommended trying an over-the-counter lubricant suppository. That was the first time I truly felt supported.\u0026quot;\u0026nbsp;\u003c/em\u003e(This illustrates the significant influence of gender on patients\u0026apos; willingness to communicate openly.)\u003c/p\u003e\n\u003cp\u003e1.2.3.2 The \u0026quot;sexless\u0026quot; construction within social discourse: Social culture persistently reinforces the stigmatization of the sexual needs of cancer patients through familial, media, and public discourses. This form of \u0026quot;non-sexual\u0026quot; regulation not only deprives patients of their right to self-expression but also marginalizes sexual health concerns into a societal taboo. \u003cstrong\u003e\u003cem\u003eP11\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: \u0026quot;After I left the hospital, my relatives came to visit, and I overheard them advising my husband not to engage in sexual activity with me, as if my illness could be transmitted to him through intercourse.\u0026quot;\u003c/em\u003e (Stigmatization and linguistic violence at the familial level) .\u003cstrong\u003e\u003cem\u003eP12\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: \u0026quot;I have read numerous posts regarding cervical cancer rehabilitation and comments addressing sexual issues. Most responses are along the lines of \u0026apos;why do you want to preserve your sex life?\u0026apos; or \u0026apos;sexual activity will only drain your energy\u0026apos;, yet few truly acknowledge our actual needs.\u0026quot;\u0026nbsp;\u003c/em\u003e(Invisible regulation within public discourse space).\u003c/p\u003e\n\u003cp\u003e1.2.4 Desire to Break the Status Quo: Calls for Health Communication through Multi-Subject Participation\u003c/p\u003e\n\u003cp\u003e1.2.4.1 The core expectation of individualized medical communication lies in patients\u0026rsquo;\u0026nbsp;emphasis on three key dimensions: timeliness, professionalism, and humanization. Patients expect healthcare providers to bridge the information gap by delivering targeted health guidance in a more proactive, confidential, and comprehensible manner. \u003cstrong\u003e\u003cem\u003eP3\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: \u0026quot;I would like a photo book illustrating potential sexual issues that may arise after surgery, preferably with a QR code linking to a doctor for immediate consultation at any time.\u0026quot;\u003c/em\u003e (The irreplaceability of non-verbal communication tools). \u003cstrong\u003e\u003cem\u003eP11:\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e\u0026nbsp;\u0026quot;Every time doctors or nurses check on my wound healing, if a nurse could take me to a safe and private space to ask about how I\u003c/em\u003e\u003cem\u003e\u0026rsquo;\u003c/em\u003e\u003cem\u003eve been getting along with my husband recently, whether there\u003c/em\u003e\u003cem\u003e\u0026rsquo;\u003c/em\u003e\u003cem\u003es any discomfort, and allow me to share my concerns and emotional distress, it would make a big difference.\u0026quot;\u003c/em\u003e(The significant impact of communication timing and style on patients).\u003c/p\u003e\n\u003cp\u003e1.2.4.2 Dual empowerment effects of peer and media: Peer experience sharing and health communication through the media were recognized as crucial forces in breaking the silence surrounding sensitive health issues. Patients expressed a strong desire to achieve emotional resonance and obtain practical advice through peer narratives. They also urged the media to address sexual health topics in a more open, scientific, and responsible manner in order to reduce social stigma. \u003cstrong\u003e\u003cem\u003eP4\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: \u0026quot;In the patient group, I saw someone share \u0026apos;using warm saline sitz bath to relieve sexual pain,\u0026apos; and after trying it for two weeks, I found it effective. ... I am not alone in experiencing this pain, nor should I be expected to endure it silently.\u0026quot;\u0026nbsp;\u003c/em\u003e(Practical value and emotional comfort derived from peer experience sharing) .\u003cstrong\u003e\u003cem\u003eP10\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: \u0026quot;If there was a media program\u003c/em\u003e\u003cem\u003e\u0026mdash;\u003c/em\u003e\u003cem\u003eeven just a short video of a few minutes\u003c/em\u003e\u003cem\u003e\u0026mdash;\u003c/em\u003e\u003cem\u003ein which doctors explained that sexual recovery is as important as wound healing, I would have experienced less psychological pressure, and more people would have become aware of this issue.\u0026quot;\u0026nbsp;\u003c/em\u003e(Mass media as a tool for knowledge-based empowerment).\u003c/p\u003e\n\u003cp\u003e1.2.5 From Silence to Voice: Sexual Health as a Critical Social Issue\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1.2.5.1 The ontological significance of breaking silence: Patients challenge societal norms and elevate their sexual health needs to the level of quality of life and personal integrity. They emphasize that sexual health is not an optional \u0026quot;add-on,\u0026quot; but a core component that must be addressed throughout the recovery process. \u003cstrong\u003e\u003cem\u003eP3\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: \u0026quot;I didn\u0026apos;t want to get cancer, nor did I wish for my life to revolve around chemotherapy and healing. Isn\u0026apos;t it natural to experience sexual difficulties? I desire greater physical respect.\u0026quot;\u003c/em\u003e (Sexual health rises to the level of human dignity). \u003cstrong\u003e\u003cem\u003eP12\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e: \u0026quot;The surgery removed my uterus; however, why does society continue to perceive cancer patients solely as medical cases to be reassessed in hospital beds? We deserve to live full lives after discharge. This aspect is undeniably part of who I am. I want to be more courageous in expressing my sexual needs and hope that more people will join me in speaking out.\u0026quot;\u0026nbsp;\u003c/em\u003e(The desire to break the silence and assert bodily autonomy).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThrough qualitative interviews, this study elucidated the multidimensional complexity of sexual health challenges faced by patients following cervical cancer surgery. By integrating perspectives from nursing and journalism, the research identified that societal public opinion and the absence of discourse within the medical field collectively form systemic barriers to expressing sexual health needs. Furthermore, it highlighted that health communication interventions represent a critical pathway to addressing this issue. The conceptual framework of this study is shown in Figure 1.\u003c/p\u003e\n\u003cp\u003e1.1 Multi-Dimensional Impacts on Sexual Function at the Biopsychosocial Level: The Dual Burden of Physiological Impairment and Sociocultural Norms\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; Vaginal stenosis, dryness, and other forms of physical functional impairment resulting from radical cervical cancer surgery create a vicious cycle in conjunction with postoperative depression and female role disruption\u003csup\u003e[15]\u003c/sup\u003e. Importantly, this study reveals that social attitudes further intensify patients' self-imposed restrictions through stigmatizing language within family settings and implicit societal norms in public discourse. The underlying nature of this \"neutralizing\" mechanism is to redefine cancer survivors primarily as \"bodies requiring medical intervention,\" thereby denying them the recognition and legitimacy to express their emotional and psychological needs as whole individuals. According to Erving Goffman's theory of stigma, individuals with chronic or socially sensitive illnesses often face social exclusion and marginalization\u003csup\u003e[17]\u003c/sup\u003e. Cervical cancer survivors, in particular, may be viewed as \"deviant\" or \"incomplete\" in terms of their social identity due to the disease's association with sexual health. At the societal level, insufficient public education has led to widespread misconceptions, wherein cervical cancer is frequently equated with behaviors such as promiscuity or poor personal hygiene. These misperceptions can heighten barriers to social interaction\u003csup\u003e[18-19]\u003c/sup\u003e. When patients encounter sexual dysfunction, they may internalize these external negative judgments, which in turn exacerbates their psychological distress.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; The prolonged neglect of cancer-related sexual health by the media has resulted in the public’s perception of postoperative sexual rehabilitation remaining at the level of \"contraindication.\" Patients consequently struggle to develop appropriate confidence in seeking medical guidance, which not only exacerbates their sense of isolation but also impedes the allocation of medical resources to the field of sexual health\u003csup\u003e[20-22]\u003c/sup\u003e. Therefore, it is essential for the media to move beyond the traditional narrative that portrays cancer patients solely as 'tragic heroes' and instead adopt a 'holistic rehabilitation' perspective. By integrating sexual health into routine cancer education and science communication, the media can play a pivotal role in reshaping public understanding and promoting comprehensive patient care.\u003c/p\u003e\n\u003cp\u003e1.2 Communication Breakdowns in Intimate Relationships: The Paradox of Silence as a Protective Mechanism\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; The decline in the frequency of sexual communication between couples following surgery was characterized by a \"demand-response\" imbalance and the adoption of a \"silent protection\" strategy in this study. The underlying causes of this communication breakdown extend beyond the physiological anxiety associated with surgical trauma to include the influence of \"sexual shame\" rooted in traditional social norms\u003csup\u003e[23-24]\u003c/sup\u003e. Notably, nonverbal forms of avoidance, such as reduced physical intimacy, may undermine mutual trust and potentially lead to emotional distance within the relationship.\u003c/p\u003e\n\u003cp\u003eThe \"spiral of silence\" theory\u003csup\u003e[25]\u003c/sup\u003e in journalism research holds particular significance in this context: when prevailing social opinion deems the sexual needs of cancer patients as \"inappropriate,\" individuals may opt for self-censorship to avoid social ostracization, thereby reinforcing a more pronounced culture of silence. The core of sexual silence lies in the dual internalization of stigma driven by cultural shame\u003csup\u003e[26]\u003c/sup\u003e, and the \"family sexual taboo\" frequently reported by patients further intensifies this negative internalization. Therefore, it is imperative for the media to disrupt this cycle of silence through diverse narrative strategies—such as interviews with survivors and their partners, as well as providing guidelines on resuming intimate relationships after surgery—and to help reshape public perceptions toward a more normalized understanding of sexual health among cancer patients.\u003c/p\u003e\n\u003cp\u003e1.3 The Dual Shackles of Systemic Silence: The Interplay of Medical Avoidance and Social Stigma\u003c/p\u003e\n\u003cp\u003eConsistent with findings from most previous studies\u003csup\u003e[23]\u003c/sup\u003e, sexual health \"aphasia\" within the medical field remains prominently evident in this research. Patients are not routinely consulted by physicians or nurses regarding their sexual health, and the use of \"non-standardized\" lubricants provided by female medical staff underscores the systemic deficiencies in the current diagnostic and treatment framework for sexual function rehabilitation among cancer patients\u003csup\u003e[27]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eAt the societal level, the \"secondary stigma\" experienced by patients—such as ridicule from relatives and online harassment—reflects a narrow interpretation of the \"patient role.\" This form of stigma originates from public misconceptions, which are largely perpetuated by the media's long-standing reluctance to address such issues\u003csup\u003e[25]\u003c/sup\u003e. Many young cancer patients choose to conceal their medical history due to concerns that disclosure may negatively affect their close relationships, thereby exacerbating communication barriers\u003csup\u003e[25-28]\u003c/sup\u003e. Therefore, it is essential for the media to address the prevailing misconception linking \"sex with shame\" through authoritative science communication initiatives, such as expert interviews and animated educational content on post-treatment sexual health. Simultaneously, efforts should be made to encourage the healthcare system to implement standardized sexual health assessment protocols.\u003c/p\u003e\n\u003cp\u003e1.4 Interdisciplinary Approaches to the Realization of Health Communication Requirements\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; This study identified peer narrative (experience sharing among patients) and media empowerment (effective science communication through media channels) as the two key drivers in breaking the silence surrounding sensitive health issues\u003csup\u003e[29-31]\u003c/sup\u003e. Peer-based storytelling facilitates the transformation of abstract rehabilitation processes into actionable experiences through a mechanism of \"empathy-imitation-practice\" \u003csup\u003e[28]\u003c/sup\u003e. As a public opinion amplifier for \"social cognitive reconstruction,\" the media can enable multi-stakeholder collaborative interventions by initiating thematic breakthroughs (e.g., reporting on postoperative sexual health clinics), introducing innovative formats (e.g., cross-disciplinary medical-documentary productions), and establishing resource linkages (e.g., integrating counseling hotlines into media content)\u003csup\u003e[30-31]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; It is noteworthy that patients' strong demand for \"progressive medical communication\" (e.g., anticipated postoperative follow-up inquiries) and \"non-verbal tools\" (e.g., visual aids and textual guides) offers practical opportunities for interdisciplinary collaboration between nursing and journalism\u003csup\u003e[29-31]\u003c/sup\u003e. For instance, the development of a \"doctor-media collaborative training module\" aimed at teaching healthcare providers how to convey sexual health information through short video formats, as well as engaging survivors as \"sexual health ambassadors\" in media content creation, can significantly enhance the credibility and accessibility of health interventions.\u003c/p\u003e\n\u003cp\u003e1.5 The Significance of Sexual Health as a Social Issue\u003c/p\u003e\n\u003cp\u003eSexual well-being is a crucial component of public health, serving as an indicator of health equity, a significant demographic measure of overall well-being, a distinct lens for understanding demographic trends beyond traditional sexual health, and an avenue to reorient public health ethics, frameworks, and practices\u003csup\u003e[32]\u003c/sup\u003e. This study revealed that patients regard sexual health issues as matters of physical autonomy and human dignity. With economic progress and cultural exchange in contemporary society, the awareness of patient subjectivity has introduced a new ethical dimension to media studies—the media not only functions as an information conduit but also acts as a promoter of social justice. For instance, by highlighting the issue of \"medical silence,\" the media can encourage the development of clinical guidelines addressing sexual health after tumor surgery. By showcasing diverse survivor narratives—such as those involving non-sexual intimate relationship reconstruction—the media can help reduce individual stigmatization and ultimately foster a positive cycle of \"knowing-understanding-acting.\" This communicative approach, where dissemination equates to intervention, not only enhances the quality of life for patients but also contributes to the broader societal recognition and protection of cancer survivors' rights\u003csup\u003e[33-36]\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study explored the multi-dimensional complexity of sexual function-related dilemmas experienced by cervical cancer survivors through qualitative interviews, offering a systematic perspective to understand the phenomenon of \"sexual silence\" among cancer survivors. Existing research has confirmed that sexual distress stems not only from physical impairments caused by medical treatments—such as vaginal dryness and dyspareunia—but also from the dual pressures of sociocultural norms and the lack of institutional support within healthcare systems. This creates an interactive disorder involving physiological, psychological, and social dimensions. Survivors often encounter a paradox in intimate relationships characterized by an imbalance between sexual desire and response, alongside a tendency toward emotional withdrawal as a protective mechanism. Furthermore, the absence of open discourse on sexual health within clinical settings—such as insufficient patient-provider communication and inadequate follow-up care—exacerbates barriers to seeking help.\u003c/p\u003e\n\u003cp\u003eThe study revealed that health communication serves as a key strategy to address the current challenges. Patients demonstrate a preference for multi-agent interventions that incorporate personalized medical communication (e.g., private consultations during postoperative follow-up), peer-based experience sharing (e.g., patient support groups), and media-driven science education (e.g., short videos on sexual health). These findings offer important insights for clinical practice: it is essential to integrate standardized health assessment tools into the processes of tumor rehabilitation, including diagnosis, treatment, and follow-up. Additionally, healthcare professionals should receive training in effectively communicating sensitive topics. Furthermore, reconstructing public understanding through media narratives can help challenge the societal stigma associated with sexuality.\u003c/p\u003e\n\u003cp\u003eAdditionally, patients have elevated sexual health to the level of physical autonomy and personal dignity, underscoring its broader social significance. In the future, our research team will further refine the \"3C (Clinical+Couple+Community) intervention protocol,\" expand the sample coverage, and explore the effectiveness of digital intervention tools, such as online support platforms, with the aim of integrating sexual health from a previously marginalized issue into the comprehensive cancer rehabilitation system. This approach will ultimately contribute to the realization of holistic health care for cancer survivors.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used to support the findings of this study are available from the corresponding author upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the Declaration of Helsinki. The study was approved by the Medical Ethics Committee of the Affiliated Hospital of Jiangnan University (Wuxi, Jiangsu, China) (Ethics acceptance number: LS2024294, IRB approval number: WXSY-YXLL-AF/SC-11/02.0). All subjects provided written informed consent before enrollment. The approval period is from September 11, 2024, to September 11, 2025.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions from authors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eChen Huang(First author) : Analyze data, participate in the formulation of intervention plans, contribute to methods and designs, conduct software analysis, manage data, and draft original manuscripts.\u003c/p\u003e\n\u003cp\u003eYanru Qiu: Data management, survey administration, verification processes, data visualization, and initial draft composition;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHong Tang and Xuan Huang(Corresponding author) : Conceptualized the study, developed the methodology, supervised it throughout, participated in the review and editing of the manuscript, and all the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the colleagues of the Medical Department of the Affiliated Hospital of Jiangnan University and the patients involved in the study for their cooperation, and the School of Literature and Art of Shihezi University for their research and cooperation.\u003c/p\u003e\n\u003ch2\u003eConflict of interest\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no conflict of Interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLokich E. 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Sexual and reproductive health and rights in humanitarian settings: a matter of life and death. Reprod Health. 2023 Mar 10;20(1):42. doi: 10.1186/s12978-023-01594-z. PMID: 36899344; PMCID: PMC9999057.\u003c/li\u003e\n\u003cli\u003eUhawenimana TC, Musabwasoni MGS, Nsengiyumva R, Mukamana D. Sexuality and Sexual and Reproductive Health Depiction in Social Media: Content Analysis of Kinyarwanda YouTube Channels. J Med Internet Res. 2023 Sep 27;25:e46488. doi: 10.2196/46488. PMID: 37756040; PMCID: PMC10568387.\u003c/li\u003e\n\u003cli\u003eMcCashin D, Murphy CM. Using TikTok for public and youth mental health - A systematic review and content analysis. Clin Child Psychol Psychiatry. 2023 Jan;28(1):279-306. doi: 10.1177/13591045221106608. Epub 2022 Jun 10. PMID: 35689365; PMCID: PMC9902978\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"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":"Cervical cancer, Radical resection of cervical cancer, Sexual dysfunction, Qualitative research, Health information dissemination","lastPublishedDoi":"10.21203/rs.3.rs-7063690/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7063690/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: To better understand the challenges related to sexual function faced by patients with cervical cancer following radical hysterectomy, and to provide evidence-based insights for the development of clinical nursing strategies and health education programs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A total of 12 cervical cancer patients who attended the outpatient department of a tertiary hospital in Jiangnan, were selected for participation in semi-structured in-depth interviews. The collected interview data were analyzed using Braun and Clarke’s thematic analysis approach, supported by the use of Nvivo 12 software.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The study identified five major themes: sexual function injury (encompassing physical dysfunction and female role trauma), which is deeply intertwined with biological, psychological, and sociocultural factors; disrupted intimate relationships (characterized by misaligned needs and the paradox of silent protection); systemic silence (manifested through medical aphasia and social stigma); communication pathways (including personalized medical communication, as well as peer and media-based empowerment); and the recognition of sexual health as a critical social issue.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eSexual dysfunction in patients following cervical cancer surgery arises from the combined effects of physiological damage and sociocultural norms. To address the issue of \"sexual silence,\" it is essential to establish a patient-centered, multi-disciplinary health communication system that facilitates the reclassification of sexual health from a \"taboo subject\" to an essential component of rehabilitation. Healthcare professionals should proactively offer comprehensive medical guidance, psychological support, and interventions aimed at reducing social stigma. These measures can help improve patients' sexual function, enhance intimate relationships with their partners, and ultimately elevate their overall quality of life.\u003c/p\u003e","manuscriptTitle":"Breaking the sexual silence of cancer survivors: exploration of sexual distress and health communication paths after cervical cancer surgery based on qualitative interviews","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-12 14:09:51","doi":"10.21203/rs.3.rs-7063690/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":"6d6b9f4d-4344-41bd-9d7b-837fe1872c8b","owner":[],"postedDate":"October 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-07T07:54:05+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-12 14:09:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7063690","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7063690","identity":"rs-7063690","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}