Sexual Health of Adolescent and Young Adults Assigned Female at Birth Post Pelvic Radiotherapy

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Gupta, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6364449/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Pelvic radiotherapy (PRT) is an effective cancer treatment for pelvic malignancies but often results in sexual dysfunction and long-term complications, particularly for patients with a vagina. This impact is heightened in adolescent and young adult (AYA) patients who face unique developmental challenges, where sexual health issues can profoundly affect relationships, self-esteem, and quality of life. This study investigates the sexual health experiences of AYAs with a vagina undergoing PRT to identify care gaps and inform tailored support and resources. Methods In this mixed-methods study, we surveyed AYA patients receiving PRT at Princess Margaret Cancer Centre (PM) to assess sexual health changes and care satisfaction. Interviews further explored their sexual dysfunction and needs. Descriptive statistics summarized survey data, and thematic analysis guided by Braun and Clarke's framework identified key interview themes. Triangulation compared survey and interview results for a comprehensive understanding. Results Fifty-eight participants (58 female, mean age 32.8) completed surveys and fifteen completed interviews. Triangulation revealed sexual health challenges, such as pain during intercourse, loss of libido, diminished intimacy, communication barriers in relationships, difficulty with fertility and emotional and psychosocial distress. Three main themes emerged: 1) managing the impact of changes in sexual function on relationships and intimacy, 2.) navigating the impact of sexual health changes on fertility and family planning, and 3.) understanding the emotional and psychosocial toll of physical discomfort and sexual dysfunction. Conclusions These findings highlight the critical need for comprehensive, tailored interventions to support sexual health in AYA patients undergoing PRT. sexual health adolescent and young adult sexual dysfunction pelvic radiotherapy cancer gynecological malignancies Figures Figure 1 Introduction Adolescents and young adults (AYA, 15–39 years old) diagnosed with cancer experience unique developmental, emotional, and psychological challenges because of their diagnosis and treatments [ 1 , 2 ]. During this critical period, they are exploring their sexual identity, relationships, and future goals [ 3 ]. Treatment of pelvic malignancies often includes pelvic radiotherapy (RT). Although effective, it can result in acute and late side-effects, including sexual toxicity and premature ovarian failure for those assigned female at birth (AFAB) [ 4 , 5 ]. Sexual dysfunction includes difficulties with sexual interest, arousal, pleasure, and orgasm, leading to issues like vaginal dryness, dyspareunia, loss of libido, and orgasmic changes [ 6 , 7 ]. This can lead to emotional distress including anxiety, depression, and reduced self-esteem which can negatively impact relationships and overall quality of life [ 8 , 9 ]. As a result, it is important for healthcare providers to proactively discuss and educate patients on sexual health during and after cancer treatment [ 10 ]. The American Society of Clinical Oncology (ASCO) has created guidelines which highlights the need for providers to ask cancer patients about their sexual health [ 11 ]. This is especially important for AYA patients AFAB as during this critical period, they are also exploring their sexual identity, relationships, and future goals and sexual dysfunction can profoundly impact the development of these key domains [ 12 – 13 ]. Effective counselling for AYAs AFAB is essential for providing guidance on fertility preservation, premature ovarian failure and sexual health, addressing long-term well-being, and meeting their unique educational needs [ 14 , 15 ]. Sexual health assessment post-RT to the pelvis is crucial for addressing the comprehensive needs of AYA patients AFAB [ 16 , 17 ]. Open communication with healthcare providers about sexual health concerns is essential, empowering patients to make informed decisions and enhancing their overall well-being despite treatment-related challenges [ 18 ]. Few studies in the literature have examined sexual health experiences of AYA cancer patients AFAB undergoing RT to the pelvis. Therefore, our objective was to assess the sexual health experiences and challenges of AYAs patients AFAB receiving RT to the pelvis to understand their experiences and education received, explore gaps in care, and inform the development of future educational resources. Methods Study Population A mixed-methods simultaneous approach was used. English-speaking AYA AFAB patients who completed RT with curative or palliative intent between January 2018 and December 2023 for a primary diagnosis of gynecological or gastrointestinal cancers, lymphoma or sarcoma, were eligible to participate. RT included external beam radiation to the pelvic organs or brachytherapy. Patients were identified using an oncologic electronic medical record database (MOSAIQ). The primary care physician at UHN was contacted to determine if it was appropriate to reach out to patients during routine follow-up. Eligible participants were then approached to participate by a member of their clinical team. Participants were subsequently contacted by the study lead (K.D.) for consent. A convenience sample of approximately 100 AYAs was sought. Ethics approval was obtained from the University Health Network (UHN) research ethics board (22-6012). Surveys - Recruitment, Data Collection, Analysis Participants completed a 23-item online survey consisting of three sections: 1) demographics (n = 17) and 2) patient-reported sexual health (n = 4), and 3) sexual health care received (n = 2) (Supplemental Table 1). The sexual health assessment section assessed the post-treatment sexual health of patients post-RT to obtain insight on their sexual health experiences, challenges, needs, and quality of life. The sexual health care received section assessed informational, physical, psychosocial, resource, advocacy, and awareness received during cancer treatment. This section also explored care adequacy and ideas for future solutions relating to their sexual experience. Survey items were created by the authors informed by a literature and clinical guidelines review to ensure they address relevant issues and capture comprehensive data on patient experiences [ 19 – 21 ]. Descriptive statistics summarized survey results. Interviews - Recruitment, Data Collection, Analysis At the end of the online survey, participants were invited to participate in a virtual one-on-one interview, conducted by a member of our study team (KD). The questions for the interview guide were developed based on insights from the survey data, literature review, and consultation with clinical experts to ensure they comprehensively addressed the patients' sexual health experiences and needs [ 22 ] (Supplemental Table 2). Interviews were conducted until thematic saturation was achieved [ 23 ]. Interviews were audio recorded, transcribed verbatim, and personal identifiers were removed. Thematic analysis was performed to identify patterns within the transcripts [ 24 ]. Three members of the research team (K.D., A.S., and K.G.) independently coded the interview transcripts, organizing codes into themes and categories using NVivo 10 software for organization. Once coded, the members discussed their comprehensive views of the data and to develop an agreed-upon coding framework. Survey data were compared with interview findings for a comprehensive understanding of the patients’ experiences. Results Between March and October 2024, 52 patients completed the survey, and of these, 15 agreed to participate in one-on-one interviews (Figure 1). Figure 1: Participant recruitment flow chart Demographics Median age was 33 (15-39) and most were diagnosed with cervical cancer (43/52, 82.7%). While all patients received RT, treatment type varied based on cancer type and stage, with some receiving external beam RT to the pelvis alone (17/52, 32.7%), brachytherapy alone (4/52, 7.7%), or a combination of both (31/52, 59.6%), surgery (47/52, 90.4%), and systematic therapy (44/52, 84.6%). All participants self-identified as female (cis gender), with 79% identifying as heterosexual, and most (32/52, 61.5%) reporting they were currently sexually active. Half were partnered (26/52, 50.0%), and most (34/52, 65.4%) reported their partners also experienced sexual challenges because of the patient’s dysfunction (Table 1). Median time for questionnaire completion from treatment was 26 months (3-82 months). Findings The triangulation of survey data and interview content revealed several challenges commonly experienced among AYAs AFAB regardless of receiving RT, such as delays in life-stage milestones like family planning (47/52, 90.4%), disruptions to intimate relationships (47/52, 90.4%), and the emotional toll of managing both treatment and post-treatment concerns (44/52, 80.0%). However, AYAs AFAB receiving RT also endorsed unique challenges specific to treatment including psychosocial, physical, and sexual health impacts. Three themes emerged: 1) managing the impact of changes in sexual function on relationships and intimacy, 2) navigating the impact of sexual health changes on fertility and family planning, and 3) understanding the emotional and psychosocial toll of physical discomfort and sexual dysfunction. Managing the impact of changes in sexual function on relationships and intimacy Among 52 survey respondents, 90% reported experiencing loss of intimacy, 75% experienced deterioration of relationship communication, 73% reported loss of sexual desire, and 69% reported persistent pain during sex after RT (Table 2). Most respondents (85%) reported that RT negatively impacted their relationships. Despite these challenges, 42% had not used vaginal dilators post-radiation, 67% had not accessed marital/relationship counseling, and 73% had not received sexual health counseling. Additionally, 56% were dissatisfied with the quality of sexual health counseling they received. Nearly half ( 48% ) felt the counseling did not address their RT-related concerns, and 62% stated it did not help them manage sexual health challenges during or after treatment. When triangulated with experiences described in the interviews, participants described how physical changes, such as pain during intercourse and loss of sexual desire, hindered their relationships and intimacy. One participant said, "I’m struggling with the anticipation of pain…. Sex is very mind body and like I’m scared to have sex because I’m scared of this pain.” Further elaborating that she had to “figure it all out on my own” despite receiving a vaginal dilator and information package (Table 3). Another participant shared ongoing difficulty with sexual desire, stating, “I just didn’t have any [sexual] desire during treatment…. I still just do not have the same interest as before treatment…. after the changes my body has gone through, I just don’t enjoy it much and barely engage in sexual activity with my partner,” emphasizing the need for greater awareness of sexual health counseling (Table 3). These experiences highlight how physical and emotional barriers to intimacy were further impacted by a lack of adequate post-treatment support. Other participants noted that the changes in sexual function from RT further impacted their relationships, placing strain on intimate relations and barriers in communication between partners. One participant noted “[RT] put extra strain on our relationship…. It’s different if you have not been intimate before… now you are taking that away from our relationship…. it creates disconnect between us,” and expressed that partner-inclusive support, such as couples counseling, would be beneficial (Table 3). Another participant echoed similar challenges discussing these changes with their partner, stating, “[My partner] is very supportive, …. but it's hard to have these conversations because he just doesn't understand what it's like for me,” emphasizing the importance of support services that help both patients and their partners navigate these challenges (Table 3). This highlights the need for comprehensive support services that address both the patient's and their partner's experiences, fostering understanding, communication, and intimacy. Navigating the impact of sexual health changes on fertility and family planning Most respondents (87%) experienced fertility issues and (85%) faced emotional distress after RT (Table 2), with 90% describing that RT impacted their fertility and family planning. Many (71%) did not undergo fertility preservation, (64%) did not use hormone replacement therapy, nor attended a sexual health clinic post-treatment (83%). Many respondents (60%) reported feeling uncomfortable discussing their sexual health concerns with their healthcare provider and 52% felt that they were not provided with resources to support their sexual health. Interviews confirmed these sexual health changes led to challenges with fertility and family planning. For example, one participant expressed the emotional toll of unanticipated infertility, sharing how treatment “put me immediately into early menopause and made me infertile,” making the loss especially difficult given their desire for children. They articulated a desire for grief counseling sharing “When you lose your ability to have children, there's a lot of grief associated with that.... that was the one piece that I didn't get from the hospital” (Table 3). Other participants also expressed similar changes in reproductive function and the need for resources specific to their sexual health, including unanticipated reproductive changes despite undergoing ovarian transposition. They shared their frustration, explaining that they “didn’t realize that my ovaries would be disconnected from my fallopian tubes” and that IVF would be necessary. They emphasized the need for educational resources to better prepare patients for potential reproductive health impacts, saying we need “information on the potential impacts of treatment on fertility…. so we know what to expect” (Table 3). For these participants, they desired more support and understanding regarding the long-term impacts of their treatment on family planning. One participant explains that during treatment "I wasn’t thinking about having a family back then [during treatment]…. I realize now…. they were also telling me I can't have kids naturally”. They highlighted the need for greater advocacy and decision-making support, adding “I needed someone to really walk me through what these choices could mean for my future” (Table 3). Another participant also requested tailored supports for fertility changes relating to RT sharing “I was told about fertility preservation…. but I couldn’t afford it…. I had to let go of that possibility”. They noted that after the initial discussion, “family planning hasn’t really been brought up again” and emphasized the importance of long-term and ongoing support, explaining that “It's not just about surviving cancer…. it's about having a quality life afterward” (Table 3). This participant emphasizes the need for holistic, ongoing support that extends beyond treatment, addressing their personal goals and quality of life after cancer, more specifically when it comes to family planning and reproductive health Understanding the emotional and psychosocial toll of physical discomfort and sexual dysfunction Among survey respondents, 92% (n = 48) reported anxiety, 89% (n = 46) faced depression, and 81% (n = 42) expressed body image concerns because of sexual health challenges they currently experience. Additionally, 73% (n = 38) experienced pelvic pain, 75% (n = 39) reported vaginal discomfort, 67% (n = 35) experienced vaginal dryness and 40% (n = 21) suffered vaginal stenosis (Table 2). RT was reported to impact psychological wellbeing of 73% (n = 38), while 35% (n = 18) experienced impacts on their social wellbeing and 92% (n = 48) felt that RT had impacted their physical well-being. While 67% (n = 35) had not tried pelvic floor physiotherapy, and 50% (n = 29) had not engaged in physical exercise to manage the impact of RT, 37% (n = 19) felt that the information they received about symptoms and side effects of RT was not adequate and 60% (n = 31) indicated that the education they received from their healthcare team about sexual healthcare did not adequately meet their needs. Although 48% (n = 25) of survey responses felt that their healthcare providers were proactive in addressing sexual health challenges they experienced during or after treatment, most (67%) did not have access to support groups, educational resources or peer support networks related to sexual health and RT. Interviews expanded these findings, highlighting that sexual dysfunction after RT negatively impacted the emotional and psychosocial well-being of AYAs. This was true for one participant who noted feeling alone in their experience, saying no one understood “how painful it is to even walk sometimes” or how severe the discomfort could be (Table 3). The pain limited their ability to engage socially, adding, “It’s hard to go out when I’m in pain…. I’d stick to staying home…. it feels isolating”. They emphasized the value of peer support, believing that “talking to somebody who’s been through it” would help in adjusting to this “new normal”. Another participant encountered mental health challenges due to RT side effects, explaining that they never expected to face such challenges at their age, including bladder issues, diarrhea, and vaginal dryness (Table 3). This compounded feelings of anxiety and depression, describing it as “all these different emotions…. all at once”. They emphasized the importance of open discussions, counseling, and peer groups, sharing, “It would help to talk about these feelings openly…. to learn coping mechanisms…. through counseling or support groups or even webinars”. These participants, as was true for others, spoke of needing tailored support and information to navigate the emotional challenges of grappling with identity and body image changes after treatment. One participant desired having a patient navigator articulating it would help to have “a point person to call” who could direct them to appropriate resources (Table 3). They spoke of the internal conflict of adjusting to their post-treatment body, explaining, “ I am figuring out how I feel in my skin and kind of who I am…. what my identity is as a young woman…. after diagnosis and treatment”. Another participant expressed that RT side effects made them avoid sexual health entirely, sharing “I just do not see my body the same way anymore…. I don’t feel good about my body…. It adds to my anxiety” (Table 3). They advocated for a centralized resource portal with guidance on sexual well-being, including recommendations on helpful programs, tools, and patient testimonials. These participants highlight the need for accessible, tailored resources and guidance to support their identity, body image, and mental well-being after treatment. While many participants reported challenges, some highlighted positive experiences that supported their sexual health post-RT. Participants appreciated when healthcare providers-initiated discussions about sexual health, with one participant noting, "My oncologist actually brought it up first, which made me feel like it was okay to talk about." Others found value in being given clear guidance on managing changes, with a participant sharing, "I was helpful when my nurse explained how to use dilators properly…. it made the process feel less overwhelming." Additionally, those who accessed pelvic floor physiotherapy reported improvements, with one participant stating, "It really helped me regain confidence in my body and reduced my discomfort." These experiences emphasize the impact of proactive provider communication, clear patient education, and rehabilitative care in supporting sexual health after RT. Discussion In this mixed methods study, we explored the sexual health experiences and challenges of AYA patients AFAB post-RT to explore gaps in care and inform the development of future educational resources. We found that AYAs AFAB face significant challenges related to the impact of sexual health changes on relationships and intimacy, fertility and family planning, and the emotional and psychosocial toll of treatment-related physical discomfort and sexual dysfunction. Addressing these sexual health challenges is critical to improving these patients’ well-being and allowing them to maintain relationships and achieve personal goals during a developmental stage where identity and intimacy are forming. Participants undergoing RT experience significant challenges in maintaining intimacy and communication within their relationships due to sexual health changes which include persistent pain during intercourse, loss of sexual desire, fear of sexual activity, and diminished relationship communication [ 21 , 25 , 26 ]. These issues lead to substantial relational strain and emotional distress, a situation exacerbated by limited access to tailored sexual health counseling and support services for both the patient and their partner [ 20 , 27 , 28 ]. While many of these challenges are shared by AYAs undergoing other cancer treatments [ 29 ], the impact on intimacy and relationship satisfaction is are particularly pronounced in this group, who experience higher rates of dyspareunia, fertility concerns, and psychosocial distress [ 20 , 30 , 31 ]. Consistent with prior research, cancer treatments frequently disrupt sexual function and communication [ 32 , 33 ], but this study highlights a critical gap in care, the lack of RT-specific sexual health counseling that involves both patients and their partners. Participants emphasized the need for tailored interventions, such as couples counseling, partner workshops, and comprehensive sexual health education, to restore intimacy and foster open communication. The findings highlight the importance of ongoing, age-appropriate support services that address both patient and partner experiences to mitigate relational challenges and improve quality of life. Similar to other studies, participants described profound emotional distress as a result of premature ovarian failure and infertility, including grief, regret over fertility preservation decisions, and feeling unprepared due to insufficient counseling [ 14 , 34 ], as well as the absence of comprehensive fertility preservation discussions during treatment or family-building options post-treatment [ 35 ]. This aligns with existing literature on reproductive health in cancer care, which emphasizes gaps in fertility preservation discussions and educational resources [ 33 , 36 ], with 72% of participants reporting insufficient sexual health counseling and over half unaware of available support resources before treatment. However, existing research often overlooks the unique emotional burden faced by AYAs undergoing RT. Participants emphasized the need for educational resources on reproductive health options and fertility preservation, as well as self-management tools, patient navigators, and advocacy to guide decisions. They called for tailored resources to improve preparedness and psychosocial outcomes. Unlike previous studies focusing on fertility outcomes, this study highlights the importance of ongoing support, grief counseling, and comprehensive education to address the emotional and psychological impact of infertility for AYAs transitioning into survivorship Participants frequently reported experiencing psychosocial distress including anxiety, depression, body image concerns, and reduced self-esteem, which can lead to social isolation and impaired overall functioning [ 30 , 37 , 38 ]. These physical symptoms intersected with psychological challenges, creating emotional distress and impacting social interactions and self-esteem [ 39 ]. While prior studies have highlighted psychological distress in cancer patients [ 40 ], this study specifically emphasizes the persistent and multifaceted challenges faced by AYAs AFAB receiving RT, a population with unique needs compared to older patients. The severity of these emotional and physical struggles highlights the critical need for tailored psychosocial interventions, peer support networks, and accessible educational resources. Participants expressed a strong desire for practical guidance on symptom management, sexual well-being, and relationship communication, revealing that the lack of information about sexual health counseling limited their post-treatment recovery. This highlights the potential benefit of structured support groups, patient navigators, and resource portals that address both the physical and emotional aspects of survivorship, particularly in terms of identity, body image, and mental well-being. This study has several limitations. This study was conducted at a single large academic cancer center and therefore our findings may not be generalizable or transferable to different populations [ 41 ]. Second, we employed a cross-sectional methodology; however, to fully understand sexual health post cancer treatment longitudinal data is needed [ 42 ]. Despite conducting interviews until thematic saturation, we may not have captured the full diversity of experiences among AYAs undergoing RT, particularly those from various cultural and socioeconomic backgrounds [ 43 ]. Additionally, there may be potential selection bias, as those who agreed to participate may have stronger views on sexual health or have experienced greater treatment-related toxicity, influencing the findings [ 44 ]. Most participants were cis-gender and heterosexual and therefore, future work focusing on sexual and gender diverse AYA AFAB is needed. In conclusion, AYAs AFAB who undergo RT experience distinct challenges to their sexual health, identity, and quality of life. The study highlights the need for tailored support interventions to address sexual dysfunction, physical, and psychosocial needs. Ongoing work is being done to examines the frequency and depth of sexual health conversations among female patients receiving RT and their healthcare practitioners. Holistic, patient-centered approaches that incorporate sexual health counseling, peer support, and educational resources are essential to promote the overall well-being and long-term recovery of AYAs receiving RT. Future work should focus on larger, multi-center, longitudinal studies and the development of tailored multimedia and educational resources and support networks to address the evolving sexual health needs of AYAs receiving RT. Declarations Author Contributions Conceptualization, K.D., J.C., and A.A.G.; Data curation, K.D., J.C., and A.A.G; Formal analysis, K.D., A.S., and K.G.; Investigation, K.D., A.S., K.G., J.C., and A.A.G.; Methodology, K.D., J.C., and A.A.G; Project administration, K.D., J.C., and A.A.G;.; Supervision, J.C., and A.A.G.; Validation, K.D., A.S., K.G., J.C., and A.A.G.; Writing—original draft, K.D., A.S., K.G., J.C., and A.A.G.; Writing—review & editing, K.D., A.S., K.G., J.C., and A.A.G. All authors have read and agreed to the published version of the manuscript. Funding This work was supported in part by the Princess Margaret Cancer Foundation. Conflicts of Interest/ Competing Interests The authors have no relevant financial or non-financial interests to disclose. Ethics Approval This study was performed in line with the principles of the Declaration of Helsinki. Ethics approval was obtained from the University Health Network (UHN) Research Ethics Board (REB) on February 26, 2024 (CAPCR # 22-6012). Consent to Participate Written, informed consent was obtained from all individual participants included in the study. Consent to Publish The participants consented to the publishing of their data in the journal. Data Availability Statement The data presented in this study are available on request from the corresponding author. References Warner LE, Kent EE, Trevino MK, Parsons MH, Zebrack JB, Kirchhoff A (2016) Social Well-Being Among Adolescents and Young Adults With Cancer: A Systematic Review. Cancer 122: 1029-1037. https://doi.org/10.1002/cncr.29866 Barnett M, McDonnell G, DeRosa A, Schuler T, Philip E, Peterson L, Touza K, Jhanwar S, Atkinson MT, Ford SJ (2016) Psychosocial outcomes and interventions among cancer survivors diagnosed during adolescence and young adulthood (AYA): a systematic review. 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World Politics 49: 56-91. https://doi.org/10.1353/wp.1996.0023 Tables Table 1: Demographics of Study Participants Characteristics Total Patients Survey (n, %) N = 52 Age at Treatment 15-19 20-29 30-39 5 (9.6) 6 (3.8) 41 (78.8) Gender Identity Female Male Non-binary 52 (100.0) 0 (0.0) 0 (0.0) Primary Cancer Diagnosis Gynecological Sarcoma Lymphoma Gastrointestinal 43 (82.7) 5 (9.6) 2 (3.8) 2 (3.8) Radiotherapy External Beam Radiotherapy (EBRT) Brachytherapy (BT) External Beam Radiotherapy (EBRT) + Brachytherapy (BT) 17 (32.7) 4 (7.7) 31 (59.6) Treatment Radiotherapy Systematic Therapy Surgery 52 (100.0) 44 (84.6) 47 (90.4) Sexual Orientation Heterosexual Bisexual Lesbian Queer I prefer not to answer 41 (78.8) 4 (7.7) 3 (5.8) 1 (1.9) 3 (5.8) Current Sexual Activity Yes No I prefer not to answer 32 (61.5) 15 (28.8) 5 (9.6) Relationship Status Partnered Not partnered I prefer not to answer 26 (50.0) 20 (38.5) 6 (11.5) Partner Sexual Challenges Related to Participant’s Sexual Dysfunction Yes No I prefer not to answer 34 (65.4) 13 (25.0) 5 (9.6) Education Completed Elementary/Middle School High school diploma University or college degree Graduate or professional degree I prefer not to answer 2 (3.8) 21 (40.4) 16 (30.8) 10 (19.2) 3 (5.8) Employment Status Student Part-time Full-time On disability Not employed I prefer not to answer 12 (23.1) 7 (13.5) 23 (44.2) 4 (7.7) 3 (5.8) 3 (5.8) Self-reported Other Health Conditions None Another cancer diagnosis Mental health (e.g., anxiety) Drug and Alcohol Abuse Obesity Eating disorders 27 (51.9) 9 (17.3) 10 (19.2) 1 (1.9) 2 (3.8) 3 (5.8) Net Household Income Less than $90,000 $91,000-$150,999 Greater than $150,000 I prefer not to answer 20 (38.5) 14 (26.9) 8 (15.4) 10 (19.2) Table 2: Survey Responses Question Selection (N %) 1. What changes to sexual health do you experience now? Not at all Rarely Sometimes/ Occasionally Frequently / Often Always Vaginal dryness 17 (32.7) 9 (17.3) 9 (17.3) 14 (26.9) 3 (5.8) Vaginal stenosis 31 (59.6) 8 (15.4) 6 (11.5) 5 (9.6) 2 (3.8) Vaginal discomfort 13 (25.0) 9 (17.3) 20 (38.5) 10 (19.2) 0 (0.0) Pain during sex 5 (9.6) 11 (21.2) 12 (23.1) 7 (13.5) 17 (32.7) Loss of libido or sexual desire 5 (9.6) 9 (17.3) 13 (25.0) 16 (30.8) 9 (17.3) Loss of enjoyment in sexual activity 7 (13.5) 9 (17.3) 19 (36.5) 5 (9.6) 12 (23.1) Loss of engagement in sexual activity 5 (9.6) 11 (21.2) 22 (42.3) 5 (9.6) 9 (17.3) Changes in orgasms or intensity of orgasms 25 (48.1) 7 (13.5) 11 (21.2) 3 (5.8) 6 (11.5) Anxiety 4 (7.7) 8 (15.4) 20 (38.5) 14 (26.9) 6 (11.5) Depression 6 (11.5) 14 (26.9) 8 (15.4) 11 (21.2) 13 (25.0) Emotional distress 8 (15.4) 12 (23.1) 10 (19.2) 7 (13.5) 15 (28.8) Body image concerns 10 (19.2) 4 (7.7) 10 (19.2) 18 (34.6) 10 (19.2) Loss of intimacy 5 (9.6) 12 (23.1) 10 (19.2) 14 (26.9) 11 (21.2) Deterioration of relationship communication 13 (25.0) 25 (48.1) 7 (13.5) 4 (7.7) 3 (5.8) Changes in self-esteem 8 (15.4) 4 (7.7) 15 (28.8) 20 (38.5) 5 (9.6) Fatigue 13 (25.0) 6 (11.5) 13 (25.0) 12 (23.1) 8 (15.4) Fertility issues 7 (13.5) 5 (9.6) 10 (19.2) 4 (7.7) 26 (50.0) Pelvic pain 14 (26.9) 9 (17.3) 11 (21.2) 11 (21.2) 7 (13.5) Bowel incontinence 29 (55.8) 2 (3.8) 12 (23.1) 6 (11.5) 3 (5.8) Bladder incontinence 13 (25.0) 4 (7.7) 15 (28.8) 11 (21.2) 9 (17.3) Lymphedema 40 (76.9) 3 (5.8) 4 (7.7) 3 (5.8) 2 (7.7) Diarrhea 28 (53.8) 8 (15.4) 6 (11.5) 10 (19.2) 0 (0.0) Cramping 31 (59.6) 12 (23.1) 5 (9.6) 0 (0.0) 4 (7.7) 2. For each statement below, please indicate which option fits your experience on management of the impact of PRT on quality of life Not at all Slightly Somewhat A lot Completely RT has impacted my psychological well-being 14 (26.9) 21 (40.4) 2 (3.8) 10 (19.2) 5 (9.6) RT has impacted my social well-being 34 (65.4) 5 (9.6) 2 (3.8) 7 (13.5) 4 (7.7) RT has impacted my physical well-being 4 (7.7) 13 (25.0) 24 (46.2) 5 (9.6) 6 (11.5) RT has impacted my relationship(s) in terms of intimacy and communication 8 (15.4) 12 (23.1) 11 (21.2) 9 (17.3) 12 (23.1) RT has impacted my fertility, fertility preservation and family planning 5 (9.6) 6 (11.5) 4 (7.7) 7 (13.5) 30 (57.7) 3. For each statement below, please indicate which option fits your experience on methods of managing the impact of RT. Yes No I am not sure I prefer not to answer Hormone replacement therapy 19 (36.5) 33 (63.5) 0 (0.0) 0 (0.0) Dilator use (after radiotherapy) 30 (57.7) 22 (42.3) 0 (0.0) 0 (0.0) Pelvic floor physiotherapy 17 (32.7) 35 (67.3) 0 (0.0) 0 (0.0) Sexual health clinic 6 (11.5) 43 (82.7) 0 (0.0) 3 (5.8) Sexual health counseling 8 (15.4) 38 (73.1) 4 (7.7) 2 (3.8) Martial/relationship counseling 10 (19.2) 35 (67.3) 0 (0.0) 7 (13.5) Pain medication 19 (36.5) 28 (53.8) 0 (0.0) 5 (9.6) Physical exercise 22 (42.3) 26 (50.0) 0 (0.0) 4 (7.7) Fertility preservation 7 (13.5) 37 (71.2) 0 (0.0) 8 (15.4) Dietary modification/management 11 (21.2) 35 (67.3) 0 (0.0) 6 (11.5) Heat therapy 7 (13.5) 40 (76.9) 0 (0.0) 5 (9.6) Psychosocial support 19 (36.5) 29 (55.8) 0 (0.0) 4 (7.7) Skin care management 5 (9.6) 44 (84.6) 0 (0.0) 3 (5.8) 4. For e ach statement below, please indicate which option fits your experience. Not enough Just enough Too much I have yet to receive any detail The information I received about symptoms and side effects of RT from my healthcare team, was it: 19 (36.5) 27 (51.9) 6 (11.5) 0 (0.0) The information I received about sexual health counseling from my healthcare team, was it: 30 (57.7) 16 (30.8) 6 (11.5) 0 (0.0) The education I received from my healthcare team about sexual healthcare, was it: 31 (59.6) 16 (30.8) 5 (9.6) 0 (0.0) The education I received from my healthcare team on the sexual health resources and support available to me, was it: 38 (73.1) 12 (23.1) 2 (3.8) 0 (0.0) 5. Which of the following described the sexual health counseling support you received? Yes No I am not sure I prefer not to answer Have you received sexual health counseling as part of your cancer treatment? 10 (19.2) 42 (80.8) 0 (0.0) 0 (0.0) Were you informed about the availability of sexual health counseling before or during your RT? 19 (36.5) 27 (51.9) 6 (11.5) 0 (0.0) Are you satisfied with the quality of sexual health counseling you received? 11 (21.2) 29 (55.8) 5 (9.6) 7 (13.5) Did sexual health counseling address your specific concerns and needs related to RT? 8 (15.4) 25 (48.1) 13 (25.0) 6 (11.5) Did you feel comfortable discussing your sexual health concerns with your healthcare provider? 17 (32.7) 31 (59.6) 0 (0.0) 4 (7.7) Were your healthcare providers proactive in addressing sexual health challenges you experience during or after PRT? 24 (46.1) 25 (48.1) 0 (0.0) 3 (5.8) Did sexual health counseling help you manage any sexual health challenges you experienced during or after PRT? 14 (26.9) 32 (61.5) 4 (7.7) 2 (3.8) Did you experience improved emotional well-being and body image because of sexual health counseling? 4 (7.7) 38 (73.1) 7 (13.5) 3 (5.8) Were you provided with resources to support your sexual health? 20 (38.5) 27 (51.9) 5 (9.6) 0 (0.0) Did you have access to support groups, educational resources, or peer support networks related to sexual health and PRT? 12 (23.1) 35 (67.3) 5 (9.6) 0 (0.0) Table 3: Themes, Sub-themes and Participant Quotes Theme Exemplification Quotes Managing the impact of changes in sexual function on relationships and intimacy “I’m struggling with the anticipation of pain…. Whenever I did try like, any intercourse or whatever, it’s really painful…. Sex is very mind body and like I’m scared to have sex because I’m scared of this pain…. I was given a dilator and an information package after radiation and basically had to figure it all out on my own…. The resources felt limited…. I wish there was a therapist I could talk to long-term about the lasting pain…. work through hormonal changes with…. and manage the build-up of scar tissue that makes any sort of sexual activity too hard”. “I just didn’t have any [sexual] desire during treatment…. I still just do not have the same interest as before treatment…. after the changes my body has gone through, I just don’t enjoy it much and barely engage in sexual activity with my partner…. more awareness on sexual health counseling would be helpful.... I didn't even know any of this stuff existed. Like, no one ever told what sexual health counselling was or that it was available.... The resources I did use I literally found myself…. maybe having access to sexual health counseling would provide me with that supportive environment I am looking for….”. “[PRT] put extra strain on our relationship…. It’s different if you have not been intimate before… now you are taking that away from our relationship…. it creates disconnect between us…. couples counseling or even some kind of partner workshop that focuses on understanding each other’s feelings…. maybe finding new ways to connect would be very helpful”. “[My partner] is very supportive, …. but it's hard to have these conversations because he just doesn't understand what it's like for me. He never will unless he’s in it you know…. I can tell it's frustrating for him not to be able to be intimate with me…. it’s still hard for him…. I would like to have support resources for my partner …. It’s a challenge for both of us…. Maybe there could be counseling or support groups that help him understand my experience and cope with his feelings about these changes”. Navigating the impact of sexual health changes on fertility and family planning “A lot of decisions are made for you in the process…. the treatment…. put me immediately into early menopause and made me infertile… losing that [fertility] was really tough because I wanted kids…. When you lose your ability to have children, there's a lot of grief associated with that.... I needed to grieve.... that was the one piece that I didn't get from the hospital”. “I underwent ovarian transposition prior to my treatment, thinking it would preserve my fertility.... I didn’t realize that my ovaries would be disconnected from my fallopian tubes…. I’d need IVF or that I’d have irregular periods and spotting…. we need educational resources that provide information on the potential impacts of treatment on fertility…. reproductive health and fertility options…. so, we know what to expect and can be better prepared”. “I wasn’t thinking about having a family back then [during treatment]…. I realize now…. I wasn’t just being told I have cancer…. they were also telling me I can't have kids naturally…. that's a big thing for any woman to go through…. It’s hard when actions taken then…. going forward or not with fertility preservation.... at a time when my priorities were different impact my life so much…. implementing advocacy that helps patients understand the long-term impact of these decisions…. I needed someone to really walk me through what these choices could mean for my future…. when I wasn’t in a headspace to fully see it myself”. “Before [PRT] I was told about fertility preservation…. but I couldn’t afford it…. I had to let go of that possibility…. After that initial conversation, family planning hasn’t really been brought up again…. I understand that their primary goal is to treat the tumor…. [but] starting a family is really important to me…. my overall well-being…. It's not just about surviving cancer…. it's about having a quality life afterward…. …. now that I am in follow-up, support from my healthcare team that focuses …. on goals like building a family…. would make a huge difference”. Understanding the emotional and psychosocial toll of physical discomfort and sexual dysfunction “No one around me that understands how painful it is to even walk sometimes because of the burns…. how severe the pelvic pain can be at times…. It’s hard to go out when I’m in pain …. and discomfort…. I’d stick to staying home…. it feels isolating…. I totally think that talking to somebody who's been through it, sharing your war stories with is really helpful.... Being able to hear how they manage from day to day and adjusted to this new normal would make me feel better I think”. “You equate cancer to something that somebody who’s 60 plus has…. mentally that was a huge hurdle for me to get through…. to this add the bladder issues…. diarrhea…. even [vaginal] dryness…. all these different emotions…. all at once…. creating more depression and anxiety…. It would help to talk about these feelings openly in a conversation…. like we are right now…. to learn coping mechanisms…. through counseling or support groups or even webinars”. “I think having that one person that can almost be like a family practitioner, but within the hospital would be a huge thing....having a point person to call to then direct you to the right place.... you don't expect them to know everything about everything, but they can point you in the right direction…. being in a dichotomy with my body…. I am figuring out how I feel in my skin and kind of who I am…. what my identity is as a young woman and someone going through all these changes after diagnosis and treatment.... I have to navigate all that as I go through this difficult journey”. “The side effects [from PRT] have made me avoid anything to do with sexual health…. I just do not see my body the same way anymore…. I don’t feel good about my body…. It adds to my anxiety… creating a resource portal with links on how to work on my sexual well-being…. what programs or objects to use…. how to use them…. maybe with testimonials from patients on what works for them”. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6364449","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":457091205,"identity":"a3ecc515-9b21-488a-938a-07f8c2a912ad","order_by":0,"name":"Kaviya Devaraja","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIiWNgGAWjYBACCSA+AMSMDWAuD4McWIgkLcZEaWFAaGFgSGwgpEWy/YzhYZ4aBtl+ieRnH37I2KVvuN17gOFHDW4t0jw5Bod5jjEYz5yRZjyzhyc5d8OdcwmMPcdwa5FjSEs4zMPGkLjhzAFjBh4e5twNN3IMmBnY8GjhfwbU8o8hcf+Z458Z//DUpxuAtfzD4zCJ5AOHeduAtrD3GDPz8BxOAGthbMPj/RmPDxyc2ydhPON4TzGzDM9xw5lALQd7+3BrkTif2PzhzTcb2f5m9s2Mb3uq5flu5Bg++PENtxYQYOKBRQ9jD4Q+gF8DUOEPOPMHHmWjYBSMglEwYgEAM29SUrEm7OUAAAAASUVORK5CYII=","orcid":"","institution":"Princess Margaret Cancer Centre","correspondingAuthor":true,"prefix":"","firstName":"Kaviya","middleName":"","lastName":"Devaraja","suffix":""},{"id":457091206,"identity":"2a265e5c-23b9-4869-aa3f-b5576ce21b7a","order_by":1,"name":"Anjali Sachdeva","email":"","orcid":"","institution":"University of Toronto","correspondingAuthor":false,"prefix":"","firstName":"Anjali","middleName":"","lastName":"Sachdeva","suffix":""},{"id":457091207,"identity":"3821b378-0d38-48fb-a941-e7cdcff48563","order_by":2,"name":"Karina Gandhi","email":"","orcid":"","institution":"University of Guelph","correspondingAuthor":false,"prefix":"","firstName":"Karina","middleName":"","lastName":"Gandhi","suffix":""},{"id":457091208,"identity":"290cd0fa-3cf0-45f2-bbb3-8fe18c052f23","order_by":3,"name":"Abha A. 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During this critical period, they are exploring their sexual identity, relationships, and future goals [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Treatment of pelvic malignancies often includes pelvic radiotherapy (RT). Although effective, it can result in acute and late side-effects, including sexual toxicity and premature ovarian failure for those assigned female at birth (AFAB) [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSexual dysfunction includes difficulties with sexual interest, arousal, pleasure, and orgasm, leading to issues like vaginal dryness, dyspareunia, loss of libido, and orgasmic changes [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This can lead to emotional distress including anxiety, depression, and reduced self-esteem which can negatively impact relationships and overall quality of life [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. As a result, it is important for healthcare providers to proactively discuss and educate patients on sexual health during and after cancer treatment [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe American Society of Clinical Oncology (ASCO) has created guidelines which highlights the need for providers to ask cancer patients about their sexual health [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This is especially important for AYA patients AFAB as during this critical period, they are also exploring their sexual identity, relationships, and future goals and sexual dysfunction can profoundly impact the development of these key domains [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Effective counselling for AYAs AFAB is essential for providing guidance on fertility preservation, premature ovarian failure and sexual health, addressing long-term well-being, and meeting their unique educational needs [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSexual health assessment post-RT to the pelvis is crucial for addressing the comprehensive needs of AYA patients AFAB [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Open communication with healthcare providers about sexual health concerns is essential, empowering patients to make informed decisions and enhancing their overall well-being despite treatment-related challenges [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Few studies in the literature have examined sexual health experiences of AYA cancer patients AFAB undergoing RT to the pelvis. Therefore, our objective was to assess the sexual health experiences and challenges of AYAs patients AFAB receiving RT to the pelvis to understand their experiences and education received, explore gaps in care, and inform the development of future educational resources.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Population\u003c/h2\u003e \u003cp\u003eA mixed-methods simultaneous approach was used. English-speaking AYA AFAB patients who completed RT with curative or palliative intent between January 2018 and December 2023 for a primary diagnosis of gynecological or gastrointestinal cancers, lymphoma or sarcoma, were eligible to participate. RT included external beam radiation to the pelvic organs or brachytherapy. Patients were identified using an oncologic electronic medical record database (MOSAIQ). The primary care physician at UHN was contacted to determine if it was appropriate to reach out to patients during routine follow-up. Eligible participants were then approached to participate by a member of their clinical team. Participants were subsequently contacted by the study lead (K.D.) for consent. A convenience sample of approximately 100 AYAs was sought. Ethics approval was obtained from the University Health Network (UHN) research ethics board (22-6012).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurveys - Recruitment, Data Collection, Analysis\u003c/h3\u003e\n\u003cp\u003eParticipants completed a 23-item online survey consisting of three sections: 1) demographics (n\u0026thinsp;=\u0026thinsp;17) and 2) patient-reported sexual health (n\u0026thinsp;=\u0026thinsp;4), and 3) sexual health care received (n\u0026thinsp;=\u0026thinsp;2) (Supplemental Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003eThe sexual health assessment section assessed the post-treatment sexual health of patients post-RT to obtain insight on their sexual health experiences, challenges, needs, and quality of life. The sexual health care received section assessed informational, physical, psychosocial, resource, advocacy, and awareness received during cancer treatment. This section also explored care adequacy and ideas for future solutions relating to their sexual experience. Survey items were created by the authors informed by a literature and clinical guidelines review to ensure they address relevant issues and capture comprehensive data on patient experiences [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Descriptive statistics summarized survey results.\u003c/p\u003e\n\u003ch3\u003eInterviews - Recruitment, Data Collection, Analysis\u003c/h3\u003e\n\u003cp\u003e At the end of the online survey, participants were invited to participate in a virtual one-on-one interview, conducted by a member of our study team (KD). The questions for the interview guide were developed based on insights from the survey data, literature review, and consultation with clinical experts to ensure they comprehensively addressed the patients' sexual health experiences and needs [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] (Supplemental Table\u0026nbsp;2). Interviews were conducted until thematic saturation was achieved [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Interviews were audio recorded, transcribed verbatim, and personal identifiers were removed. Thematic analysis was performed to identify patterns within the transcripts [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Three members of the research team (K.D., A.S., and K.G.) independently coded the interview transcripts, organizing codes into themes and categories using NVivo 10 software for organization. Once coded, the members discussed their comprehensive views of the data and to develop an agreed-upon coding framework.\u003c/p\u003e \u003cp\u003eSurvey data were compared with interview findings for a comprehensive understanding of the patients\u0026rsquo; experiences.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eBetween March and October 2024, 52 patients completed the survey, and of these, 15 agreed to participate in one-on-one interviews (Figure 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFigure 1: Participant recruitment flow chart\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDemographics\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eMedian age was 33 (15-39) and most were diagnosed with cervical cancer (43/52, 82.7%). While all patients received RT, treatment type varied based on cancer type and stage, with some receiving external beam RT to the pelvis alone (17/52, 32.7%), brachytherapy alone (4/52, 7.7%), or a combination of both (31/52, 59.6%), surgery (47/52, 90.4%), and systematic therapy (44/52, 84.6%). All participants self-identified as female (cis gender), with 79% identifying as heterosexual, and most (32/52, 61.5%) reporting they were currently sexually active. Half were partnered (26/52, 50.0%), and most (34/52, 65.4%) reported their partners also experienced sexual challenges because of the patient\u0026rsquo;s dysfunction (Table 1). Median time for questionnaire completion from treatment was 26 months (3-82 months).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFindings\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe triangulation of survey data and interview content revealed several challenges commonly experienced among AYAs AFAB regardless of receiving RT, such as delays in life-stage milestones like family planning (47/52, 90.4%), disruptions to intimate relationships (47/52, 90.4%), and the emotional toll of managing both treatment and post-treatment concerns (44/52, 80.0%). However, AYAs AFAB receiving RT also endorsed unique challenges specific to treatment including psychosocial, physical, and sexual health impacts.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThree themes emerged: 1) managing the impact of changes in sexual function on relationships and intimacy, 2) navigating the impact of sexual health changes on fertility and family planning, and 3) understanding the emotional and psychosocial toll of physical discomfort and sexual dysfunction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eManaging the impact of changes in sexual function on relationships and intimacy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong 52 survey respondents, 90% reported experiencing loss of intimacy, 75% experienced deterioration of relationship communication, 73% reported loss of sexual desire, and 69% reported persistent pain during sex after RT (Table 2). Most respondents (85%) reported that RT negatively impacted their relationships. Despite these challenges, 42% had not used vaginal dilators post-radiation, 67% had not accessed marital/relationship counseling, and 73% had not received sexual health counseling.\u0026nbsp;Additionally,\u0026nbsp;\u003cstrong\u003e56% were dissatisfied with the quality of sexual health counseling they received.\u003c/strong\u003e Nearly half (\u003cstrong\u003e48%\u003c/strong\u003e) felt the counseling did not address their RT-related concerns, and\u0026nbsp;\u003cstrong\u003e62% stated it did not help them manage sexual health challenges during or after treatment.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen triangulated with experiences described in the interviews, participants\u0026nbsp;described how physical changes, such as pain during intercourse and loss of sexual desire, hindered their relationships and intimacy. One participant said, \u0026quot;I\u0026rsquo;m struggling with the anticipation of pain\u0026hellip;. Sex is very mind body and like I\u0026rsquo;m scared to have sex because I\u0026rsquo;m scared of this pain.\u0026rdquo; Further elaborating that\u0026nbsp;she had to \u0026ldquo;figure it all out on my own\u0026rdquo;\u0026nbsp;despite receiving a vaginal dilator and information package (Table 3). Another participant shared ongoing difficulty with sexual desire, \u0026nbsp;stating, \u0026ldquo;I just didn\u0026rsquo;t have any [sexual] desire during treatment\u0026hellip;. I still just do not have the same interest as before treatment\u0026hellip;.\u0026nbsp;after the changes my body has gone through, I just don\u0026rsquo;t enjoy it much and barely engage in sexual activity with my partner,\u0026rdquo; emphasizing the need for greater awareness of sexual health counseling (Table 3). These experiences highlight how physical and emotional barriers to intimacy were further impacted by a lack of adequate post-treatment support.\u003c/p\u003e\n\u003cp\u003eOther participants noted that the changes in sexual function from RT further impacted their relationships, placing strain on intimate relations and barriers in communication between partners. One participant noted \u0026ldquo;[RT] put extra strain on our relationship\u0026hellip;. It\u0026rsquo;s different if you have not been intimate before\u0026hellip; now you are taking that away from our relationship\u0026hellip;. it creates disconnect between us,\u0026rdquo;\u0026nbsp;and expressed that partner-inclusive support, such as couples counseling, would be beneficial (Table 3). Another participant echoed similar challenges discussing these changes with their partner, stating, \u0026ldquo;[My partner] is very supportive, \u0026hellip;. but it\u0026apos;s hard to have these conversations because he just doesn\u0026apos;t understand what it\u0026apos;s like for me,\u0026rdquo;\u0026nbsp;emphasizing the importance of support services that help both patients and their partners navigate these challenges (Table 3). This highlights the need for comprehensive support services that address both the patient\u0026apos;s and their partner\u0026apos;s experiences, fostering understanding, communication, and intimacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNavigating the impact of sexual health changes on fertility and family planning\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMost respondents (87%) experienced fertility issues and (85%) faced emotional distress after RT (Table 2), with 90% describing that RT impacted their fertility and family planning. Many (71%) did not undergo fertility preservation, (64%) did not use hormone replacement therapy, nor attended a sexual health clinic post-treatment (83%). Many respondents (60%) reported feeling uncomfortable discussing their sexual health concerns with their healthcare provider and 52% felt that they were not provided with resources to support their sexual health. Interviews confirmed these sexual health changes led to challenges with fertility and family planning. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor example, one participant expressed the emotional toll of unanticipated infertility, sharing how treatment \u0026ldquo;put me immediately into early menopause and made me infertile,\u0026rdquo;\u0026nbsp;making the loss especially difficult given their desire for children.\u0026nbsp;They articulated a desire for grief counseling sharing \u0026ldquo;When you lose your ability to have children, there\u0026apos;s a lot of grief associated with that.... that was the one piece that I didn\u0026apos;t get from the hospital\u0026rdquo; (Table 3). Other participants also expressed similar changes in reproductive function and the need for resources specific to their sexual health,\u0026nbsp;including unanticipated reproductive changes despite undergoing ovarian transposition. They shared their frustration, explaining that they \u0026ldquo;didn\u0026rsquo;t realize that my ovaries would be disconnected from my fallopian tubes\u0026rdquo; and that IVF would be necessary. They emphasized the need for educational resources to better prepare patients for potential reproductive health impacts, saying we need \u0026ldquo;information on the potential impacts of treatment on fertility\u0026hellip;. so we know what to expect\u0026rdquo; (Table 3).\u003c/p\u003e\n\u003cp\u003eFor these participants, they desired more support and understanding regarding the long-term impacts of their treatment on family planning. \u0026nbsp;One participant explains that during treatment \u0026quot;I wasn\u0026rsquo;t thinking about having a family back then [during treatment]\u0026hellip;. I realize now\u0026hellip;. they were also telling me I can\u0026apos;t have kids naturally\u0026rdquo;. They highlighted the need for greater advocacy and decision-making support, adding \u0026ldquo;I needed someone to really walk me through what these choices could mean for my future\u0026rdquo; (Table 3). Another participant also requested tailored supports for fertility changes relating to RT sharing \u0026ldquo;I was told about fertility preservation\u0026hellip;. but I couldn\u0026rsquo;t afford it\u0026hellip;. I had to let go of that possibility\u0026rdquo;. They noted that after the initial discussion, \u0026ldquo;family planning hasn\u0026rsquo;t really been brought up again\u0026rdquo; and emphasized the importance of long-term and ongoing support, explaining that \u0026ldquo;It\u0026apos;s not just about surviving cancer\u0026hellip;. it\u0026apos;s about having a quality life afterward\u0026rdquo; (Table 3). This participant emphasizes the need for holistic, ongoing support that extends beyond treatment, addressing their personal goals and quality of life after cancer, more specifically when it comes to family planning and reproductive health\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUnderstanding the emotional and psychosocial toll of physical discomfort and sexual dysfunction\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong survey respondents, 92% (n = 48) reported anxiety, 89% (n = 46) faced depression, and 81% (n = 42) expressed body image concerns because of sexual health challenges they currently experience. Additionally, 73% (n = 38) experienced pelvic pain, 75% (n = 39) reported vaginal discomfort, 67% (n = 35) experienced vaginal dryness and 40% (n = 21) suffered vaginal stenosis (Table 2). RT was reported to impact psychological wellbeing of 73% (n = 38), while 35% (n = 18) experienced impacts on their social wellbeing and\u0026nbsp;92% (n = 48) felt that RT had impacted their physical well-being. While 67% (n = 35) had not tried pelvic floor physiotherapy, and 50% (n = 29) had not engaged in physical exercise to manage the impact of RT, 37% (n = 19) felt that the information they received about symptoms and side effects of RT was not adequate and 60% (n = 31) indicated that the education they received from their healthcare team about sexual healthcare did not adequately meet their needs. Although 48% (n = 25) of survey responses felt that their healthcare providers were proactive in addressing sexual health challenges they experienced during or after treatment, most (67%) did not have access to support groups, educational resources or peer support networks related to sexual health and RT. Interviews expanded these findings, highlighting that sexual dysfunction after RT negatively impacted the emotional and psychosocial well-being of AYAs.\u003c/p\u003e\n\u003cp\u003eThis was true for one participant who noted feeling alone in their experience, saying no one understood \u0026ldquo;how painful it is to even walk sometimes\u0026rdquo; or how severe the discomfort could be (Table 3). The pain limited their ability to engage socially, adding, \u0026ldquo;It\u0026rsquo;s hard to go out when I\u0026rsquo;m in pain\u0026hellip;. I\u0026rsquo;d stick to staying home\u0026hellip;. it feels isolating\u0026rdquo;. They emphasized the value of peer support, believing that \u0026ldquo;talking to somebody who\u0026rsquo;s been through it\u0026rdquo; would help in adjusting to this \u0026ldquo;new normal\u0026rdquo;. Another participant encountered mental health challenges due to RT side effects, explaining that\u0026nbsp;they never expected to face such challenges at their age, including bladder issues, diarrhea, and vaginal dryness (Table 3). This compounded feelings of anxiety and depression, describing it as \u0026ldquo;all these different emotions\u0026hellip;. all at once\u0026rdquo;. They emphasized the importance of open discussions, counseling, and peer groups, sharing, \u0026ldquo;It would help to talk about these feelings openly\u0026hellip;. to learn coping mechanisms\u0026hellip;. through counseling or support groups or even webinars\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eThese participants, as was true for others, spoke of needing tailored support and information to navigate the emotional challenges of grappling with identity and body image changes after treatment. One participant desired having a patient navigator articulating it would help to have \u0026ldquo;a point person to call\u0026rdquo; who could direct them to appropriate resources (Table 3).\u0026nbsp;They spoke of the internal conflict of adjusting to their post-treatment body, explaining, \u0026ldquo;\u0026nbsp;I am figuring out how I feel in my skin and kind of who I am\u0026hellip;. what my identity is as a young woman\u0026hellip;. after diagnosis and treatment\u0026rdquo;. Another participant expressed that RT side effects made them avoid sexual health entirely, sharing \u0026ldquo;I just do not see my body the same way anymore\u0026hellip;. I don\u0026rsquo;t feel good about my body\u0026hellip;. It adds to my anxiety\u0026rdquo; (Table 3). They advocated for a centralized resource portal with guidance on sexual well-being, including recommendations on helpful programs, tools, and patient testimonials. These participants highlight the need for accessible, tailored resources and guidance to support their identity, body image, and mental well-being after treatment.\u003c/p\u003e\n\u003cp\u003eWhile many participants reported challenges, some highlighted positive experiences that supported their sexual health post-RT. Participants appreciated when healthcare providers-initiated discussions about sexual health, with one participant noting, \u0026quot;My oncologist actually brought it up first, which made me feel like it was okay to talk about.\u0026quot; Others found value in being given clear guidance on managing changes, with a participant sharing, \u0026quot;I was helpful when my nurse explained how to use dilators properly\u0026hellip;. it made the process feel less overwhelming.\u0026quot; Additionally, those who accessed pelvic floor physiotherapy reported improvements, with one participant stating, \u0026quot;It really helped me regain confidence in my body and reduced my discomfort.\u0026quot; These experiences emphasize the impact of proactive provider communication, clear patient education, and rehabilitative care in supporting sexual health after RT.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this mixed methods study, we explored the sexual health experiences and challenges of AYA patients AFAB post-RT to explore gaps in care and inform the development of future educational resources. We found that AYAs AFAB face significant challenges related to the impact of sexual health changes on relationships and intimacy, fertility and family planning, and the emotional and psychosocial toll of treatment-related physical discomfort and sexual dysfunction. Addressing these sexual health challenges is critical to improving these patients\u0026rsquo; well-being and allowing them to maintain relationships and achieve personal goals during a developmental stage where identity and intimacy are forming.\u003c/p\u003e \u003cp\u003eParticipants undergoing RT experience significant challenges in maintaining intimacy and communication within their relationships due to sexual health changes which include persistent pain during intercourse, loss of sexual desire, fear of sexual activity, and diminished relationship communication [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. These issues lead to substantial relational strain and emotional distress, a situation exacerbated by limited access to tailored sexual health counseling and support services for both the patient and their partner [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. While many of these challenges are shared by AYAs undergoing other cancer treatments [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], the impact on intimacy and relationship satisfaction is are particularly pronounced in this group, who experience higher rates of dyspareunia, fertility concerns, and psychosocial distress [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Consistent with prior research, cancer treatments frequently disrupt sexual function and communication [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], but this study highlights a critical gap in care, the lack of RT-specific sexual health counseling that involves both patients and their partners. Participants emphasized the need for tailored interventions, such as couples counseling, partner workshops, and comprehensive sexual health education, to restore intimacy and foster open communication. The findings highlight the importance of ongoing, age-appropriate support services that address both patient and partner experiences to mitigate relational challenges and improve quality of life.\u003c/p\u003e \u003cp\u003eSimilar to other studies, participants described profound emotional distress as a result of premature ovarian failure and infertility, including grief, regret over fertility preservation decisions, and feeling unprepared due to insufficient counseling [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], as well as the absence of comprehensive fertility preservation discussions during treatment or family-building options post-treatment [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. This aligns with existing literature on reproductive health in cancer care, which emphasizes gaps in fertility preservation discussions and educational resources [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], with 72% of participants reporting insufficient sexual health counseling and over half unaware of available support resources before treatment. However, existing research often overlooks the unique emotional burden faced by AYAs undergoing RT. Participants emphasized the need for educational resources on reproductive health options and fertility preservation, as well as self-management tools, patient navigators, and advocacy to guide decisions. They called for tailored resources to improve preparedness and psychosocial outcomes. Unlike previous studies focusing on fertility outcomes, this study highlights the importance of ongoing support, grief counseling, and comprehensive education to address the emotional and psychological impact of infertility for AYAs transitioning into survivorship\u003c/p\u003e \u003cp\u003eParticipants frequently reported experiencing psychosocial distress including anxiety, depression, body image concerns, and reduced self-esteem, which can lead to social isolation and impaired overall functioning [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. These physical symptoms intersected with psychological challenges, creating emotional distress and impacting social interactions and self-esteem [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. While prior studies have highlighted psychological distress in cancer patients [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], this study specifically emphasizes the persistent and multifaceted challenges faced by AYAs AFAB receiving RT, a population with unique needs compared to older patients. The severity of these emotional and physical struggles highlights the critical need for tailored psychosocial interventions, peer support networks, and accessible educational resources. Participants expressed a strong desire for practical guidance on symptom management, sexual well-being, and relationship communication, revealing that the lack of information about sexual health counseling limited their post-treatment recovery. This highlights the potential benefit of structured support groups, patient navigators, and resource portals that address both the physical and emotional aspects of survivorship, particularly in terms of identity, body image, and mental well-being.\u003c/p\u003e \u003cp\u003eThis study has several limitations. This study was conducted at a single large academic cancer center and therefore our findings may not be generalizable or transferable to different populations [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Second, we employed a cross-sectional methodology; however, to fully understand sexual health post cancer treatment longitudinal data is needed [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Despite conducting interviews until thematic saturation, we may not have captured the full diversity of experiences among AYAs undergoing RT, particularly those from various cultural and socioeconomic backgrounds [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Additionally, there may be potential selection bias, as those who agreed to participate may have stronger views on sexual health or have experienced greater treatment-related toxicity, influencing the findings [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Most participants were cis-gender and heterosexual and therefore, future work focusing on sexual and gender diverse AYA AFAB is needed.\u003c/p\u003e \u003cp\u003eIn conclusion, AYAs AFAB who undergo RT experience distinct challenges to their sexual health, identity, and quality of life. The study highlights the need for tailored support interventions to address sexual dysfunction, physical, and psychosocial needs. Ongoing work is being done to examines the frequency and depth of sexual health conversations among female patients receiving RT and their healthcare practitioners. Holistic, patient-centered approaches that incorporate sexual health counseling, peer support, and educational resources are essential to promote the overall well-being and long-term recovery of AYAs receiving RT. Future work should focus on larger, multi-center, longitudinal studies and the development of tailored multimedia and educational resources and support networks to address the evolving sexual health needs of AYAs receiving RT.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAuthor Contributions\u003c/p\u003e\n\u003cp\u003eConceptualization, K.D., J.C., and A.A.G.; Data curation, K.D., J.C., and A.A.G; Formal analysis, K.D., A.S., and K.G.; Investigation, K.D., A.S., K.G., J.C., and A.A.G.; Methodology, K.D., J.C., and A.A.G; Project administration, K.D., J.C., and A.A.G;.; Supervision, J.C., and A.A.G.; Validation, K.D., A.S., K.G., J.C., and A.A.G.; Writing\u0026mdash;original draft, K.D., A.S., K.G., J.C., and A.A.G.; Writing\u0026mdash;review \u0026amp; editing, K.D., A.S., K.G., J.C., and A.A.G. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis work was supported in part by the Princess Margaret Cancer Foundation.\u003c/p\u003e\n\u003cp\u003eConflicts of Interest/ Competing Interests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003eEthics Approval\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Ethics approval was obtained from the University Health Network (UHN) Research Ethics Board (REB) on February 26, 2024 \u0026nbsp;(CAPCR # 22-6012).\u003c/p\u003e\n\u003cp\u003eConsent to Participate\u003c/p\u003e\n\u003cp\u003eWritten, informed consent was obtained from all individual participants included in the study.\u003c/p\u003e\n\u003cp\u003eConsent to Publish\u003c/p\u003e\n\u003cp\u003eThe participants consented to the publishing of their data in the journal.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData Availability Statement\u003c/p\u003e\n\u003cp\u003eThe data presented in this study are available on request from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n\u003cli\u003eWarner LE, Kent EE, Trevino MK, Parsons MH, Zebrack JB, Kirchhoff A (2016) Social Well-Being Among Adolescents and Young Adults With Cancer: A Systematic Review. 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Appl Rad Oncol 3: 5-12. https/doi.org/10.37549/ARO-D-23-00017\u003c/li\u003e\n\u003cli\u003eKaufman R, Agrawal L, Teplinsky E, Kiel L, Abioye O, Florez N (2024) From diagnosis to survivorship addressing the sexuality of women during cancer. Oncologist 29: 1014-1023. https://doi.org/10.1093/oncolo/oyae242 \u003c/li\u003e\n\u003cli\u003eSchover RL, Van der Kaaij M, Van Dorst E, Creutzberg C, Huyghe E, Kiseru EC (2014) Sexual dysfunction and infertility as late effects of cancer treatment. Eur J Cancer Suppl 12: 41-53. https://doi.org/10.1016/j.ejcsup.2014.03.004\u003c/li\u003e\n\u003cli\u003ePark RE, Norris LR, Bober LS (2009) Sexual Health Communication During Cancer Care Barriers and Recommendations. Cancer J 15: 74-77. https://doi.org/10.1097/PPO.0b013e31819587dc\u003c/li\u003e\n\u003cli\u003eLawson KA, Klock CS, Pavone EM, Hirshfeld-Cytron J, Smith NK, Kazer RR (2016) Psychological Counseling of Female Fertility Preservation Patients. 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Clin Oncol 26: 10-17. https://doi.org/10.1016/j.clon.2013.08.003\u003c/li\u003e\n\u003cli\u003eRiedl D, Gastl R, Gamper E, Arnold RC, Dejaco D, Schoellmann F, Rumpold G (2018) Cancer patients\u0026rsquo; wish for psychological support during outpatient radiation therapy. Strahlenther Onkol 194: 655\u0026ndash;663. https://doi.org/10.1007/s00066-018-1288-0\u003c/li\u003e\n\u003cli\u003eAkeflo L, Dunberger G, Elmerstig E, Skokic V, Steineck G, Bergmark K (2022) Sexual health and wellbeing among female pelvic cancer survivors following individualized interventions in a nurse-led clinic. Support Cancer Care 30: 8981-8996. https://doi.org/10.1007/s00520-022-07294-x\u003c/li\u003e\n\u003cli\u003eAbdelhadi O (2023) The impact of psychological distress on quality of care and access to mental health services in cancer survivors. Front Health Serv 3: 1-9. https://doi.org/10.3389/frhs.2023.1111677\u003c/li\u003e\n\u003cli\u003eStalmeijer RE, Brown MEL, O\u0026rsquo;Brien BC (2024) How to discuss transferability of qualitative research in health professions education. Clin Teach 1: 1-7. https://doi.org/10.1111/tct.13762\u003c/li\u003e\n\u003cli\u003eGermeni E, Bianchi M, Valcarenghi D, Schultz JP (2015) Longitudinal qualitative exploration of cancer information-seeking experiences across the disease trajectory: the INFO-SEEK protocol. BMJ Open 5: 1-6. http://dx.doi.org/10.1136/ bmjopen-2015-008933\u003c/li\u003e\n\u003cli\u003eGiuliano RA, DSW MN, Hughes C, Tortolero-Luna G, Risendal B, Ho SCR, Prewitt ET, Maccaskill-Stevens JW (2000) Participation of Minorities in Cancer Research: The Influence of Structural, Cultural, and Linguistic Factors. Ann Epidemiol 10: 22-34. https://doi.org/10.1016/S1047-2797(00)00195-2\u003c/li\u003e\n\u003cli\u003eCollier D, Mahoney J (1996) Insights and Pitfalls: Selection Bias in Qualitative Research. World Politics 49: 56-91. https://doi.org/10.1353/wp.1996.0023\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1: Demographics of Study Participants\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 373px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Patients Survey (n, %)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN = 52\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge at Treatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 373px;\"\u003e\n \u003cp\u003e15-19\u003c/p\u003e\n \u003cp\u003e20-29\u003c/p\u003e\n \u003cp\u003e30-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003cp\u003e6 (3.8)\u003c/p\u003e\n \u003cp\u003e41 (78.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender Identity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 373px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003cp\u003eNon-binary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e52 (100.0)\u003c/p\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrimary Cancer Diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 373px;\"\u003e\n \u003cp\u003eGynecological\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSarcoma\u003c/p\u003e\n \u003cp\u003eLymphoma\u003c/p\u003e\n \u003cp\u003eGastrointestinal\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e43 (82.7)\u003c/p\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003cp\u003e2 (3.8)\u003c/p\u003e\n \u003cp\u003e2 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRadiotherapy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 373px;\"\u003e\n \u003cp\u003eExternal Beam Radiotherapy (EBRT)\u003c/p\u003e\n \u003cp\u003eBrachytherapy (BT)\u003c/p\u003e\n \u003cp\u003eExternal Beam Radiotherapy (EBRT) + Brachytherapy (BT)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp; 17 (32.7)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 4 (7.7)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 31 (59.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 373px;\"\u003e\n \u003cp\u003eRadiotherapy\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSystematic Therapy\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSurgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp; 52 (100.0)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 44 (84.6)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 47 (90.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexual Orientation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 373px;\"\u003e\n \u003cp\u003eHeterosexual\u003c/p\u003e\n \u003cp\u003eBisexual\u003c/p\u003e\n \u003cp\u003eLesbian\u003c/p\u003e\n \u003cp\u003eQueer\u003c/p\u003e\n \u003cp\u003eI prefer not to answer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp; 41 (78.8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 4 (7.7)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 3 (5.8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 1 (1.9)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 3 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrent Sexual Activity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 373px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eI prefer not to answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp; 32 (61.5)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 15 (28.8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRelationship Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 373px;\"\u003e\n \u003cp\u003ePartnered\u003c/p\u003e\n \u003cp\u003eNot partnered\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eI prefer not to answer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp; 26 (50.0)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 20 (38.5)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 6 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePartner Sexual Challenges Related to Participant\u0026rsquo;s Sexual Dysfunction\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 373px;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eI prefer not to answer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp; 34 (65.4)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 13 (25.0)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation Completed\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 373px;\"\u003e\n \u003cp\u003eElementary/Middle School\u003c/p\u003e\n \u003cp\u003eHigh school diploma\u003c/p\u003e\n \u003cp\u003eUniversity or college degree\u003c/p\u003e\n \u003cp\u003eGraduate or professional degree\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; I prefer not to answer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e2 (3.8)\u003c/p\u003e\n \u003cp\u003e21 (40.4)\u003c/p\u003e\n \u003cp\u003e16 (30.8)\u003c/p\u003e\n \u003cp\u003e10 (19.2)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 3 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment Status \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 373px;\"\u003e\n \u003cp\u003e\u0026nbsp; Student\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Part-time\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Full-time\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; On disability\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; Not employed\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; I prefer not to answer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp; 12 (23.1)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 7 (13.5)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 23 (44.2)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 4 (7.7)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 3 (5.8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;3 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelf-reported Other Health Conditions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 373px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;None\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Another cancer diagnosis\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Mental health (e.g., anxiety)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Drug and Alcohol Abuse\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Obesity\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Eating disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;27 (51.9)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;9 (17.3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;10 (19.2)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;1 (1.9)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;2 (3.8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;3 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNet Household Income\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 373px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Less than $90,000\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;$91,000-$150,999\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Greater than $150,000\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; I prefer not to answer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp; 20 (38.5)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 14 (26.9)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 8 (15.4)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 10 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2: Survey Responses\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"636\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuestion\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 479px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSelection (N %)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\u003cstrong\u003e1. \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eWhat changes to sexual health do you experience now?\u003c/strong\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot at all\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRarely\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSometimes/ Occasionally\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequently / Often\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAlways\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVaginal dryness\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e17 (32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e9 (17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e9 (17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e14 (26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e3 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVaginal stenosis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e31 (59.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e8 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e6 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e2 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eVaginal discomfort\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e13 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e9 (17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e20 (38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e10 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePain during sex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e11 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e12 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e7 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e17 (32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eLoss of libido or sexual desire\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e9 (17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e13 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e16 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e9 (17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eLoss of enjoyment in sexual activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e7 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e9 (17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e19 (36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e12 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eLoss of engagement in sexual activity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e11 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e22 (42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e9 (17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eChanges in orgasms or intensity of orgasms\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e25 (48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e7 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e11 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e6 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAnxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e4 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e8 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e20 (38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e14 (26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e6 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDepression\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e6 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e14 (26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e8 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e11 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e13 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eEmotional distress\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e8 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e12 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e10 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e7 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e15 (28.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eBody image concerns\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e10 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e4 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e10 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e18 (34.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e10 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLoss of intimacy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e12 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e10 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e14 (26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e11 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eDeterioration of relationship communication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e13 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e25 (48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e7 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e4 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e3 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eChanges in self-esteem\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e8 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e4 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e15 (28.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e20 (38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFatigue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e13 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e6 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e13 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e12 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e8 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFertility issues\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e7 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e10 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e4 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e26 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePelvic pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e14 (26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e9 (17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e11 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e11 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e7 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eBowel incontinence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e29 (55.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e2 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e12 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e6 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e3 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eBladder incontinence\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e13 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e4 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e15 (28.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e11 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e9 (17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLymphedema\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e40 (76.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e3 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e4 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e2 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eDiarrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e28 (53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e8 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e6 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e10 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCramping\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e31 (59.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e12 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e4 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\u003cstrong\u003e2. \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eFor each\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003estatement below, please indicate which option fits your experience on management of the impact of PRT on quality of life\u003c/strong\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot at all\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSlightly\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSomewhat\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eA lot\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCompletely\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eRT has impacted my psychological well-being\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e14 (26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e21 (40.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e2 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e10 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eRT has impacted my social well-being\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e34 (65.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e2 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e7 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e4 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eRT has impacted my physical well-being\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e4 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e13 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e24 (46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e6 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eRT has impacted my relationship(s) in terms of intimacy and communication\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e8 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e12 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e11 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e9 (17.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e12 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 156px;\"\u003e\n \u003cp\u003eRT has impacted my fertility, fertility preservation and family planning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e6 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e4 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e7 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e30 (57.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\u003cstrong\u003e3. For each statement below, please indicate which option fits your experience on methods of managing the impact of RT.\u003c/strong\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI am not sure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI prefer not to answer\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eHormone replacement therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e19 (36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e33 (63.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eDilator use (after radiotherapy)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e30 (57.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e22 (42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003ePelvic floor physiotherapy\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e17 (32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e35 (67.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eSexual health clinic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e6 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e43 (82.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e3 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eSexual health counseling\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e8 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e38 (73.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e4 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e2 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eMartial/relationship counseling\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e10 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e35 (67.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e7 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003ePain medication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e19 (36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e28 (53.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003ePhysical exercise\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e22 (42.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e26 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e4 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eFertility preservation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e7 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e37 (71.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e8 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eDietary modification/management\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e11 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e35 (67.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e6 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eHeat therapy\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e7 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e40 (76.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003ePsychosocial support\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e19 (36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e29 (55.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e4 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eSkin care management\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e44 (84.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e3 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\u003cstrong\u003e4. For e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;ach statement below, please indicate which option fits your experience.\u003c/strong\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot enough\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eJust enough\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eToo much\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI have yet to receive any detail\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eThe information I received about symptoms and side effects of RT from my healthcare team, was it:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e19 (36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e27 (51.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eThe information I received about sexual health counseling from my healthcare team, was it:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e30 (57.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e16 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eThe education I received from my healthcare team about sexual healthcare, was it:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e31 (59.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e16 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eThe education I received from my healthcare team on the sexual health resources and support available to me, was it:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e38 (73.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e12 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\u003cstrong\u003e5. Which of the following described the sexual health counseling support you received?\u0026nbsp;\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI am not sure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI prefer not to answer\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eHave you received sexual health counseling as part of your cancer treatment?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e10 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e42 (80.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eWere you informed about the availability of sexual health counseling before or during your RT?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e19 (36.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e27 (51.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eAre you satisfied with the quality of sexual health counseling you received?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e11 (21.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e29 (55.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e7 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eDid sexual health counseling address your specific concerns and needs related to RT?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e8 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e25 (48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e6 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eDid you feel comfortable discussing your sexual health concerns with your healthcare provider?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e17 (32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e31 (59.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e4 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eWere your healthcare providers proactive in addressing sexual health challenges you experience during or after PRT?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e24 (46.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e25 (48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e3 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eDid sexual health counseling help you manage any sexual health challenges you experienced during or after PRT?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e14 (26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e32 (61.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;4 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e2 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eDid you experience improved emotional well-being and body image because of sexual health counseling?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e4 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e38 (73.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e3 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eWere you provided with resources to support your sexual health?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e20 (38.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e27 (51.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 291px;\"\u003e\n \u003cp\u003eDid you have access to support groups, educational resources, or peer support networks related to sexual health and PRT?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e12 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e35 (67.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (9.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3: Themes, Sub-themes and Participant Quotes\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eTheme\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 416px;\"\u003e\n \u003cp\u003eExemplification Quotes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eManaging the impact of changes in sexual function on relationships and intimacy\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 416px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;I\u0026rsquo;m struggling with the anticipation of pain\u0026hellip;. Whenever I did try like, any intercourse or whatever, it\u0026rsquo;s really painful\u0026hellip;. Sex is very mind body and like I\u0026rsquo;m scared to have sex because I\u0026rsquo;m scared of this pain\u0026hellip;. I was given a dilator and an information package after radiation and basically had to figure it all out on my own\u0026hellip;. The resources felt limited\u0026hellip;. I wish there was a therapist I could talk to long-term about the lasting pain\u0026hellip;. work through hormonal changes with\u0026hellip;. and manage the build-up of scar tissue that makes any sort of sexual activity too hard\u0026rdquo;.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;I just didn\u0026rsquo;t have any [sexual] desire during treatment\u0026hellip;. I still just do not have the same interest as before treatment\u0026hellip;. after the changes my body has gone through, I just don\u0026rsquo;t enjoy it much and barely engage in sexual activity with my partner\u0026hellip;. more awareness on sexual health counseling would be helpful.... I didn\u0026apos;t even know any of this stuff existed. Like, no one ever told what sexual health counselling was or that it was available.... The resources I did use I literally found myself\u0026hellip;. maybe having access to sexual health counseling would provide me with that supportive environment I am looking for\u0026hellip;.\u0026rdquo;.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;[PRT] put extra strain on our relationship\u0026hellip;. It\u0026rsquo;s different if you have not been intimate before\u0026hellip; now you are taking that away from our relationship\u0026hellip;. it creates disconnect between us\u0026hellip;. couples counseling or even some kind of partner workshop that focuses on understanding each other\u0026rsquo;s feelings\u0026hellip;. maybe finding new ways to connect would be very helpful\u0026rdquo;.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;[My partner] is very supportive, \u0026hellip;. but it\u0026apos;s hard to have these conversations because he just doesn\u0026apos;t understand what it\u0026apos;s like for me. He never will unless he\u0026rsquo;s in it you know\u0026hellip;. I can tell it\u0026apos;s frustrating for him not to be able to be intimate with me\u0026hellip;. \u0026nbsp;it\u0026rsquo;s still hard for him\u0026hellip;. I would like to have support resources for my partner \u0026hellip;. It\u0026rsquo;s a challenge for both of us\u0026hellip;. Maybe there could be counseling or support groups that help him understand my experience and cope with his feelings about these changes\u0026rdquo;.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNavigating the impact of sexual health changes on fertility and family planning\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 416px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;A lot of decisions are made for you in the process\u0026hellip;. the treatment\u0026hellip;. put me immediately into early menopause and made me infertile\u0026hellip; losing that [fertility] was really tough because I wanted kids\u0026hellip;. When you lose your ability to have children, there\u0026apos;s a lot of grief associated with that.... I needed to grieve.... that was the one piece that I didn\u0026apos;t get from the hospital\u0026rdquo;.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;I underwent ovarian transposition prior to my treatment, thinking it would preserve my fertility.... I didn\u0026rsquo;t realize that my ovaries would be disconnected from my fallopian tubes\u0026hellip;. I\u0026rsquo;d need IVF or that I\u0026rsquo;d have irregular periods and spotting\u0026hellip;. we need educational resources that provide information on the potential impacts of treatment on fertility\u0026hellip;. reproductive health and fertility options\u0026hellip;. so, we know what to expect and can be better prepared\u0026rdquo;.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;I wasn\u0026rsquo;t thinking about having a family back then [during treatment]\u0026hellip;. I realize now\u0026hellip;. I wasn\u0026rsquo;t just being told I have cancer\u0026hellip;. they were also telling me I can\u0026apos;t have kids naturally\u0026hellip;. that\u0026apos;s a big thing for any woman to go through\u0026hellip;. It\u0026rsquo;s hard when actions taken then\u0026hellip;. going forward or not with fertility preservation.... at a time when my priorities were different impact my life so much\u0026hellip;. implementing advocacy that helps patients understand the long-term impact of these decisions\u0026hellip;. I needed someone to really walk me through what these choices could mean for my future\u0026hellip;. when I wasn\u0026rsquo;t in a headspace to fully see it myself\u0026rdquo;.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Before [PRT] I was told about fertility preservation\u0026hellip;. but I couldn\u0026rsquo;t afford it\u0026hellip;. I had to let go of that possibility\u0026hellip;. After that initial conversation, family planning hasn\u0026rsquo;t really been brought up again\u0026hellip;. I understand that their primary goal is to treat the tumor\u0026hellip;. [but] starting a family is really important to me\u0026hellip;. my overall well-being\u0026hellip;. It\u0026apos;s not just about surviving cancer\u0026hellip;. it\u0026apos;s about having a quality life afterward\u0026hellip;. \u0026hellip;. now that I am in follow-up, support from my healthcare team that focuses \u0026hellip;. on goals like building a family\u0026hellip;. would make a huge difference\u0026rdquo;.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eUnderstanding the emotional and psychosocial toll of physical discomfort and sexual dysfunction\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 416px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;No one around me that understands how painful it is to even walk sometimes because of the burns\u0026hellip;. how severe the pelvic pain can be at times\u0026hellip;. It\u0026rsquo;s hard to go out when I\u0026rsquo;m in pain \u0026hellip;. and discomfort\u0026hellip;. I\u0026rsquo;d stick to staying home\u0026hellip;. it feels isolating\u0026hellip;. I totally think that talking to somebody who\u0026apos;s been through it, sharing your war stories with is really helpful.... Being able to hear how they manage from day to day and adjusted to this new normal would make me feel better I think\u0026rdquo;.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;You equate cancer to something that somebody who\u0026rsquo;s 60 plus has\u0026hellip;. mentally that was a huge hurdle for me to get through\u0026hellip;. to this add the bladder issues\u0026hellip;. diarrhea\u0026hellip;. even [vaginal] dryness\u0026hellip;. all these different emotions\u0026hellip;. all at once\u0026hellip;. creating more depression and anxiety\u0026hellip;. It would help to talk about these feelings openly in a conversation\u0026hellip;. like we are right now\u0026hellip;. to learn coping mechanisms\u0026hellip;. through counseling or support groups or even webinars\u0026rdquo;.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;I think having that one person that can almost be like a family practitioner, but within the hospital would be a huge thing....having a point person to call to then direct you to the right place.... you don\u0026apos;t expect them to know everything about everything, but they can point you in the right direction\u0026hellip;. being in a\u0026nbsp;dichotomy with my body\u0026hellip;. I am figuring out how I feel in my skin and kind of who I am\u0026hellip;. what my identity is as a young woman and someone going through all these changes after diagnosis and treatment.... I have to navigate all that as I go through this difficult journey\u0026rdquo;.\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;The side effects [from PRT] have made me avoid anything to do with sexual health\u0026hellip;. I just do not see my body the same way anymore\u0026hellip;. I don\u0026rsquo;t feel good about my body\u0026hellip;. It adds to my anxiety\u0026hellip; creating a resource portal with links on how to work on my sexual well-being\u0026hellip;. what programs or objects to use\u0026hellip;. how to use them\u0026hellip;. maybe with testimonials from patients on what works for them\u0026rdquo;.\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\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":"sexual health, adolescent and young adult, sexual dysfunction, pelvic radiotherapy, cancer, gynecological malignancies","lastPublishedDoi":"10.21203/rs.3.rs-6364449/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6364449/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003ePelvic radiotherapy (PRT) is an effective cancer treatment for pelvic malignancies but often results in sexual dysfunction and long-term complications, particularly for patients with a vagina. This impact is heightened in adolescent and young adult (AYA) patients who face unique developmental challenges, where sexual health issues can profoundly affect relationships, self-esteem, and quality of life. This study investigates the sexual health experiences of AYAs with a vagina undergoing PRT to identify care gaps and inform tailored support and resources.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eIn this mixed-methods study, we surveyed AYA patients receiving PRT at Princess Margaret Cancer Centre (PM) to assess sexual health changes and care satisfaction. Interviews further explored their sexual dysfunction and needs. Descriptive statistics summarized survey data, and thematic analysis guided by Braun and Clarke's framework identified key interview themes. Triangulation compared survey and interview results for a comprehensive understanding.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFifty-eight participants (58 female, mean age 32.8) completed surveys and fifteen completed interviews. Triangulation revealed sexual health challenges, such as pain during intercourse, loss of libido, diminished intimacy, communication barriers in relationships, difficulty with fertility and emotional and psychosocial distress. Three main themes emerged: 1) managing the impact of changes in sexual function on relationships and intimacy, 2.) navigating the impact of sexual health changes on fertility and family planning, and 3.) understanding the emotional and psychosocial toll of physical discomfort and sexual dysfunction.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThese findings highlight the critical need for comprehensive, tailored interventions to support sexual health in AYA patients undergoing PRT.\u003c/p\u003e","manuscriptTitle":"Sexual Health of Adolescent and Young Adults Assigned Female at Birth Post Pelvic Radiotherapy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-16 12:58:35","doi":"10.21203/rs.3.rs-6364449/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":"50eace63-f0f8-42ee-9b4f-b9282c6010c7","owner":[],"postedDate":"May 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-24T18:53:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-16 12:58:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6364449","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6364449","identity":"rs-6364449","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}