Sexual Dysfunction in Cervix Cancer Survivors After Surgery and/or Radio(chemo)therapy: A Bayesian Network Analysis Based on the SENECA Study Cohort

Background: To better understand the complexity of sexual dysfunction, we aim to construct multi-factorial explanatory models of sexual dysfunction using data from participants enrolled in the Danish cross-sectional Study of latE effects for those liviNg through cErvical CAncer (SENECA). Methods: In a nationwide survey, patient-reported outcomes (PRO) were collected from 2002 cervical cancer survivors treated with surgery and/or radio(chemo)therapy between 2005–2020 and a reference cohort consisting of 7853 women without a history of cancer. PROs in the EORTC C30/CX24 questionnaires were analysed. Bayesian Network models were developed for sexual activity and dyspareunia in reference and cancer survivor cohorts, resulting in four explanatory models. The reference cohort served as a structural prior for the cancer models. Sexual activity models included participants with complete data (6706 reference, 1694 cancer), while dyspareunia models included those reporting sexual activity in the past four weeks (4521 reference, 996 cancer). Results: Respondents were stratified by treatment received: (1) reference group (n = 7853), (2) surgery alone (n = 1285), (3) radio(chemo)therapy (RCT) with/without prior surgery (n = 951). Sexual inactivity was reported by 28%, 29% and 49% of reference, surgery and RCT groups respectively, and dyspareunia by 23%, 39% and 54%. Sexual activity was associated with age, treatment modality and social functioning. Social functioning was associated with cognitive and role functioning, global QoL, and financial difficulties, all of which were associated strongly with fatigue. Dyspareunia was associated with vaginal functioning and soreness. The strong associations observed in the cancer survivor cohort between fatigue and functional outcomes/QoL/sexual activity were absent in the reference cohort. Conclusions: Sexual inactivity and dyspareunia were more common in cervical cancer patients, particularly in those treated with RCT compared with the reference cohort. Differences in explanatory factors between cancer and reference cohorts highlight the need for cancer-specific approaches to sexual rehabilitation.