Radiation-specific sexual and reproductive health challenges in adolescent and young adults assigned female at birth: a mixed-methods study of unmet needs post pelvic radiotherapy

Purpose: Pelvic radiotherapy (RT) is an effective treatment for pelvic malignancies but often leads to sexual and reproductive health (SRH) challenges, particularly among adolescent and young adult (AYA) patients assigned female at birth (AFAB). Despite known toxicities, no study has systematically explored the SRH experiences, challenges, and unmet care needs of this population post-RT. This study aimed to assess SRH impacts and identify gaps in care among AYA AFAB cancer survivors following pelvic RT. Patients and Methods: We conducted a simultaneous mixed-methods study at a tertiary cancer center. AYA AFAB patients aged 18–39 who completed pelvic RT between 2018 and 2023 completed a 23-item survey assessing SRH experiences and care satisfaction; a subset participated in in-depth interviews. Quantitative data were analyzed descriptively, and qualitative data were examined using thematic analysis. Triangulation enabled a comprehensive understanding of patient experiences. Results: Fifty-two participants completed the survey (median age 33), and 15 completed interviews. Most reported sexual dysfunction (90%), intimacy disruption (90%), and fertility-related distress (87%). Three themes emerged: (1) RT-induced sexual dysfunction negatively affected relationships and intimacy, (2) fertility and reproductive disruptions were compounded by inadequate education and support, and (3) chronic pelvic discomfort and body image changes caused emotional and psychosocial distress. Participants emphasized limited provider communication, scarce RT-specific SRH resources, and lack of post-treatment supports. Conclusions: This first study characterizing RT-specific SRH disruptions among AYA AFAB survivors underscores the urgent need for age-appropriate survivorship care integrating SRH education, counseling, and partner-inclusive supports.