Appraisal of sexual functioning before and after cancer: Insights from adolescent and young adult (AYA) cancer survivors and matched healthy controls

Purpose
Adolescence and young adulthood (AYA) are developmental phases in which individuals establish their identity. A cancer diagnosis during this stage disrupts sexual health, but research remains limited, particularly outside of reproductive-organ cancers. This study examined perceived changes in sexual functioning from pre- to post-diagnosis among survivors and compared their current sexual functioning and satisfaction with matched controls.

Methods
Dutch-speaking AYA cancer survivors (N = 174; age = 32.7 years; 85.6% female) recruited via convenience sampling and N = 348 matched controls completed self-reported measures of sexual functioning [MOS-SF] and satisfaction [GMSEX]. Paired sample t-tests assessed perceived changes in sexual functioning. Repeated measures ANOVAs tested the effects of sociodemographic and cancer-related factors on these variations. Independent sample t-tests compared current sexual functioning and satisfaction between survivors and controls.

Results
Survivors reported significant declines in multiple domains of sexual functioning, including interest, arousal, orgasm function, pleasure, and lubrication (women). Greater dysfunction was observed among females, individuals diagnosed in their 30s, those in early survivorship, and those who remained with the same partner. Survivors who had engaged in partnered sexual activity reported less dysfunction than those who had not. Compared with controls, survivors reported significantly greater dysfunction and lower sexual satisfaction, while retrospectively rating their pre-diagnosis sexual functioning as more positive.

Conclusions
AYA cancer survivors reported declines in sexual functioning over time, worse outcomes than controls, and more favorable recollections of their pre-diagnosis sexual health, a pattern consistent with response shift. Findings emphasize the need for comprehensive survivorship care that includes routine, proactive sexual health discussions, and tailored interventions responsive to survivors' evolving needs.