Sexual Dysfunction in Female Rectal and Anal Cancer Survivors: Pathophysiology, Clinical Management, and Integration into Survivorship Care

Background: Sexual dysfunction (SD) is a frequent but under-recognized consequence of treatment for rectal and anal cancers in women. While advances in oncologic therapy have improved survival rates, quality-of-life outcomes—particularly those related to sexual health—remain poorly integrated into survivorship care. A multidisciplinary understanding of the pathophysiological, psychological, and social factors contributing to SD is essential for holistic patient management.Methods: A narrative review was conducted to examine the impact of cancer treatments on female sexual function. Articles published in English between January 2000 and June 2025 were identified via PubMed. The search strategy used the following keywords combined with the Boolean operator “AND”: female sexual dysfunction AND rectal cancer AND anal cancer AND pelvic surgery AND radiotherapy AND survivorship AND quality of life AND FSFI AND psychosexual care AND immunotherapy.Two independent reviewers (DD and MS) screened the titles and abstracts of the retrieved articles. Of the 100 articles initially identified, 70 met the inclusion criteria and were selected for full-text review and thematic analysis.To synthesize current evidence on female sexual dysfunction following rectal and anal cancer treatments, critically analyze the pathophysiological mechanisms and psychosocial implications, and propose evidence-based strategies for clinical assessment and multidisciplinary care.Results: Sexual dysfunction affects more than 60% of female survivor post-treatment, with symptoms including decreased libido, vaginal dryness, dyspareunia, and arousal difficulties. Pathophysiological drivers include estrogen/testosterone deficiency, autonomic nerve injury during pelvic surgery, and radiation-induced fibrosis. Psychological distress, body image changes, stoma-related stigma, and poor partner communication exacerbate the dysfunction. Validated instruments like FSFI are frequently used but lack specificity for pelvic cancer populations. Data show significant geographic variability, with greater stigma and reduced access to care in low- and middle-income countries. Immunotherapy-based regimens (e.g., dostarlimab in dMMR rectal cancer) may preserve pelvic anatomy and reduce SD, though sexual outcomes remain underexplored.Conclusions: Female sexual dysfunction after rectal and anal cancer is a multifactorial, highly prevalent condition that significantly impairs quality of life. Despite the recognized burden, sexual health remains insufficiently assessed and managed in oncologic follow-up. Multidisciplinary, culturally sensitive models integrating validated screening, psychosexual support, and individualized rehabilitation are urgently needed. Future research should include longitudinal designs, underrepresented populations, and dedicated endpoints on sexual health—especially in emerging treatment settings such as immunotherapy.