Gender inequalities in sexual health assessment after pelvic radiotherapy.

OBJECTIVE: The objective of this study was to evaluate the number of patients with gynecological cancer treated with pelvic radiotherapy whose consent included sexual health-related side effects and who asked about sexual health before and after treatment, and to compare these findings with those for male patients treated with pelvic radiotherapy for prostate cancer. METHODS: Retrospective data from the electronic records of 214 patients (107 gynecological, 107 prostate cancer) treated with pelvic radiotherapy in 2024 were reviewed for documentation of consent for sexual side effects and assessment of physical, psychological, and social domains of sexual health at baseline, end of radiotherapy, and 3-, 6-, and 12-month follow-up. Assessment with patient-reported outcome measures and availability of patient education materials were also analyzed. χ2 analysis was used to determine statistical differences between groups. RESULTS: Data from 107 women with gynecological cancer and 107 men with prostate cancer were analyzed. All 214 patients provided consent that included radiotherapy side effects affecting physical domains of sexual health, but psychological domains were only discussed in men. Social domains were not discussed at consent in either group. Across the 3 pre-defined time points (baseline, end of radiotherapy, and 3 month follow-up), sexual health was assessed in only 25% of women with gynecological cancer compared with 80% of men with prostate cancer, the difference was statistically significant (p <.05). Sexual health assessment in women with gynecological cancer was conducted at baseline, end of treatment, 3, 6, and 12 months in 3%, 18%, 16%, 37%, and 40% of cases, respectively. In comparison, the corresponding rates in men with prostate cancer were 49%, 52%, 51%, 51%, and 53%. Patient-reported outcome measures-based assessment and the availability of educational resources were more common in prostate cancer care. CONCLUSION: Women treated with pelvic radiotherapy for gynecological cancer receive significantly less comprehensive sexual health assessment and support than men treated for prostate cancer. Standardized, guideline-based sexual health pathways are needed to eliminate these disparities and improve survivorship care.