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

82% of young adult cancer survivors reported at least mild sexual dysfunction; female survivors scored nearly twice as impaired as males

Journal: Supportive Care in Cancer | Published: 2026-06-25 | Type: Journal Article | PMID: 42343064 Authors: Acquati C (U Minnesota), den Oudsten BL (Tilburg), Both S (Amsterdam UMC), Lehmann V (Amsterdam UMC) Funding/COI: Funding not disclosed. Authors declare no competing interests.

Summary

174 Dutch-speaking AYA cancer survivors (mean age 32.7, 85.6% female) reported significant declines across every sexual functioning domain — interest, arousal, orgasm, pleasure, and lubrication — compared to 348 matched healthy controls. More than four in five survivors reported at least mild dysfunction. A response shift finding draws the most methodological scrutiny: survivors rated their pre-diagnosis sexual functioning more positively than matched controls rated their own current functioning, suggesting survivors may be reconstructing their past rather than accurately recalling it.

Claims

• 82.2% of survivors reported at least mild sexual dysfunction on the MOS-SF; 43.1% reported moderate-to-severe dysfunction
• Most common problems: loss of sexual interest (51.7% reported "never" or "occasionally" interested) and arousal difficulties (40.8%)
• Female survivors scored substantially higher dysfunction than males: M = 51.0 vs. 30.2 (t(172) = 4.80, p < 0.001, Hedges' g = 1.03)
• Survivors who engaged in partnered sexual activity in the prior 4 weeks reported lower dysfunction than those who had not
• Survivors who remained with the same partner since diagnosis reported greater deterioration than those whose relationship status had changed
• Those diagnosed in their 30s reported greater dysfunction than those diagnosed younger
• Early survivorship (< 1 year from diagnosis) was associated with greater dysfunction than longer survivorship phases
• Response shift: survivors retrospectively rated their pre-diagnosis functioning more positively than controls rated their own current functioning

Study Quality

The between-group comparison is the most credible piece of this paper. Matching controls 2:1 on sex, age, and relationship status, then running independent-sample t-tests, is methodologically appropriate and the effect sizes are large. The MOS-SF is validated; the addition of a lubrication item for women and an erectile function item for men is a reasonable extension.

The within-survivor "change over time" analysis is fundamentally limited by design. Survivors rated pre-diagnosis functioning retrospectively, and the study protocol explicitly displayed the retrospective and current scales on the same webpage, noting that participants could "adjust their responses relative to one another." This is an invitation for response bias, not a control for it. The authors correctly invoke response shift as an explanation for their most striking finding, but they cannot determine whether the pre-diagnosis recall reflects genuine prior functioning or a cognitively reconstructed baseline shaped by the cancer experience. No longitudinal data exist here — this is a cross-sectional study with retrospective recall.

Red Flags

• Convenience sampling via social media posts from patient support organizations heavily biases toward engaged, health-literate survivors — those least likely to represent the full population
• Retrospective pre-diagnosis ratings collected on the same screen as current ratings, with instructions allowing adjustment: this design actively creates the response shift the authors then describe as a finding
• n = 25 males: the male subsample is too small for any sex-specific conclusions to hold; the g = 1.03 effect comparing male and female dysfunction is derived from 25 vs. 149 participants
• No hormonal or clinical data: self-report only — the paper cannot attribute dysfunction to specific cancer treatments (chemotherapy, surgery, radiotherapy) versus psychological sequelae
• Breast cancer (30.5%) and leukemia/lymphoma (29.9%) dominate: findings may not generalize to rarer cancer types
• Funding not disclosed: for a study of this scope, recruiting 522 participants including a commercial panel, the absence of any funding disclosure is notable

Strengths

• Well-matched control group (2:1 ratio), which is uncommon in survivorship sexual health research
• Measures were inclusive of solo sexual activity, non-penetrative sex, and diverse orientations — not purely heterosexual or penetration-focused
• Examined five sexual functioning domains rather than a single composite, allowing domain-specific analysis
• Broad cancer type inclusion across both reproductive-organ and non-reproductive-organ cancers

Verdict

Read the survivor-vs.-control comparison and stop there. The finding that cancer survivors in their early 30s report substantially worse sexual function than matched healthy peers — with more than 40% in the moderate-to-severe range — is a real signal worth attention, even accounting for the study's sampling biases. The "pre-vs.-post-diagnosis change" analysis, which the paper leads with, is on shakier ground: asking people to recall their sex lives before a traumatic illness, on the same screen where they just rated how bad things are now, is not a measurement of change. It is a measurement of how people feel about having cancer. The authors are honest about response shift but treat it as a nuance rather than a central confound. The male findings are clinically useless at n = 25.