(107) Time to Sexual Dysfunction Diagnosis in Gynecologic and Colorectal Cancer Patients After Pelvic Radiotherapy: A TriNetX Database Analysis

Abstract Introduction Pelvic radiotherapy is associated with sexual dysfunction in female gynecologic and colorectal cancer patients. Gynecologic cancer patients typically receive treatment from gynecologic-oncologists within established environments where sexual dysfunction concerns are readily addressed. However, studies have shown that colorectal cancer patients treated in traditional oncology settings often do not readily discuss their sexual health with their oncologists or surgeons, potentially leading to delays in care. Objective To compare time to sexual dysfunction diagnosis amongst female colorectal and gynecologic cancer patients who underwent radiotherapy to the pelvis, hypothesizing that gynecologic cancer patients receive diagnoses earlier than colorectal cancer patients. Methods Female gynecologic and colorectal cancer patients aged 18 and older who underwent pelvic radiation therapy were analyzed using the TriNetX database on 10/23/25. Risk ratios with 95% CI were generated for sexual dysfunction defined as dyspareunia, vaginismus, orgasmic disorder, pelvic and perineal pain, and vulvodynia diagnoses in the intervals between 1 month and 3, 6, 12, 24, 36, 48, and 60 months after first radiotherapy treatment. Analyses were started at 1 month to reflect current sexual practice guidelines post-radiation. Results Using ICD-10 codes, 2235 individuals were identified as both having a gynecologic cancer diagnosis (C51-58) and receiving radiotherapy to the pelvic region defined by beam radiation, brachytherapy, stereotactic radiosurgery, or other radiation to the pelvic region (ICD-10 DW06, DW16, DW26, and DWY6, respectively), versus 425 425 gynecologic cancer control patients who did not receive radiotherapy. 783 individuals were identified as both having a colorectal cancer diagnosis (C18-20) and receiving radiotherapy to the pelvic region, versus 193 983 colorectal cancer control patients who did not receive radiotherapy. After propensity matching to balance clinical characteristics between cohorts, patients with colorectal cancer had a greater risk of developing sexual dysfunction at any time point after pelvic radiation treatment, compared to those without radiation treatment (RR = 2.321, 95%CI = 1.63-3.305). The same risk relationship held true for gynecologic cancer patients with pelvic radiation therapy compared to those without (RR = 2.052, 95% CI =1.691-2.489). In comparing cancer + radiotherapy patient cohorts, those with gynecologic cancers had a significantly greater risk of sexual dysfunction diagnosis within the first two months after radiotherapy treatment (RR = 2.165, 95% CI = 1.092-4.290) compared to colorectal cancer patients with pelvic radiotherapy. At all other time points (6mo, 12mo, 24mo, 36mo, 48mo, 60mo), there were no statistically significant differences in risk for sexual dysfunction diagnosis. Conclusions Although overall risk of sexual dysfunction diagnosis amongst colorectal and gynecologic cancer patients treated with pelvic radiotherapy is the same five years after treatment, early diagnosis of sexual dysfunction is more common in gynecologic cancer patients. This aligns with findings in the literature that colorectal cancer patients may not be receiving timely care for their sexual wellness. These findings highlight the need for traditional oncology settings to better recognize and address sexual health concerns with increased referrals to sexual medicine clinics around the time of treatment initiation. Disclosure No.