# Sexual health assessed and treated as a standard toxicity domain

Source: https://onco.cc/ideas/idea-moon-sexual-health-as-toxicity-domain/  
OnCo record `idea-moon-sexual-health-as-toxicity-domain` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Cancer treatment often damages sexual function and intimacy, and almost nobody asks. Make it a routine question with a clinic to refer to.

## Summary

Sexual dysfunction after pelvic surgery, radiotherapy, endocrine therapy and stem cell transplant is very common and is among the least discussed toxicities. The proposal is routine screening with a brief validated item set at treatment milestones, a referral pathway to sexual health services (pelvic floor physiotherapy, vaginal and erectile therapies, counselling), and inclusion of sexual function as a PRO domain in trials of pelvic and endocrine treatments.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Routine screening and referral increases treatment of sexual dysfunction severalfold and improves patient-reported quality of life and adherence to endocrine therapy.
- Rationale: Under-treatment is driven by embarrassment and absent pathways, not absent treatments; adherence to endocrine therapy is known to fall with sexual side-effects.
- Proposed test: Implementation trial in prostate, cervical, rectal and breast cancer clinics with screening rates, referral, and quality of life at 12 months as endpoints.
- Maturity: early-clinical
- Actor: clinic

## Sources

- Bottleneck evidence (Toxicity and quality of life are undervalued): Di Maio et al., Symptomatic toxicities experienced during anticancer treatment: agreement between patient and physician reporting (JCO 2015): https://doi.org/10.1200/JCO.2014.57.9334

## Connected records

- cancers: [Cervical cancer](https://onco.cc/cancers/cervical/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- bottlenecks: [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- key papers: [Symptomatic toxicities experienced during anticancer treatment: agreement between patient and physician reporting in three randomized trials](https://onco.cc/key-papers/paper-di-maio-j-clin-oncol/)
- technologies: [A changed face and voice: body image after head and neck cancer treatment](https://onco.cc/technologies/rejuv-mind-visible-difference-head-and-neck/), [Body image after cancer treatment: how it is measured, what drives it, and what helps](https://onco.cc/technologies/rejuv-mind-body-image-after-cancer/), [Partners and relationships after cancer: what the divorce data actually show](https://onco.cc/technologies/rejuv-life-partners-and-intimacy/), [Sexual function and intimacy after cancer, for both sexes](https://onco.cc/technologies/sexual-function-after-cancer/), [Vaginal oestrogen after breast cancer: what the evidence says, and where it disagrees](https://onco.cc/technologies/vaginal-oestrogen-after-breast-cancer/)

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