Association of post-treatment vaginal structural changes with psychosexual dysfunction in young cervical cancer survivors: Evidence from a low- and middle-income country.

5542 Background: Vaginal stenosis is a known late side effect of pelvic radiotherapy for cervical cancer. In low- and middle-income countries (LMICs), the extent of vaginal changes and their effects on sexual and emotional health are poorly studied due to cultural stigma and limited counseling. This study examined objective vaginal changes and their association with psychosexual distress among young cervical cancer survivors. Methods: This cross-sectional mixed-method study included 300 women aged ≤45 years who completed pelvic radiotherapy, with or without surgery and/or brachytherapy, 6–24 months earlier at Delta Hospital and collaborating centers. Participants completed a bilingual interviewer-administered questionnaire on counseling, intimacy, psychosocial distress, and perceived barriers. A standardized clinical examination was used to assess vaginal changes, including vaginal length, elasticity, adhesions, dryness, and dyspareunia, graded using LENT-SOMA and CTCAE v5.0 criteria. Outcomes were compared between women treated with definitive chemoradiation and those who underwent surgery followed by adjuvant radiotherapy ± brachytherapy. Results: The mean post-treatment vaginal length was 4.1 ± 1.2 cm. Reduced vaginal elasticity and adhesions were found in 68% of participants. Severe vaginal shortening (≤2 cm) or blind-ending occurred more often in women who received surgery followed by adjuvant radiotherapy and brachytherapy (approximately 40%) compared with those treated with definitive chemoradiation (p<0.05). The psychosexual impact was marked: 80% of women reported no return to penetrative intimacy or regular vaginal dilation, and 85% reported loss of sexual interest. The most common barriers were fear of injury or cancer recurrence (72%), pain during intercourse (65%), sociocultural stigma (48%), and partner separation or dysfunction (36%). Although 52% recalled receiving some counseling, only 15% actively discussed sexual health concerns, and fewer than 10% accessed specialized psychosexual care. Conclusions: Objective vaginal shortening and fibrosis are strongly linked to psychosexual distress and avoidance of intimacy among young cervical cancer survivors, especially after multimodality treatment. In low- and middle-income countries, unstructured counseling alone is not sufficient. Survivorship care should include regular vaginal assessment and culturally sensitive, partner-inclusive psychosexual counseling.