Table 3.

Interventions targeting sexual and gynecological dysfunction after radiotherapy for anal cancer.

Study	Population	Study design	Intervention type	Timing/setting/duration	Key outcomes
Vaginal care routines
Fakhrian et al. [45]	N = 10 anal cancer patients	Cross-sectional	Vaginal supportive care (vaginal creams, vaginal bath) during, and 8 weeks after the treatment	Median time since RT 68 (range 9–222)	Patient reported use of vaginal supportive care during and shortly after RT was not associated with vaginal toxicities
Law et al. [39]	N = 109 pelvic cancers; 35 anal cancer patients	Prospective cohort	Vaginal dilator use with nurse-led instruction	Start 4–6 weeks post-RT; home use; instructed 3×/week for 10 min; 12-month follow-up	Higher adherence to VD was significantly associated with maintaining/returning to VD size across the full cohort. Anal cancer subgroup had 51% mean adherence.
Son et al. [40]	N = 54 Rectal and anal cancer; 27 anal cancer patients	Prospective cohort	Vaginal dilator use	Dilator use initiated 1 month post-RT; follow-up at 1 and 12 months	VD compliance <40% linked to higher grade of vaginal stenosis.
Psycho-sexual education
Carter et al. [46]	N = 175 female; mostly breast and gynecologic cancer pt.; 9% anal/colorectal patients	Prospective cohort	Psycho-sexual education	In-person, multi-session consults during or post-treatment; NP + PhD team approach	Improved VAS/VuAS, FSFI, SAQ; pelvic pain and vaginal dryness decreased in ~50%
DuHamel et al. [47]	N = 70 female rectal/anal cancer survivors; 21 anal cancer patients	Pilot randomized controlled trial (RCT)	4-session telephone-based psychoeducational intervention	Post-treatment; 4 sessions over 8 months; phone based.	Significant FSFI improvement in sexually active women only; non-significant overall
Lubotzky et al. [48]	N = 82 female cervical, endometria, vulva, vaginal, rectal or anal pt.; 6 anal cancer patients	Randomized controlled trial (RCT)	Psychosexual rehabilitation booklet	Distributed 2 weeks post-RT; mailed booklet; 12-month follow-up; RCT across 7 sites	Increased dilator adherence; no effect on sexual function/satisfaction
Sexological clinics
Li et al. [49]	N = 69 female cervical, endometria, vulva/vaginal or anal/rectal cancer pt.; 4 anal/rectal patients	Retrospective cohort	Multidisciplinary SIMS clinic	Clinic-based, median 36-month follow-up; interventions included HRT, vaginal therapy, counseling	55.7% improved, 27.9% stable, 8.3% worsened; worse outcomes with non-adherence
Mikkelsen et al. [50]	N = 127 colorectal/anal cancer pt.; 14 anal cancer patients	Prospective cohort	Nurse-led sexological clinics	Referral-based, any time post-treatment; public hospitals in Denmark; 3-month follow-up post-discharge	≥1-point improvement in 68%; ~50% improved on key sexual health outcomes

FSFI Female Sexual Function Index, HRT hormone replacement therapy, NP nurse practitioner, RCT randomized controlled trial, RT radiotherapy, SAQ Sexual Activity Questionnaire, SIMS Sexuality, Intimacy, and Menopause Service, SCP Survivorship Care Plan, VAS Vaginal Assessment Scale, VD vaginal dilator, VuAS Vulvar Assessment Scale.