KEY POINTS
- The Danish SENECA study surveyed women previously diagnosed with cervical cancer and an age-comparable reference population. Responses containing at least one outcome scale were obtained from 2,002/3,746 survivors (53.6%) and 7,853/34,409 reference women (22.8%); an additional 235 recently diagnosed survivors contributed to prevalence analyses.
- Long-term sexual inactivity was reported by approximately 28% of reference women, 29% after surgery alone and 49% after radio(chemo)therapy ± surgery. Dyspareunia showed a similar gradient at approximately 23%, 39% and 54%, respectively.
- Among sexually active cervical cancer survivors, 44% reported dyspareunia. Among women who were sexually inactive, pain during intercourse was cited as a reason by 6% of reference women, 16% after surgery and 21% after radio(chemo)therapy, suggesting that analyses restricted to currently sexually active women may underestimate the burden.
- Bayesian network models incorporated EORTC QLQ-C30 and cervical cancer-specific QLQ-CX24 patient-reported outcomes. The sexual-activity model included 6,706 reference women and 1,694 cancer survivors, while the dyspareunia model was restricted to sexually active participants.
- Across both survivor and reference models, age remained associated with sexual activity, while vaginal/sexual function was closely connected to dyspareunia and sexual enjoyment. In survivors, treatment modality showed strong associations with bowel control and either sexual activity or vaginal functioning.
- Fatigue emerged as a particularly central node in the cancer-survivor network, linking insomnia, pain and gastrointestinal symptoms with cognitive, social, role and global quality-of-life domains. This interconnected pattern was much less prominent in the reference population.
- The networks are explanatory rather than causal. Disease stage is strongly correlated with treatment selection, the cross-sectional survey cannot reconstruct symptom trajectories, reference-population response was only 22.8%, and the questionnaire largely frames sexual activity around penetrative intercourse during the preceding four weeks.
CLINICAL TAKEAWAY
Sexual morbidity remains a major survivorship issue after cervical cancer treatment, particularly after radio(chemo)therapy, and should be addressed explicitly rather than waiting for patients to raise it. The network analysis also suggests that vaginal symptoms, fatigue and broader functional impairment often coexist, supporting multidisciplinary survivorship assessment rather than isolated symptom management.