The impact of childhood cancer on sexual identity development: the CISEO (Cancer-Induced Sexual Exploration Obstacles) model

Abstract

Young Adult Childhood Cancer Survivors (YACCS) often face significant challenges to their psychosexual development, including body image issues, later sexual debut, and worse sexual functioning and/or satisfaction.1 While physical consequences are well-studied, emotional and developmental impacts on sexuality—defined here as the broader constructions of sexualidentity andpractice—remainunder-examined. Sexual identity development, i.e., the process of defining oneself as a sexual being, is a critical adolescent milestone which relies on two essential components: exploration and commitment.2 Life-threatening trauma, such as childhood cancer (CC), can profoundly disrupt this process by creating barriers that complicate identity development and integration. Survivors struggle to integrate their pre-cancer and postcancer selves, potentially leading to maladaptive identity formation (eg, identity diffusion or foreclosure).3 Since YACCS consistently report unmet sexual health needs,4 identifying the psychosocial drivers of these challenges is essential t o improve routine clinical interventions.