Understanding the impact of childhood cancer on survivors’ sexuality: sexual dysfunction vs sexual satisfaction

Abstract

Purpose Psychosexual development disruption and sexual dysfunction are widely recognized as profoundly distressing long-term side effects of childhood cancer. However, the specific sexual challenges faced by young adult childhood cancer survivors (CCS) remain poorly understood. This study used qualitative methods to characterize the impacts of cancer on CCS’ sexuality and explore the simultaneous reports of both sexual dysfunctions and overall sexual satisfaction.

Method In-depth, semi-structured interviews were conducted with 41 Spanish childhood cancer survivors with a history of a solid tumour diagnosis (ages 19–28, M = 21.9, SD = 1.79). Reflexive Thematic Analysis identified key themes related to cancer’s impact on their sexuality.

Results The interviews revealed three key themes characterizing cancer’s impact on CCS’ sexuality: negative (physical and psychological), positive (psychological), and no impact. A fourth theme described an apparent inconsistency in participants’ testimonies, as they often asserted that cancer had no impact while also acknowledging that it had, in fact, influenced their sexuality.

Conclusion Several interconnected factors likely explained why CCS appeared unaware of cancer’s impact on their sexuality. These included the developmental age at the time of diagnosis, a tendency to not relate sexual experiences to their cancer history, a shift in priorities towards survival, a reluctance to explore sexuality due to distressing negative impacts, and a potential need to protect their self-image. Importantly, cancer often positively reshaped their concept of sexuality, emphasizing emotional intimacy and mature relationships. This contributed to high levels of sexual satisfaction that CCS deemed more significant than any negative impact.

Implications for Cancer Survivors Follow-up care should consistently address sexuality, even without patient-reported difficulties, be individualized, multidisciplinary, and encompass both physical and psycho-affective dimensions.