Sexual Health Remains Largely Ignored in Advanced Cancer Care, Malaysian Study Finds

Sexual health is one of the most frequently neglected dimensions of cancer care, and a new study from Malaysia suggests that this silence persists even among patients living with advanced disease. Researchers at Sunway Medical Centre, working with colleagues from Monash University and Universiti Sains Malaysia, surveyed 120 patients with stage III or IV solid-organ cancers using a culturally adapted version of the EORTC Quality of Life Questionnaire Sexual Health, known as the QLQ SH-22. Their findings, published in Supportive Care in Cancer, reveal that sexuality remains a meaningful part of life for more than half of patients with advanced cancer, yet conversations about it remain rare in oncology clinics across Southeast Asia.

The World Health Organization defines sexual health as a state of physical, emotional, mental, and social well-being in relation to sexuality, not merely the absence of dysfunction. By that broad standard, cancer is a formidable adversary. Estimates cited in the study suggest that over 90 percent of cancer patients experience some form of sexual dysfunction, ranging from diminished libido and altered satisfaction to difficulties with arousal. Despite this prevalence, clinicians are less likely to raise sexual health with patients on life-prolonging or palliative treatments than with those pursuing curative care, and prior research indicates that discussions about treatment effects on sexual function reach men roughly twice as often as women, at rates of 64 percent versus 28 percent.

The Malaysian study recruited participants from an oncology outpatient clinic at a private quaternary hospital between March 2023 and March 2024. Eligible patients had advanced solid-organ cancer, were at least 18 years old, had a sexual partner, and were proficient in English. The average participant was 49.1 years old, 63.3 percent were women, and 82.5 percent had good performance status as measured by the Eastern Cooperative Oncology Group scale, where lower scores indicate better physical function. Breast cancer was the most common diagnosis at 28.3 percent, followed by gastrointestinal malignancies at 26.7 percent and lung cancer at 13.3 percent. Most participants were married, lived with their partner, and had been in their relationship for more than two decades.

Participants completed the EORTC QLQ SH-22, which assesses functional domains such as sexual satisfaction, activity, libido, and partner relationships alongside symptom domains including sexual pain, vaginal dryness, erectile function, fatigue, and treatment impact. Scores are transformed to a 0 to 100 scale, with higher values indicating more severe symptoms or dysfunction. The researchers supplemented this with the six-item Female Sexual Function Index, adapted so that the lubrication item also captured erection, and with single-item measures of self-esteem, life satisfaction, and relationship satisfaction rated on seven-point scales. Statistical analysis employed Pearson correlations, independent t-tests, analyses of variance, and multiple linear regression using SPSS version 25, with effect sizes interpreted according to Cohen’s conventions.

One of the most striking findings was that 51.6 percent of participants reported sexual activity within the previous four weeks, a figure that contrasts sharply with studies from other populations. Research cited by the authors found that nearly 60 percent of highly educated men with advanced cancer in stable relationships had abstained from sexual activity in the preceding month despite yearning for intimacy, while a study of urban Chinese breast cancer survivors found that fewer than one-third had been sexually active in the past year, often fearing that intercourse could impede recovery. The authors suggest that stable long-term partnerships, cultural and relational factors, and the healthcare context may all shape these divergent patterns, underscoring that sexual behavior in serious illness is not determined by disease status alone.

The correlational results revealed clear gender-specific signatures. Among women, better sexual functioning was associated with higher perceived importance of sex (r = 0.60), greater sexual satisfaction (r = 0.61), less vaginal dryness (r = -0.43), less sexual pain (r = -0.33), and less interference of treatment with sex (r = -0.35), all statistically significant. Among men, better functioning tracked with erectile confidence (r = 0.51), perceived importance of sex (r = 0.46), greater satisfaction, and less treatment interference (r = -0.49). Direct comparisons showed that an active sex life mattered more to men than to women, with a moderate effect size (p = 0.005, d = 0.54), while women reported substantially more sexual pain than men, with a large effect size (p < 0.001, d = 0.87).

Physical function emerged as a second major axis of sexual well-being. Patients with poor performance status, defined as an ECOG score of 2 or above, reported significantly greater impact of fatigue on their sex lives (p = 0.010, d = 0.65) and more worries about incontinence (p = 0.013, d = 0.60) than those with good performance status. Interestingly, apparent differences in sexual pain between cancer types dissolved when gender was added to a regression model, suggesting that gender, with its physiological and sociocultural dimensions, exerts a stronger influence on sexual pain than tumor site alone. The authors note that treatments such as surgery, chemotherapy, radiotherapy, and endocrine therapy may contribute to sexual difficulties through effects on body image, fatigue, menopausal symptoms, and organ function.

The sources of sexual distress also diverged sharply by gender. Men who experienced more sex-related stress reported poorer body image, feeling less masculine, greater insecurity about satisfying their partners, and lower sexual satisfaction, consistent with evidence that men place heavy emphasis on sexual performance. Women’s distress, by contrast, was linked to vaginal dryness and worries about incontinence, pointing to physical discomfort as a central driver. Only among women were sexual health variables associated with self-esteem, life satisfaction, and relationship satisfaction; among men, none of the QLQ SH-22 domains correlated significantly with these broader well-being measures. Both genders showed a link between sex-related stress and more communication with health professionals, hinting that distressed patients may actively seek conversations that clinics rarely initiate.

The cultural context of Malaysia adds a distinctive layer to these findings. Norms of modesty, religiosity, and traditional gender roles can inhibit open discussion of sexuality, particularly among older adults and women, contributing to underreporting and unmet needs. Qualitative research from Malaysian hospitals has found that healthcare providers cite embarrassment, limited knowledge, sociocultural taboos, and time constraints when explaining why they avoid sexual health conversations, often prioritizing disease management over comprehensive care. Surveys of Malaysian medical students similarly reveal widespread feelings of being ill-equipped to discuss sexual matters, pointing to gaps in training that begin long before clinical practice.

The authors argue that these findings justify integrating structured sexual health assessment into routine oncology and palliative care. They propose a simple screening question, asking whether cancer or its treatment has affected intimacy or sexual well-being, followed by fuller evaluation with validated instruments such as the QLQ SH-22 for patients who report concerns. Gender-sensitive pathways could offer women management of vaginal symptoms, gynecological assessment, and body image support, while men might benefit from interventions targeting erectile confidence and communication with partners. Referral networks spanning gynecology, urology, psycho-oncology, counseling, and palliative care could support multidisciplinary management. The study’s limitations, including its cross-sectional design, the predominance of educated Malaysian Chinese women in stable relationships, recruitment at a single private center, and the absence of partner perspectives, caution against broad generalization. Even so, the message is clear: sexuality does not disappear with an advanced cancer diagnosis, and culturally responsive, person-centered care must make room for it.

Subject of Research: Sexual health and function in Malaysian patients with advanced cancer assessed using the EORTC QLQ SH-22 questionnaire

Article Title: Exploring sexual health and function among Malaysian patients with advanced cancer: insights from the EORTC QLQ SH-22 questionnaire

Article References: Exploring sexual health and function among Malaysian patients with advanced cancer: insights from the EORTC QLQ SH-22 questionnaire. (n.d.). https://doi.org/10.1007/s00520-026-11261-1

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11261-1

Keywords: advanced cancer, sexual health, sexual dysfunction, EORTC QLQ SH-22, palliative care, supportive care, quality of life, Malaysia, gender differences, oncology, performance status, patient-reported outcomes