From vaginal morbidity to sexual health: rethinking sexual rehabilitation after gynecological cancer through a survivor-informed patient expert perspective.

Sexual health is a core component of quality of life in gynecologic cancer survivorship, yet it remains not fully integrated into routine oncologic care. Advances in treatment have improved survival, shifting attention toward long-term outcomes, including sexual function, identity, and relational well-being. Vaginal morbidity represents a common and clinically accessible entry point for interventions. However, the relationship between tissue changes and sexual experience is non-linear, as psychological, behavioral, and relational factors critically modulate outcomes. Evidence from cognitive-behavioral models suggests that repeated pain experiences may reinforce maladaptive avoidance patterns, whereas positive experiential learning and gradual exposure may restore adaptive sexual functioning. Current clinical guidelines appropriately emphasize prevention and management of vaginal morbidity through lubricants, local estrogen therapy, and vaginal dilation. Nonetheless, these approaches often implicitly prioritize penetrative intercourse as the primary marker of sexual health, potentially overlooking broader dimensions of sexuality. Alternative tools, such as vibrators, may provide comparable mechanical benefits to dilators while additionally enhancing arousal, reducing pelvic floor tension, and supporting patient agency. Furthermore, re-centering sexual pleasure as a legitimate therapeutic goal and addressing relational dynamics are essential for meaningful recovery. Ultimately, successful sexual rehabilitation should not be defined by anatomical restoration alone but by alignment with individual preferences, restoration of bodily trust, and the capacity for intimacy and pleasure. Integrating multidisciplinary, patient-centered sexual health care into survivorship pathways is critical to achieving comprehensive oncologic outcomes.