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Eligibility criteria were defined a priori; prevalence was restricted to studies using modern techniques (IMRT\/VMAT), whereas studies of risk factors and interventions were included regardless of modality. Data were extracted using a Cochrane-adapted form, and risk of bias assessed with AXIS. Due to heterogeneity, evidence was synthesized using a narrative approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 3764 records, 32 reported prevalence estimates, 23 examined risk factors, and 8 evaluated interventions. FSD prevalence ranged from 0.9 to 85%. Dyspareunia (0.3\u201379%), vaginal stenosis (1\u201388%), and dryness (up to 98%) were frequent and persistent. Higher vaginal doses were associated with worse outcomes, though thresholds varied. Intervention evidence was limited: two studies linked dilator use to less stenosis, and nurse-led or multidisciplinary programs showed promise.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>FSD is a prevalent, long-term consequence of RT for AC. This review provides symptom-specific evidence for patient counseling. It underscores the need for standardized assessment, dose optimization, and integrated follow-up strategies for female AC survivors.<\/jats:p>\n                    <jats:p>Registration: PROSPERO\u00a0CRD42024592088.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1038\/s41416-026-03425-x","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T18:36:22Z","timestamp":1775759782000},"page":"1773-1785","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence, risk factors, and interventions for female sexual dysfunction after radiotherapy for anal cancer: a systematic review"],"prefix":"10.1038","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-3097-9641","authenticated-orcid":false,"given":"Johanne H.","family":"Steffensen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lise K.","family":"Schou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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