Sexual health behaviors and contraceptive practices among Canadian childhood, adolescent, and young adult cancer survivors and controls

Background: Sexual health, central to overall well-being, remains under assessed in childhood, adolescent and young adult (CAYA) cancer survivorship. This study examined sexual health outcomes among CAYA cancer survivors using repeated assessments collected as part of routine survivorship care and compared these outcomes with population-based controls. Methods: Survivors completed one to six assessments on sexual activity, concerns about sex life, and contraceptive and condom use. Controls included age-matched Canadian Community Health Survey respondents. Multilevel and Bayesian models quantified predictors of sexual health outcomes whereas latent class growth analysis tested for high-risk subgroups. Results: Among survivors (n = 305; median age, 21.9 years; 49.8% male), 47.5% were not sexually active, compared with 11.2% of controls (unweighted n = 108,252; χ² = 404.35; p <.001; odds ratio [OR], 7.18; 95% Confidence Interval [CI], 5.73–8.99). Being in a relationship predicted sexual activity (Bayesian OR, 1806.83; 95% Credible Interval [CrI], 255.08–20,535.08). Condom use was less frequent among survivors than controls (45.6% vs. 27.2%; χ² = 27.48; p <.001; OR, 1.68; 95% CI, 1.42–1.99) and negatively associated with age (OR, 0.44; 95% CI, 0.26–0.74) and relationship status (OR, 0.09; 95% CI, 0.03–0.24). Not using birth control was similar between survivors and controls (26.9% vs. 25.8%; χ² = 0.10; p =.758). Within survivors, older age (OR, 0.41; 95% CI, 0.20–0.85) and higher treatment intensity (OR, 0.02; 95% CI, 0.00–0.47) were negatively associated with birth control use. Conclusions: CAYA cancer survivors demonstrate less sexual activity and condom use than controls. Higher treatment intensity is associated with less birth control use, suggesting potential misaligned fertility perceptions. Survivorship programs should integrate structured sexual health counselling.