Abstract
Background and Objectives: Sexual dysfunction (SD) is common in cancer but remains poorly characterized among patients receiving immune checkpoint inhibitors (ICIs). This study aimed to determine the prevalence and predictors of SD in ICI-treated patients using validated instruments. Materials and Methods: In this cross-sectional study, adults with histologically confirmed malignancies who received ≥ 3 cycles of ICIs and reported sexual activity were included. Sexual function was evaluated with the Arizona Sexual Experience Scale (ASEX) and the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Univariate and multivariate logistic regression analyses identified demographic and clinical predictors of SD. Results: Among 208 patients (median age 59 years; 35.1% female), SD prevalence was 66.3% by ASEX and 59.1% by GRISS. ASEX revealed impairment across five domains-sexual drive, psychological and physiological arousal, orgasm, and satisfaction-while GRISS indicated dysfunction mainly in impotence/orgasmic disorder, avoidance, and satisfaction subscales. In multivariate analysis, age ≥ 60 years (OR: 3.14, 95% CI 1.51-6.53, p = 0.002), female sex (OR: 3.19, 95% CI 1.31-7.74, p = 0.010), Eastern Cooperative Oncology Group (ECOG) performance status ≥ 1 (OR: 2.82, 95% CI 1.39-5.71, p = 0.004), ≥2 metastatic sites (OR: 3.08, 95% CI 1.53-6.19, p = 0.002), and later treatment lines (OR: 2.43, 95% CI 1.20-4.94, p = 0.013) independently predicted ASEX-defined SD. GRISS-based analysis revealed comparable outcomes, identifying ECOG ≥1 and higher metastatic burden as the most prominent predictors of SD, consistent with ASEX findings. Conclusions: SD affected nearly two-thirds of patients receiving ICIs. Female sex, later treatment lines, poor ECOG performance status, and higher metastatic burden were key determinants, emphasizing the importance of routine sexual health evaluation in cancer care.