Introduction and aims Pelvic radiotherapy creates physical and psychological effects that impact negatively on the sexual well-being of women and their partners. The aim of this ethnographic study was to develop an assessment methodology to improve the clinical assessment of sexual morbidity following radiotherapy in women with pelvic malignancy.

Methods Observation of follow-up clinics (50 gynaecological, 19 colorectal consultations) plus interviews with women (n=24), partners (n=5) and health professionals (n=20) explored sexual morbidity assessment after treatment completion. Women with pelvic malignancy who had completed radical radiotherapy 3, 6, 12 and 24 months previously were included. Doctors, nurses and therapy radiographers were interviewed to establish professional perspectives on assessment. Observation and interview data were analysed using both SPSS v.14 and NVivo v.2 software.

Results Consultations focused on disease surveillance, specific aspects of toxicity monitoring and managing active symptoms. Sexual concerns were not routinely assessed in gynaecological (11/50) or colorectal (6/19) clinics. Health professionals felt inhibited discussing sexual concerns with older women and when partners were present. Patient and partner interviews revealed inconsistency in the management of treatment induced menopause, inadequate knowledge of sexual health resources and unidentified difficulties including loss of desire, dyspareunia and reduced sexual satisfaction.

Conclusions Traditional models of medical follow-up may not offer an appropriate clinical context for the optimal assessment and management of sexual concerns associated with pelvic radiotherapy. These findings are important for the development of survivorship services and can inform the training of health professionals engaged in post-treatment toxicity assessment, patient information and support.