Deborah Marshall, MD

Of the many challenges attached to pelvic cancer, sexual health outcomes often prove especially difficult following radiation treatment. The female anatomy, in particular, is susceptible to its own unique range of concerns.

While numerous studies explain the impacts of post-radiation on male sexual function, similar research is scarce for female and gender-diverse patients. It’s a gap that Dr. Marshall hopes to bridge.

As an assistant professor in the Department of Radiation Oncology at the Icahn School of Medicine at Mount Sinai, Dr. Marshall focuses her research on improving sexual health outcomes for patients during and after radiation treatment. Her area of interest was partially inspired by one of her patients, who asked how radiation would affect their clitoris. This notable interaction is one among many that drives Dr. Marshall’s research today.

“I made it my mission to transform the scientific paradigm of sexual health for female, gender-diverse, and sexual minority persons with cancer to one that is more just and equitable by incorporating the functional and physiologic anatomic basis for sexual pleasure,” Dr. Marshall says. “Our ultimate goal is to pioneer key discoveries in these underrepresented scientific areas to provide innovative, tailored approaches to prevention, mitigation, and treatment of radiotherapy-associated sexual toxicities in female and gender-diverse patients.”

The First of Many Milestones

Supported by a Conquer Cancer grant, Dr. Marshall led a multidisciplinary research study to develop new approaches for defining the functional anatomy involved in female sexual outcomes after radiotherapy. This research encourages doctors to consider and prioritize the sexual function and well-being of patients and survivors with female anatomies. It also works to destigmatize patient-physician conversations around sexual well-being after radiation treatment. The funding provided Dr. Marshall with protected time for cancer research and the ability to recruit and collaborate with a multi-disciplinary team of physician-scientists.

Dr. Marshall and her team developed the first description of female erectile tissues specifically for radiation treatment planning. This innovation can help radiation oncologists more effectively develop and outline treatments designed to spare these tissues using emerging radiation techniques. Such improvements can also help more patients maintain sexual health and well-being after treatment.

“The Conquer Cancer grant provided key pilot data to establish our research program which is the first to analyze the effects of radiotherapy on the erectile anatomic organs such as the clitoris and vestibular bulbs,” Dr. Marshall says. The resulting advances, she continues, will enable researchers to redesign standards for radiation treatment that can improve specific sexual outcomes and to identify the biological signals for assessing how patients will respond to treatment. “We’re currently analyzing patient- and clinician-reported outcomes to establish dose-volume effects of radiotherapy on sexual organs,” she says. “We also completed feasibility studies to prove our topic would be worth pursuing further.”

Initial Research Inspires Next Steps

The preliminary data generated through this project enabled Dr. Marshall and colleagues to pursue further research. They also cultivated meaningful collaborations with oncology experts conducting similar research at other institutions. These connections helped them secure a high-risk high-reward grant from the National Institute of Health (NIH) to continue this work.

“We were able to establish strong collaborations with our anatomist and to continue building our collaborations through NRG Oncology,” Dr. Marshall says. “This resulted in an NIH grant that let us establish an independent research lab and continue our multidisciplinary work across multiple institutions. Conquer Cancer support made all of this possible.”

The next steps in Dr. Marshall’s research aim to more effectively address and manage radiation-associated sexual dysfunction in female and gender-diverse patients with pelvic cancers. She and her team are working to formally classify different types of sexual dysfunction based on anatomy (dermatologic, vaginal, and erectile) and incorporate erectile tissues for the first time. This research may have promising implications for patients with female anatomic structures and gender-diverse people with cancer.

“This will enable the identification of novel dosimetric predictors of female sexual dysfunction and quantitative imaging and microbiome-based biomarker indices associated with radiation damage to specific sexual organs,” Dr. Marshall says. “We also have planned a new atlas for female sexual structures based on our work above, which will help to redefine and standardize female sexual structures for future study in addition to establishing such structures in those who have undergone gender affirmation surgeries for gender incongruence.”

Bringing Care to Every Patient

Improving the well-being of every patient and survivor, including gender-diverse people, is at the core of Dr. Marshall’s commitment to conquering cancer.

“One of the best moments near the conclusion of the Conquer Cancer-supported project was when a young patient with rectal cancer visited our clinic with her spouse, and one of their primary concerns was how radiation was going to impact her ability to have pleasurable sexual experiences,” Dr. Marshall recalls. “Even though we didn’t have all the answers yet, for the very first time, we were able to say we are working hard to figure it out. This is empowering on so many levels.”