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Pelvic radiation and some chemotherapies cause mucosal atrophy, fibrosis, and pelvic floor hypertonicity, leading to pain, dryness, and sexual avoidance. A multidisciplinary, behaviorally informed plan is most effective. Begin with regular use of nonhormonal vaginal moisturizers (several times weekly) and lubricants during sexual activity. A structured vaginal dilator program reduces stenosis and maintains elasticity; pairing this with pelvic floor physical therapy addresses hypertonicity and pain guarding. Topical lidocaine applied before penetration can reduce introital pain. Sex therapy—individual or couples—improves communication, reduces anticipatory anxiety, and rebuilds intimacy. For persistent genitourinary syndrome, carefully consider low-dose vaginal estrogen after oncology consultation; systemic absorption is low, but individualized risk–benefit is essential in hormone-sensitive cancers. Systemic estrogen for everyone (Option A) is inappropriate. Simple reassurance (Option C) neglects modifiable contributors. Opioids (Option D) do not address underlying dysfunction and carry risk. The APRN should normalize discussion of sexual health, provide handouts/demonstrations for dilator use, screen for mood/body-image concerns, and schedule follow-up to adjust the plan.