Effect of radiotherapy for rectal cancer on female sexual function: a prospective cohort study

Abstract

Background Clinical experience and limited data show that female sexual function is influenced negatively by preoperative radiotherapy (RT) for rectal cancer. The aim of this prospective study was to investigate the impact of RT on sexual function and ovarian reserve measured by levels of anti‐Müllerian hormone (AMH). Methods Women with stage I–III rectal cancer scheduled for surgery with or without preoperative (chemo)RT were included and followed for 2 years. Female Sexual Function Index (FSFI) questionnaire responses and blood samples for hormone analyses, including AMH in women aged 45 years or less, were collected at baseline and during follow‐up. Results In the group of 109 women who received preoperative RT, median scores in all FSFI domains decreased over time, as did the total FSFI score (from 18·5 (range 2·0–36·0) at baseline to 10·8 (2·0–34·8) at 2 years; P < 0·001). In the group of 30 women who did not receive preoperative RT, only satisfaction declined over time (from 3·2 (0·8–6·0) to 1·8 (0·8–6·0); P = 0·012). In longitudinal regression analysis, the mean decline in FSFI total score was –9·33 (95 per cent c.i. –16·66 to –1·99; P = 0·013) for women who had preoperative RT compared with those who did not, with adjustment for age, Psychological General Well‐being Index score and relationship with partner. A corresponding association was seen for arousal, lubrication, orgasm and pain. Five of six women aged 45 years or less with detectable serum levels of AMH at baseline had undetectable levels after RT. Conclusion Preoperative RT was associated with impairment in sexual function in women with rectal cancer. This needs to be considered when discussing choice of treatment and rehabilitation. In younger women, undetectable AMH levels after RT indicate an irreversible loss of ovarian follicles.

Impact of Androgens on Sexual Function in Women with Rectal Cancer – A Prospective Cohort Study

“…36 The observed decrease in sexual function and the increased prevalence of FSD are consistent with earlier findings. 1,5,13,34,37 The present study's main findings are the associations between the androgens T and A-4 with overall sexual function, lubrication, and orgasm, and A-4 with arousal and pain/discomfort. The association between endogenous T and overall female sexual function is not well described in the literature before.…”

“…2,3,9 Preoperative radiotherapy induces cell death, inflammation, ischemia, and radiation fibrosis in exposed tissues, 10 and thereby an increased risk of vaginal dryness, narrowing and stenosis, and radiation-induced menopause in premenopausal women. [11][12][13][14] An association between radiotherapy for pelvic cancer and decreased ovarian androgen production in non-oophorectomized patients has been reported, [15][16][17] similar to the decrease seen after oophorectomy. 17 Androgens seem to play an important role in female sexual function.…”

“…For further descriptions of applied methods, see previous publications based on the same cohort study reporting the effect of radiotherapy for rectal cancer on ovarian androgen production and female sexual function. 13,15,23 The Regional Ethical Review Board in Stockholm approved the study (2008/247-31/3, 2012/1730-30/3).…”

Male urogenital function after robot-assisted and laparoscopic total mesorectal excision for rectal cancer: a prospective cohort study

“…Age, tumor location, use of preoperative radiotherapy, the operation method and the stoma can affect postoperative urogenital function [ 5 , 21 – 23 ]. Havenga K reported that [ 24 ] more than 86% of patients under 60 years of age were sexually active, while only 60% of patients over 60 years of age were sexually active; thus, in this study, we only included patients who were sexually active one month before surgery and were younger than 60 years old.…”

The challenge posed by young-onset rectal cancer

“…It follows that young patients with rectal cancer are those who may benefit most from more aggressive neoadjuvant treatment, if a complete response and organ preservation can be achieved. However, if rectal resection will ultimately be required, despite neoadjuvant radiotherapy, this group may also have most to lose from the digestive, urological and sexual function point of view, if irradiation could safely have been avoided. Concern also exists about the use of radiotherapy in young patients because of the increased risk of late toxicity and potential future secondary cancer, reported as 5 per cent at 12 years' follow‐up in the Dutch trial.…”