Objective and subjective effects of treatment for testicular cancer on sexual function

Abstract

Objective To determine whether the treatment of patients with testicular cancer, using cisplatin combined with etoposide and bleomycin (BEP) after orchidectomy in those with disseminated disease, causes changes in sex hormones and penile vascularization, possibly related to sexual dysfunction. Patients and methods Ten patients treated with BEP were compared with 11 undergoing orchidectomy alone followed by surveillance. Sex hormone levels were analysed and cavernosal artery duplex ultrasonography performed before orchidectomy and at 6 and 12 months afterward. Patients were questioned about their sexual function. After 1 year, a visual erotic stimulation (VES) test was performed to assess penile rigidity. Results In contrast to the surveillance group, BEP‐treated patients had higher follicle‐stimulating hormone (4.6 vs 26.5 U/L) and luteinizing hormone (1.4 vs 8.2 U/L) levels, and lower testosterone levels (21.1 vs 14.7 nmol/L) at 6 months than at baseline. At 1 year, most patients had compensated hypergonadotrophic eugonadism, but Leydig cell function had recovered. Changes in cavernosal artery peak flow velocities induced by local injection with papaverine/phentolamine showed no difference between the groups before and 6 months after orchidectomy. Loss of libido and erectile dysfunction were reported more frequently by BEP‐treated patients. However, 1 year after treatment, most reported a satisfying sex life and VES resulted in a rigid erection in nearly all patients. The reported erectile dysfunction could not be explained by changes in plasma testosterone levels or diminished blood flow velocities. Conclusions After being diagnosed with testicular cancer, sexual morbidity is considerable, but within 1 year some improvement may be expected. BEP induces transient testicular dysfunction but this recovers. Although BEP is related to symptoms of angiopathy, cavernosal blood flow seems to be unaffected. These findings and the normal VES‐evoked penile rigidity suggest that sexual dysfunction is more psychological than organically induced by BEP.

Erectile dysfunction in men treated for testicular cancer

“…The role of organic factors in the pathogenesis of ED in men with TC is ill-defined in the literature. It has been suggested that ED may be associated with hormonal imbalances, including low testosterone and elevated gonadotropin and oestradiol levels, however, other investigators have failed to corroborate this association [3,5,[7][8][9]. It has also been suggested, that radiotherapy does not play a pivotal role in the pathogenesis of ED in patients with TC; understandably, as the corpora cavernosa are generally not exposed to a significant radiation dose in this population [10].…”

Sexual functions after high-dose chemotherapy in survivors of germ cell tumors

“…11 The current standard firstline chemotherapy regimen for advanced GCT consists of three-four courses of PEB. 12 Although PEB is related to symptoms of angiopathy, cavernosal blood flow seems to be unaffected. These findings and the normal visual erotic stimulation-evoked penile rigidity suggest that sexual dysfunction is more psychologically than organically induced by PEB.…”

“…These findings and the normal visual erotic stimulation-evoked penile rigidity suggest that sexual dysfunction is more psychologically than organically induced by PEB. 12 Compared with orchidectomy alone, polychemotherapy, with or without RPLND, more often induced post treatment sexual dysfunction. Over the last decade, HDCT has been increasingly investigated as a salvage therapy for patients with relapsed or refractory GCT and as late intensification of first-line treatment for patients with poor prognosis GCT.…”

Uitgespeeld. Een casus over testiskanker: seksuele gevolgen en emotionele verwerking

“…Vooral patie¨nten met testiskanker die behandeld zijn met chemotherapie rapporteren verminderd seksueel functioneren (Bloom, Fobair, Gritz, Wellisch, Spiegel, Varghese & Hoppe, 1993; Jonker-Pool, Van de Wiel, Hoekstra, Sleijfer, Van Driel, Van Basten & Schraffordt Koops, 1997). Er is hierbij echter geen verband gevonden met fysiologische of hormonale veranderingen na behandeling ( Van Basten, Van Driel, Hoekstra, Sleijfer, Van de Wiel, Droste, Schraffordt Koops & Mensink, 1999).…”