Prevalence of Male and Female Sexual Dysfunction is High Following Surgery for Rectal Cancer

Abstract

Objective: To measure sexual function and quality of life (QOL) after rectal cancer treatment. Summary Background Data: Previous studies on sexual function after rectal cancer treatment have focused on males and have not used validated instruments. Methods: Patients undergoing curative rectal cancer surgery from 1980 to 2003 were administered a questionnaire, including the Female Sexual Function Index (FSFI) or International Index of Erectile Function (IIEF), and the EORTC QLQ-C30/CR-38. Multiple logistic regression was used to test associations of clinical factors with outcomes. Results: Eighty-one women (81.0%) and 99 men (80.5%) returned the questionnaire; 32% of women and 50% of men are sexually active, compared with 61% and 91% preoperatively (P Ͻ 0.04); 29% of women and 45% of men reported that "surgery made their sexual lives worse." Mean (SD) FSFI and IIEF scores were 17.5 (11.9) and 29.3 (22.8). Specific sexual problems in women were libido 41%, arousal 29%, lubrication 56%, orgasm 35%, and dyspareunia 46%, and in men libido 47%, impotence 32%, partial impotence 52%, orgasm 41%, and ejaculation 43%. Both genders reported a negative body image. Patients seldom remembered discussing sexual risks preoperatively and seldom were treated for dysfunction. Current age (P Ͻ 0.001), surgical procedure (P ϭ 0.003), and preoperative sexual activity (P ϭ 0.001) were independently associated with current sexual activity. Gender (male, P ϭ 0.014), surgical procedure (P ϭ 0.005), and radiation therapy (P ϭ 0.0001) were independently associated with the outcome "surgery made sexual life worse." Global QOL scores were high. Conclusions: Sexual problems after surgery for rectal cancer are common, multifactorial, inadequately discussed, and untreated. Therefore, sexual dysfunction should be discussed with rectal cancer patients, and efforts to prevent and treat it should be increased.

Sexual Health as a Survivorship Issue for Female Cancer Survivors

“…Although studies show that the overall quality of life of survivors is quite good (especially in long-term survivors) [16][17][18], a significant proportion of patients remain at risk for persistent or worsening symptoms, including symptoms related to sexual health [19]. Although much of this work has been done in breast cancer survivors [19][20][21][22][23], emerging literature shows similar figures affected for survivors of gynecologic cancer [17,[24][25][26] and other cancer types [27][28][29][30].…”

“…Beyond gynecologic and breast cancer, other surgical approaches have also been evaluated specifically as they affect sexual health; for example, both primary excision and mesorectal excision performed for rectal cancer result in a high rate of sexual dysfunction that approaches 60% [29,30]. Additional data suggest that patients who underwent colectomy for colorectal cancer that required placement of an ostomy (in the past or presently) were at significant risk for sexual dysfunction and distress related to body image [27].…”

Risk factors for recurrence after transanal endoscopic microsurgery for rectal malignant neoplasm

“…In the field of malignant rectal neoplasms, radical resection, consisting of anterior resection with total mesorectal excision (TME) when feasible and abdominoperineal resection (APR) when mandatory, represents the best curative treatment. Nevertheless, these procedures are burdened with a consistent morbidity rate, including genitourinary and sexual dysfunction (30-40%) [1][2][3][4], anastomotic leakage (5-17%) [5], and long-term functional bowel disturbance [6]. Up to 40% of patients experience perineal wound complications and long-term discomfort following APR, while stoma and stoma appliance-related complications occur in up to 66%.…”

Impact of Total Mesorectal Excision on Bladder and Sexual Function in Rectal Cancer

“…Ameda et al [23] reported that postoperative EF was a serious complication, even in complete nerve preservation [22]. Hendren et al [34] also reported that a high rate of sexual dysfunction is detected after rectal cancer excision, despite the use of nervepreserving techniques. The incidence of erectile dysfunction (ED) depends on the extent of resection, which may be reduced with nerve preservation [28].…”