Prospective study of sexual function and analysis of risk factors after rectal cancer surgery

Abstract

The aim of this study was to assess the evolution of sexual function over time after rectal cancer surgery and to identify risk factors that may have an impact on the deterioration of postoperative function. Method:This was a prospective cohort study of sexual function after rectal cancer surgery using the International Index of Erectile Function (IIEF) and Female Sexual Function Index (FSFI) preoperatively and at 6 and 12 months after surgery. Predictive factors of worsening were identified by univariate and multivariate analysis.Results: One hundred and one patients were included (56 men and 45 women). In men, the average IIEF showed decreased erectile function and intercourse satisfaction at 6 months (respectively 21.58 ± 7.18 to 16.60 ± 7.96, p = 0.002 and 10.87 ± 2.94, to 8.09 ± 4.45, p = 0.002) with recovery at 1 year. As a percentage, erectile dysfunction increased from the preoperative value to 6 months (64.5% vs 87.1%, p = 0.022) and was observed in 72% at 1 year. Patients with moderate to severe dysfunction increased from 22% preoperatively to 58% (p = 0.009) at 6 months and 44% at 1 year (p < 0.0001). Neoadjuvant chemoradiotherapy (OR 5.4, 95% CI 0.9-29.6; p = 0.041) and erectile worsening at 6 months (OR 20, 95% CI 1.6-238; p = 0.004) were independent factors for worse function at 6 or 12 months, respectively. No significant worsening of the FSFI was found, although there was an improvement in lubrication and orgasm. Conclusion:Temporary deterioration of erectile function in men is common at 6 months after surgery and chemoradiotherapy is the only predictive factor. Furthermore, patients who remain dysfunctional show an increase in the severity of symptoms in relation to the preoperative period.

Risk factors for and longitudinal course of male sexual dysfunction after robotic rectal cancer surgery

“…Japanese men are reportedly less sexually active than Western men [38]. In the present study, the rate of preoperative normal sexual function was only 19.2%, the same as that in a large prospective trial, JCOG0212 [36], and much lower than that reported in other countries [26].…”

“…Although the oncological benefit of radiation therapy is apparent, sexual function after radiation therapy, including CRT, has been frequently reported [26][27][28]. Mechanisms underlying the effects of radiation on sexual function include nerve and vascular damage, as well as fibrosis [29].…”

“…Other obstacles to sexual function assessment include different criteria [12,26], follow-up duration [3,6], and characteristics of the study participants [39]. Limiting the participants by exclusively targeting those with a normal sexual function status preoperatively is controversial.…”

“…Limiting the participants by exclusively targeting those with a normal sexual function status preoperatively is controversial. While most studies, including JCOG0212, focused exclusively on sexually normal participants [26,36], data collected from the entire cohort should be analysed without excluding patients who are sexually inactive before surgery [39].…”

Long‐term quality of life, sexual health and gastrointestinal function following colorectal cancer resection in an Asian cohort

“…Parasympathetic injury results in erectile dysfunction in men and vaginal dryness or dyspareunia in women. The incidence of sexual disorders after total mesorectal excision for rectal cancer is estimated to be 10%–35% [35]. Colon cancer survivors have also been found to report a higher rate of sexual dysfunction compared to a normative population [36] which may be less a result of autonomic nerve impairment and more multifactorial in nature.…”