The A-TAC appears to be a reliable and valid instrument for identifying autistic spectrum disorder, ADHD, tics, learning disorders and developmental coordination disorder.

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.

Background The impact of radiotherapy (RT) for rectal cancer on ovarian androgen production is unknown. The aim was to examine the effect of RT for rectal cancer on androgen levels in non‐oophorectomized women and the association with female sexual desire. Methods This prospective cohort study included women who had surgery for rectal cancer with or without RT. Serum testosterone, free testosterone, androstenedione and dehydroepiandrosterone sulphate (DHEA‐S) levels were assessed at baseline, after RT and 1 year after surgery. Sexual desire was assessed by means of the Female Sexual Function Index. Results Twenty‐seven participants had surgery alone (RT– group) and 98 had preoperative RT and surgery (RT+ group). During the first year after surgery, median serum testosterone and free testosterone levels decreased from 0·6 (range 0·1–3·6) to 0·5 (0·1–2·3) nmol/l (P < 0·001) and from 9·1 (1·6–45·8) to 7·9 (1·4–22·7) pmol/l (P < 0·001) respectively in the RT+ group, but did not change in the RT– group. Longitudinal regression analysis confirmed a decrease in testosterone and free testosterone after RT. The adjusted change in androstenedione and DHEA‐S was not significant in any group. The mean change in testosterone (odds ratio (OR) 2·74, 95 per cent c.i. 1·06 to 7·11; P = 0·038), free testosterone (OR 1·08, 1·02 to 1·15; P = 0·011), androstenedione (OR 1·52, 1·07 to 2·16; P = 0·019) and DHEA‐S (OR 0·49, 0·27 to 0·89; P = 0·019) was related to change in sexual desire. Conclusion RT decreased levels of androgens predominantly derived from the ovaries, whereas androgens of mainly adrenal origin remained unchanged. Reduction in ovarian androgens may be associated with reduced sexual desire.

Background: Women treated for rectal cancer are at risk of sexual dysfunction and impaired ovarian androgen production. Aim: To investigate a possible association between serum levels of endogenous androgens and sexual function in women with rectal cancer. Methods: Women diagnosed with stage I−III rectal cancer were consecutively included and prospectively followed with the Female Sexual Function Index (FSFI) questionnaire from baseline to 2 years postoperatively and blood samples for hormone analyses, baseline to 1 year. Androgens were measured with liquid chromatogra-phyÀmass spectrometry and electrochemiluminescence. The associations between the 4 measured androgens (testosterone, free testosterone, androstenedione, and dehydroepiandrosterone sulphate) and sexual function were assessed with generalized least squares random effects regression analysis in sexually active women. Outcomes: The primary outcome measure was the mean change observed in the FSFI total score when the serum androgen levels changed with one unit. Secondary outcomes were the corresponding mean changes in the FSFI domain scores: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain/discomfort. Results: In the 99 participants, the median FSFI total score decreased from 21.9 (range 2.0 − 36.0) to 16.4 (3.5 − 34.5) and 11.5 (2.0 to 34.8) at 1 and 2-years follow-up. After adjustment for age, partner, psychological well-being, preoperative (chemo)radiotherapy, and surgery, total testosterone and androstenedione were significantly associated with FSFI total score (b-coefficients 3.45 (95% CI 0.92 − 5.97) and 1.39 (0.46 − 2.33) respectively). Testosterone was significantly associated with the FSFI-domains lubrication and orgasm, free testosterone with lubrication, androstenedione with all domains except desire and satisfaction, and dehydroepiandrosterone sulphate with none of the domains. Strengths and Limitations: This is the first study investigating whether androgen levels are of importance for the impaired sexual function seen in women following rectal cancer treatment. The prospective design allows for repeated measures and the use of the FSFI for comparisons across studies. No laboratory data were collected at the 2-year follow-up, and the missing data could have further clarified the studied associations. Conclusion and Clinical Implication: Testosterone and androstenedione were associated with sexual function in female rectal cancer patients. The results are of interest for future intervention studies and contribute to the understanding of sexual problems, which is an essential component of the rehabilitation process in pelvic cancer survivors.