Patient-Reported Outcomes After Chemoradiation in Patients With Anal Cancer: A Qualitative Analysis

Corrigan, Kelsey L.; De, Brian; Rooney, Michael K.; Ludmir, Ethan B.; Das, Prajnan; Smith, Grace L.; Taniguchi, Cullen M.; Minsky, Bruce D.; Koay, Eugene J.; Koong, Albert C.; Holliday, Emma B.

doi:10.1016/j.adro.2022.100986

Cited by 1 publication

(1 citation statement)

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“…Patients might experience anodyspareunia due to damage of the sensitive perianal skin and anal canal. Thematic analysis of qualitative interviews with survivors of anal cancer (n = 84) identified problematic RAI as a contributing factor to poor quality of life, for example, one sexual minority male patient discussed his inability to enjoy pleasurable RAI with his husband due to fear of anodyspareunia 321 . Similarly, prostate-directed radiation has been associated with anodyspareunia through incidental damage to the anus 4,15 .…”

Section: Radiation and Raimentioning

confidence: 99%

Pleasurable and problematic receptive anal intercourse and diseases of the colon, rectum and anus

Dickstein,

Edwards,

Rowan

et al. 2024

Nat Rev Gastroenterol Hepatol

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The ability to experience pleasurable sexual activity is important for human health. Receptive anal intercourse (RAI) is a common, though frequently stigmatized, pleasurable sexual activity. Little is known about how diseases of the colon, rectum, and anus and their treatments affect RAI. Engaging in RAI with gastrointestinal disease can be difficult due to the unpredictability of symptoms and treatment-related toxic effects. Patients might experience sphincter hypertonicity, gastrointestinal symptom-specific anxiety, altered pelvic blood flow from structural disorders, decreased sensation from cancer-directed therapies or body image issues from stoma creation. These can result in problematic RAI -encompassing anodyspareunia (painful RAI), arousal dysfunction, orgasm dysfunction and decreased sexual desire. Therapeutic strategies for problematic RAI in patients living with gastrointestinal diseases and/or treatment-related dysfunction include pelvic floor muscle strengthening and stretching, psychological interventions, and restorative devices. Providing health-care professionals with a framework to discuss pleasurable RAI and diagnose problematic RAI can help improve patient outcomes. Normalizing RAI, affirming pleasure from RAI and acknowledging that the gastrointestinal system is involved in sexual pleasure, sexual function and sexual health will help transform the scientific paradigm of sexual health to one that is more just and equitable. Sections Key points• Receptive anal intercourse (RAI) is common worldwide.• Pleasurable RAI occurs through stimulation of the perianal or anal nerves and prostate or paraurethral glands, inducing vasodilation, erectile tissue engorgement, anopelvic tissue sensitization, and anal sphincter and pelvic muscular contractions.• Patients with a stoma and anorectal stump should be counselled on hygiene and dilator use to minimize infections, maintain anorectal patency, and prevent a permanent stoma, promoting RAI restoration.• Antidiarrhoeals, anti-flatulence medications, fibre supplements, lower residue diet to control regularity, avoiding spicy foods, timing meals, and defecation prior to RAI can help control symptoms and relieve distress.• Survivors of anal, rectal, and colon cancer and patients with gastrointestinal disease should be counselled on problematic RAI due to anal sphincter, neurovasculature, and prostate or paraurethral gland damage resulting in arousal dysfunction, anodyspareunia or orgasm dysfunctions.• Management strategies, including anal dilators for anodyspareunia, anal vibrators for arousal disorders, pelvic floor strengthening for anorgasmia and psychological interventions for decreased desire, should be discussed with patients.Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author selfarchiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

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Section: Radiation and Raimentioning

confidence: 99%