Pelvic Radiotherapy and Sexual Function in Men and Women

Abstract

Introduction Despite the decrease in overall cancer incidence and mortality rates in developed countries since the early 1990s, cancer remains a major public health problem. Sexual dysfunction is one of the more common consequences of cancer treatment. Aim To shortly review the literature and level of evidence on sexual dysfunction in men and women following pelvic radiotherapy. Main Outcome Measures Male and female sexual dysfunction. Methods Literature review. Results Sexual dysfunction in cancer patients is multidimensional and may result from biological, psychological, and social factors. Anatomic changes caused by surgery and/or radiotherapy, physiological changes following hormonal manipulation, and the secondary effect of medical intervention may impede or preclude sexual functioning, even when sexual desire is intact. Pelvic irradiation constitutes the primary or adjuvant treatment for a large number of both female and male cancers. No randomized controlled trials could be identified regarding the effect of radiotherapy on sexual dysfunction. However, prospective and clinical controlled trials all demonstrated a severe negative effect on sexual functioning in men and women following radiotherapy for a pelvic cancer. Following pelvic radiotherapy for prostate cancer, a positive effect of phosphodiesterase type 5 inhibitors on erectile dysfunction has been demonstrated, whereas no significant effect on female sexuality was found. Few studies evaluated treatment of female sexual dysfunction following radiotherapy; hormone replacement therapy and the use of vaginal dilator in combination with psycho-educational support is recommended. Conclusion Pelvic radiotherapy plays a significant negative role in the complex scenario of male and female sexual dysfunction. The literature has focused on sexual dysfunction and intervention in prostate and cervical cancer patients. Sexual dysfunction following pelvic radiotherapy for cancer in other pelvic organs, e.g., bladder, rectum, and anus, requires more attention in future studies. Health care providers should pay attention to and provide psychological and medical support regarding sexual dysfunction to all patients who have received pelvic radiotherapy.

Cancer, Benign Gynecology, and Sexual Function—Issues and Answers

“…90,91 Radiotherapy is likely to alter patients' sexual function secondary to treatment because of its effect on pelvic nerves and vessels, similar to radical cystectomy. 82,92 The literature concerning female sexual dysfunction after surgery and radiotherapy is sparse. Henningsohn et al 93,94 included a large number of patients in their cross-sectional study of long-term bladder cancer survivors, 13 of whom were treated with irradiation.…”

“…However, the literature is too sparse for a conclusion. 82 The treatment of NMIBC can result in sexual problems. 83,84,95 The prevalence of sexual dysfunction in patients with NMIBC is very high (54%) compared with an age-and gender-matched healthy population (20%e45%).…”

“…In particular, radiotherapy affects sexual function. 82 Recently, sexual function in NMIBC has been evaluated. 83,84 Sexual dysfunction is a prevalent problem after female radical cystectomy.…”

A Review on Surgical Techniques and Organ Sparing Procedures in Bladder/Prostate Rhabdomyosarcoma

“…15 Several others have also reported post-RT bladder dysfunction. There are several adult studies 16,17 exploring the effect of radiation on long-term urinary and sexual function. According to the results of those studies, high-risk patients experienced moderate-to-severe urinary and sexual symptoms 5 years after RT.…”

Determination of Sexual Problems of Turkish Patients Receiving Gynecologic Cancer Treatment: a Cross-sectional Study

“…Basak Demirtas 1 *, Gul Pinar 1,2 chemotherapy in addition to surgery and radiotherapy (CT+RT+Surgery) have also been shown to be associated with poor sexual functioning (Kaplan et al, 1999;Yılmaz and Eryılmaz, 2004;Demirezen, 2006;Incrocci and Jensen, 2013). It has also been demonstrated that sexual dysfunction is common and chronic in patients who undergo radical hysterectomy (Shell, 2007).…”