Sexual dysfunction and infertility as late effects of cancer treatment

Abstract

Sexual dysfunction is a common consequence of cancer treatment, affecting at least half of men and women treated for pelvic malignancies and over a quarter of people with other types of cancer. Problems are usually linked to damage to nerves, blood vessels, and hormones that underlie normal sexual function. Sexual dysfunction also may be associated with depression, anxiety, relationship conflict, and loss of self-esteem. Innovations in cancer treatment such as robotic surgery or more targeted radiation therapy have not had the anticipated result of reducing sexual dysfunction. Some new and effective cancer treatments, including aromatase inhibitors for breast cancer or chemoradiation for anal cancer also have very severe sexual morbidity. Cancer-related infertility is an issue for younger patients, who comprise a much smaller percentage of total cancer survivors. However, the long-term emotional impact of being unable to have a child after cancer can be extremely distressing. Advances in knowledge about how cancer treatments may damage fertility, as well as newer techniques to preserve fertility, offer hope to patients who have not completed their childbearing at cancer diagnosis. Unfortunately, surveys in industrialised nations confirm that many cancer patients are still not informed about potential changes to their sexual function or fertility, and all modalities of fertility preservation remain underutilised. After cancer treatment, many patients continue to have unmet needs for information about restoring sexual function or becoming a parent. Although more research is needed on optimal clinical practice, current studies suggest a multidisciplinary approach, including both medical and psychosocial treatment options.

Managing Erectile Dysfunction After Cancer: More Than Penile Rigidity

“…Yet, rates of sexual problems after cancer are even higher than the review suggests. 2 Furthermore, limiting assessment and treatment to ED has not overcome barriers to help-seeking among men with cancer-related sexual problems and has led to dismal outcomes among men who actually try a urologic treatment.…”

“…2 Voznesensky et al 1 cited one of several recent studies showing that return to baseline erectile function after radical pelvic surgery has been greatly overestimated. [2][3][4] However, they also underestimate rates of ED after pelvic radiation therapy 3,4 and among survivors of hematologic and childhood malignancies.…”

“…2,5 The exception are men who have radical prostatectomy, because surgeons typically suggest that they try penile rehabilitation to promote recovery of erections. A variety of surveys find that patients with cancer want and expect their medical team to initiate discussions of sexual problems.…”

“…Sexual bother also occurs with urinary or bowel incontinence or interference from ostomy appliances. 2 …”

Self-Image and Sexuality Issues among Young Women with Breast Cancer: Practical Recommendations

“…In addition, sexual dysfunction for young breast cancer survivors is also significantly associated with the quality of their intimate relationships 32,34 . It has been observed that survivors' perceived satisfaction in their intimate relationships is significantly correlated with sexual satisfaction, pain during sexual activity, and their overall sexual functioning, both during partnered and non-partnered activity 32 .…”