Sexual Function After Treatment for Rectal Cancer: A Review

Abstract

Sexual function is one element of QOL that may be significantly altered following treatment for rectal cancer, but the incidence and contributing risk factors are generally poorly understood. Nevertheless, the impact of rectal cancer therapy on sexual function should be conveyed to patients preoperatively. In addition to helping patients evolve realistic expectations, it will help clinicians identify those for whom interventions may be appropriate. In the past 10 years, there has been an increase in the number of studies reporting sexual dysfunction following rectal cancer treatment. However, these studies are difficult to interpret collectively for a variety of reasons. Most importantly, sexual dysfunction lacks a standardized definition, which leads to poor comparability between studies. The best inclusive definitions describe sexual dysfunction as a collection of distinct symptoms, which differ for men and women. The absence of sexual activity is sometimes used as a surrogate for sexual dysfunction, but this is confounded by an individual's desire and opportunity for sexual activity, and may not be an accurate reflection of physiologic functionality. Additional factors complicating assimilation of studies include the absence of baseline data, missing data, small sample sizes, and heterogeneity in use of validated and nonvalidated instruments. The purpose of this article is to systematically review the contemporary literature reporting sexual function after rectal surgery to determine the overall risk of sexual dysfunction, evaluate possible contributing factors, and identify questions that should be addressed in future studies.

Survivorship Care Plans for People with Colorectal Cancer: Do They Reflect the Research Evidence?

“…Although forty reviews met the inclusion criteria with respect to quality assessment, twenty-nine studies were eliminated because they were investigating the primary crc risk in general populations , and another three systematic reviews were eliminated because the original studies included in those reviews were of poor quality due to numerous methodologic flaws and inconclusive findings [54][55][56] . Thus, only the remaining eight reviews (seven systematic reviews and one meta-analysis) were included in our synthesis [57][58][59][60][61][62][63][64] . Figure 1 presents details of the search and inclusion and exclusion process.…”

“…One review of 6247 crc survivors who underwent surgery reported that the percentage of preoperatively potent men who experienced sexual dysfunction postoperatively ranged from 5% to 88% and that about half the women reported sexual dysfunction. The dysfunctions were more frequent and more pronounced in individuals treated for rectal cancer than in those treated for cancer of the colon and were worse if the patient had undergone rectal excision surgery or had received radiation treatments, or both 59 . Preoperative radiotherapy, a stoma, and complications during or after surgery were significantly associated with higher sexual dysfunction 59,64 .…”

“…Of the eight included reviews, six investigated the challenges of crc patients or survivors (qol, sexual and bowel dysfunctions) [59][60][61][62][63][64] , and two investigated the effect of physical activity on the well-being of crc survivors 57,58 . No reviews for the population of interest were found that investigated cancer risk; urinary problems, fertility concerns, body image, weight-gain issues, concerns about diet or nutrition, or spirituality; or interventions such as physiotherapy, sex therapy, education and information provision, cognitive therapies, meditation, or relaxation therapies.…”

“…Two reviews investigated sexual dysfunction in crc survivors 59,64 . According to both reviews, sexual dysfunctions were the most frequently observed treatment-related complications in crc survivors, although the signs and symptoms and the degree of severity varied from person to person and by sex, tumour location, and treatment received.…”

“…Sexual dysfunction is a frequently observed treatment side effect in crc survivors, although the severity varies from person to person, by sex, and also by treatment type 59,64 . Individuals with cancer of the rectum experience higher levels of sexual dysfunction, especially if they undergo certain types of treatment.…”