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C. Erectile dysfunction (ED) according to the IIEF score by type of operation. APR: abdominoperineal resection, LAR: low anterior resection, Other: left hemicolectomy, right hemicolectomy, transverse colectomy and sigmoidectomy.
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Purpose:
Improved long-term survival of colorectal cancer patients (CRC) treated with surgery and/or chemotherapy ± radiotherapy (RT) has led to increased awareness of long-term side effects, including effecting sexual life, which can ultimately affect the quality of life in these patients. Because the absolute risk factors of erectile dysfunction...
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Citations
... Par ailleurs, les études sur le cancer colorectal se concentrent surtout sur le cancer du rectum en raison de l'impact direct de la chirurgie mutilante et de la radiothérapie sur les organes sexuels. En effet, les études comparant les cancers du côlon et du rectum mettent en évidence que l'impact sexuel est plus fréquent dans le cancer du rectum [31][32][33]. Cependant, ces études montrent que des difficultés apparaissent également dans le cancer du côlon et sont plus importantes que dans la population générale [32,33]. Elles révèlent l'apparition de troubles sexuels et une forte diminution de la fréquence des rapports et de la satisfaction sexuelle globale [18]. ...
Contexte : Le cancer du côlon est le troisième cancer le plus diagnostiqué au monde et a un impact sur tous les aspects de la vie des patients et de leur partenaire. Jusqu’à présent, peu d’études ont étudié l’ajustement sexuel des patients et aucune n’a analysé les interactions entre les partenaires.
Objectif : Décrire les facteurs individuels et dyadiques liés à l’ajustement sexuel des couples.
Méthode : Treize couples ont répondu à un ensemble de questionnaires portant sur le soutien social, la communication et les stratégies de coping dyadique et la satisfaction sexuelle. Des analyses non paramétriques ont été réalisées sur les données quantitatives.
Résultats : Le soutien social, la communication et les stratégies d’adaptation dyadique jouent un rôle dans l’ajustement sexuel des couples. La satisfaction ressentie par les patients et leurs partenaires quant au soutien conjugal est corrélée positivement à l’ajustement sexuel du patient. La qualité de la communication des patients quant au stress engendré par la maladie est liée à la satisfaction sexuelle des partenaires. Le coping dyadique de soutien comme la gestion commune du stress favorisent l’ajustement sexuel des patients et des partenaires. Ces stratégies démontrent l’importance de l’unité au sein du couple, le cancer étant abordé comme une « maladie du couple ». Cet engagement mutuel semble favoriser la satisfaction sexuelle des couples.
Conclusion : Gérer la maladie et le stress lié aux traitements en tant que couple et percevoir son partenaire comme une source de soutien satisfaisante est particulièrement bénéfique pour la satisfaction sexuelle des couples dont un membre est atteint d’un cancer du côlon.
... Our findings showed that sexual problems occur across all age groups, indicating the relevance of sexual health and corresponding issues in all stages of life. As previous findings show, sexual problems do both occur in older and younger cancer patients as they range from erectile dysfunction (Ellis et al., 2010;Sendur et al., 2014;Fekih-Romdhane et al., 2019) and impotence (Bailey et al., 2015) in older men, and lubrication disorders in older women (Milbury et al., 2013), as well as in younger cancer patients with both reproductive and non-reproductive cancer experiencing, sexual dissatisfaction and changes in sexuality (Mütsch et al., 2019). ...
Background
Multimodal cancer treatments are often associated with sexual problems. Identifying patients with sexual problems could help further elucidate serious issues with their sexuality and thus promote or maintain patients’ sexual health. We aimed to assess the occurrence of sexual problems in patients across different tumor locations and to explore associated sociodemographic, medical and psychosocial factors.
Methods
We included 3,677 cancer patients (mean age 58 years, age range 18–75 years, 51.4% women) from a large epidemiological multicenter study in Germany on average 13.5 months after cancer diagnosis. The occurrence and frequency of sexual problems were assessed via a binary item on the problem checklist of the Distress Thermometer (DT). Controlled associations of these problems with sociodemographic, medical and psychosocial factors including distress (DT), anxiety (GAD-7), depression (PHQ-9), quality of life (EORTC-QLQ-C30), and social support (SSUK-8) are analyzed using logistic regression analysis.
Results
We found that 31.8% of patients reported sexual problems, with a significant higher proportion in men (40.5%) compared to women (23.7%), OR 2.35, 95% CI [1.80–3.07] and a higher proportion in patients with a partner (35.6%) compared to those without a partner (3.5%), OR 2.83, 95% CI [2.17–3.70]. Tumor location was associated with occurrence of sexual problems: patients with cancer, affecting the male genital organs had the highest chance for sexual problems, OR 2.65, 95% CI [1.18–3.95]. There was no significant difference in the occurrence of sexual problems between age groups OR 0.99, 95% CI [2.13–3.53] and type of therapy (e.g., operation OR 0.91, 95% CI [0.72–1.15]). Sexual problems were further associated with elevated levels of anxiety, OR 1.05, 95% CI [1.02–1.10], less social support, OR 0.93, 95% CI [0.90–0.97] and lower quality of life in terms of impaired functioning (e.g., social function, OR 0.99, 95% CI [0.99–1.00]).
Conclusions
Sexual problems are commonly reported by patients. Male patients and those living with a partner are more likely to report sexual problems. Sexual problems are associated with different aspects of well-being. The findings imply the practical relevance to screen for sexual problems among patients and identified groups that should be particularly monitored.
... Published research shows that sexual dysfunction in CRC may be due to several factors. For instance, certain treatments are known to increase the risk of sexual dysfunction, such as large and invasive surgeries, 18 radiotherapy, 18 as well as the presence of an ostomy, even a temporary one. [19][20][21] The influence of chemotherapy, on the other hand, is harder to assess. ...
... Published research shows that sexual dysfunction in CRC may be due to several factors. For instance, certain treatments are known to increase the risk of sexual dysfunction, such as large and invasive surgeries, 18 radiotherapy, 18 as well as the presence of an ostomy, even a temporary one. [19][20][21] The influence of chemotherapy, on the other hand, is harder to assess. ...
... It is indeed often associated with surgery, thus preventing a proper differentiation of their respective impacts on patients' sexuality. 18 Findings suggest that sexual dysfunction is often a long-term effect of multimodality therapies. 22,23 Sexual dysfunctions may also be related to other medications (eg, antidepressants), body image (eg, weight, hair), age, previous sexuality, socioeconomic status, cultural beliefs surrounding sexuality, global quality of life, and comorbid medical conditions. ...
Objective
Despite the impact that diagnosis and treatment can have on patients’ sexual health, very little research has been conducted on the impact of colon cancer on sexual health. The aim of this systematic review was to assess the prevalence of sexual dysfunctions in colon cancer and describe the sociodemographic, clinical and psychological correlates of sexual dysfunction.
Methods
Four electronic databases (PsycINFO, PubMed, AcademicSearchPremier, Cochrane Library) were searched for studies reporting sexual adjustment outcomes for colorectal cancer patients from January 1990 to July 2019.
Results
Of the 380 articles screened, 14 were included in this review. Sexual function is affected by colon cancer: patients’ sexual satisfaction decreases significantly, as does the frequency of sexual intercourse. There is an increase in sexual problems (desire, excitement or pleasure disorders). Male gender, advanced age, distress and the comorbidities increase sexual disorders. In addition, it appears that partner distress negatively affects patients’ sexual health. Taking such difficulties into account appears key for these patients and their partners. They could benefit from better care throughout treatment and in remission.
Conclusion
The results of this systematic review highlight the importance of taking an interest in the sexual health of patients with colon cancer.
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... 4 A postoperative erectile dysfunction rate after colorectal neoplastic surgery of 83%. 5 Risk factors already demonstrated are older age, the presence of stoma, the radiotherapy, technique applied, the tumour stage, and the surgeon's experience. 5,6 Reduced sexual function is also related to a lower quality of life in cancer survivors. ...
... 4 A postoperative erectile dysfunction rate after colorectal neoplastic surgery of 83%. 5 Risk factors already demonstrated are older age, the presence of stoma, the radiotherapy, technique applied, the tumour stage, and the surgeon's experience. 5,6 Reduced sexual function is also related to a lower quality of life in cancer survivors. 7 China has the largest population in the world and there are at least 100,000 colostomy operations performed every year. ...
Purpose
This study was conducted to explore the effect of intervention in the form of sexual behavior guidance on the quality of sexual life of young and middle-aged male patients with rectal cancer.
Methods
Twenty cases of young and middle-aged male patients with rectal cancer were randomly divided into experimental and control group in each group including 10 cases per group. The control group was given the traditional health education after the rectal cancer Miles operation. While the experimental group was given sexual behavior guidance and “sex focused training therapy” after the Miles operation and before sexual intercourse in order to overcome erectile dysfunction. The International Index of Erectile Function (IIEF-5) questionnaire was used to measure the sexual functionality of both groups upon admission, at the time of discharge and after 3, 6 and 9 months.
Results
In the experimental group, patients with normal sexual function at the 6th and 9th month after discharge were 7 cases and 9 cases respectively, which were significantly higher than the control group which included 5 cases and 6 cases (p-value < 0.05).
Conclusion
In conclusion, sexual health education not only could effectively improve the sexual function of young and middle-aged male patients with rectal cancer after Miles operation, but also could improve the quality of the sexual life of the patients. It is considered to be worthy to promotion and application on clinical practice.
... Physicians, nurses, and paramedical staff who are responsible for the care of cancer survivors should recognize the potential negative impact of vaginal stenosis on their physical and psychological well-being [27][28][29][30][31]. Although there is a lack of high level evidence, vaginal dilation remains a uniformly adopted prevention method for radiation-induced vaginal stenosis. ...
Purpose: Pelvic radiotherapy holds a vital role in the management of gynaecological and pelvic gastrointestinal cancers. However, radiotherapy can result in shortening and narrowing of the vagina which is known as vaginal stenosis. The objective of this paper is to review the prevention and treatment options of radiation-induced vaginal stenosis and discuss their benefits and harms as well.
Methods: A literature search was performed (1972-2017) on PubMed, Cochrane Database of Controlled Trials, and SCOPUS. There were no language restrictions. Cross references from the included studies were hand searched. The criteria for the included studies were any and every measure for preventing radiation-induced vaginal stenosis.
Results: The use of vaginal dilators, sexual intercourse, and topical therapies are the current options for the management of vaginal stenosis after pelvic radiotherapy.
Conclusion: Vaginal dilation should be encouraged in cancer survivors after pelvic radiotherapy, with counseling by expertized medical and paramedical personnel. Limited evidence exists in favor of the use of vaginal lubricating creams for radiation-related vaginal irritation.
... The higher the questionnaire score, the lower the loss of function. The erectile dysfunction domain of the IIEF scale is classified according to scores as severe (1-10), moderate (11)(12)(13)(14)(15)(16), moderate-to-mild (17)(18)(19)(20)(21), mild (22)(23)(24)(25), and no erectile dysfunction (26)(27)(28)(29)(30) [13]. The validity and reliability of the IIEF was established by the Turkish Society of Andrology (2004). ...
... Similarly, in Ozturk's study [14], patients were found to experience sexual dysfunction in all subscales. Sendur et al. [17] found moderately-severe erectile dysfunction in 80.0% of patients with a stoma. In Asgari's study [18], patients with a urostomy were found to have severe erectile dysfunction and decreased sexual desire. ...
Many patients who undergo stoma surgery experience erectile dysfunction or dyspareunia after the procedure. The purpose of this study was to evaluate sexual satisfaction and function in stoma patients. Data were collected from 100 stoma patients between March 2015 and 2016 using the International Index of Erectile Function (IIEF), Female Sexual Function Index (FSFI), and Golombok-Rust Inventory of Sexual Satisfaction (GRISS). Statistical analysis was performed using descriptive methods, the Mann–Whitney U test, and Kruskal–Wallis test. GRISS female (n = 24) and male (n = 76) mean scores were 6.20 ± 2.02 and 7.43 ± 1.44, respectively. FSFI mean score was 6.17 ± 8.97 and IIEF mean score was 23.5 ± 18.0. Severe erectile dysfunction was present in 60.5% of males (n = 46). Reportedly, 79.0% of patients had not been informed about possible sexual problems after surgery. Patients shared their experience with sexual problems with a partner (n = 28), medical doctor (n = 9), or no one (n = 20). Statistical significance was found between GRISS female mean scores and education level, marital status, chronic disease and stoma status (permanent/temporary) (p < .05), and between FSFI mean scores and chronic disease and drug use (p < .05). This study suggests that stoma patients experience sexual dissatisfaction and sexual dysfunction, and most patients had not been informed about possible sexual problems and treatment options. Based upon our findings, patients undergoing stoma surgery should receive perioperative sexual counseling conducted by a multidisciplinary team including stomatherapy nurses.
... For example, in studies which assessed erectile dysfunction using single items derived from generic or disease-specific quality of life instruments, prevalence ranged from 13-58% (Gosselink et al. 2006, Den Oudsten et al. 2012, Abu-Helalah et al. 2014, Bailey et al. 2015. Meanwhile, studies which collected data using the International Index of Erectile Function reported much higher, although still varying, prevalence rates (45-84%) (Ellis et al. 2010, Au et al. 2012a, Milbury et al. 2013, Sendur et al. 2014. Similar patterns were identified among studies investigating female sexual dysfunction (Gosselink et al. 2006, Au et al. 2012a, Den Oudsten et al. 2012, Milbury et al. 2013, Bailey et al. 2015. ...
... Treatment modalities appear to be an important factor in determining these outcomes. Consistent evidence indicates that males who have undergone more destructive surgery requiring an ostomy report more negative sexual function and enjoyment (Ellis et al. 2010, Hoerske et al. 2010, Thong et al. 2011a, Den Oudsten et al. 2012, Kilic et al. 2012, Knowles et al. 2013, Milbury et al. 2013, Orsini et al. 2013, Sendur et al. 2014. A single cross-sectional survey study from the USA highlights the associations between pelvic radiotherapy, pain and vaginal dryness in female survivors due to radiation-induced atrophy (Milbury et al. 2013). ...
... 13-92% (Gosselink et al. 2006, Ellis et al. 2010, Au et al. 2012a, Den Oudsten et al. 2012, Ball et al. 2013, Milbury et al. 2013, Abu-Helalah et al. 2014, Sendur et al. 2014, Bailey et al. 2015 Ejaculation Problem 60% (Den Oudsten et al. 2012) populations (Thong et al. 2011a, Thong et al. 2011b, Den Oudsten et al. 2012, Milbury et al. 2013, Orsini et al. 2013. ...
Background and Aim: Following cancer treatment, colorectal cancer survivors may continue to experience a multitude of physical, psychological and social effects. Follow-up care is an integral part of cancer survivorship, yet less frequent contact with healthcare professionals after treatment may affect survivors’ perceptions of their care and access to formal support. In addition, the emphasis placed on monitoring for recurrence during follow-up may lead to unmet supportive care and informational needs. There is limited research to determine the impact of healthcare experiences upon cancer survivors’ quality of life. Therefore, this study seeks to understand colorectal cancer survivors’ quality of life, symptom experience and the healthcare factors which may influence their quality of life.
Methodology: A pragmatic mixed methods sequential explanatory approach.
Methods: A purposive sample of adult colorectal cancer survivors (n=304) were recruited from three public and private hospitals and 21 cancer support centres in Ireland. The sample, who were between six and 60 months post-diagnosis completed a questionnaire including the Functional Assessment of Therapy–Colorectal Cancer Survey and the Patient Continuity of Care Questionnaire. A subsample of 22 survey participants took part in semi-structured interviews to elicit information about experiences relating to their quality of life, healthcare and unmet needs.
Findings: On average, colorectal cancer survivors evaluated their quality of life positively. However, more than half were dissatisfied with their quality of life; more than three-quarters reported at least one negative consequence of their treatment. Survivors appeared to mediate dissatisfaction with their quality of life through a process of reframing their illness experience, including social comparison and use of optimistic coping strategies.
Colorectal cancer survivors’ quality of life was associated with a selection of socio-ecological (insurance status, social difficulties), medical (tumour status), and healthcare (continuity of care, use of cancer support) variables. Although two-thirds of survivors were satisfied with their continuity of care, an undercurrent of positive and negative healthcare events were evident, influenced by behaviours or actions at individual, organisational and political levels. Negative care events diminished survivors’ autonomy, dignity and confidence in their self-management skills, and created an array of unmet information and supportive care needs. In response to these unmet needs, survivors developed a network of support beyond the healthcare system encompassing family members, social networks, local advocacy services and virtual communities. However, engagement with these networks was dependent upon the cultural context in which the individual resided and received healthcare and barriers to accessing support, such as awareness, local availability, perceived need, trustworthiness and stigma relating to discussion of symptoms.
Discussion and Conclusion: The results of this mixed methods study demonstrate the importance of continuity of care and dissemination of cancer-related information in promoting more positive quality of life among colorectal cancer survivors. Given the relationship between poorer quality of life, greater social difficulty and participation in cancer support, strategies to address cancer survivors’ psychosocial needs are necessary. The study has implications for the recommendations of the 2017 National Cancer Strategy, particularly the development of cancer survivorship models of care; the implementation of cancer survivorship care plans, treatment summaries; and provision of psychosocial support. Most critically, given the finding that colorectal cancer survivors feel under-prepared for quality of life issues following treatment, there is a need for interventions to support the delivery of cancer survivorship information and assist survivors to develop self-management strategies. Recommendations are made for future research, healthcare delivery, and oncology policy, practice, and cancer support and advocacy services to begin to ameliorate the challenges and unmet needs associated with colorectal cancer survivorship.
... Similarly, Sendur and colleagues [32] found that three quarters (72.4%) of men treated for colorectal cancer reported some degree of ED. According to the IIEF, 41.3% of patients reported mild ED, 20.6% reported moderate ED, and 10.3% reported severe ED. ...
... Given the range of assessment tools used in these studies, the generalizability of these findings may be somewhat limited. Fourth, the studies varied in the amount of time between diagnosis/treatment and assessment, ranging from a mean of 6 months post-treatment [21,32] to a median of 70 months post-treatment [27]. In certain cases, patients who were assessed multiple years after receiving their initial diagnoses no longer fell within the AYA age range. ...
... A few other experiments included both AYAs and older participants; in one such study [34], more AYAs than older individuals met for sexual dysfunction (8 vs. 6); however, increased age was associated with greater overall sexual problems in a different study [25]. Sendur and colleagues [32] found that older participants met for severe ED more frequently than did AYAs (37.5 vs. 13.6%), but more AYAs than older participants endorsed moderate ED (20.7 vs. 12.5%). ...
Purpose:
The purpose of this systematic review was to identify, with supporting evidence, the impact of cancer and its treatment on the sexual function of adolescents and young adults.
Methods:
PubMed, CINAHL, and PsycINFO articles were searched for relevant studies published in English. Fifteen studies, 13 quantitative and two qualitative, were included in this review.
Results:
Results indicated that cancer during the adolescent and young adult period has a significant negative impact on certain domains of sexual function in both men and women.
Conclusions:
Among adolescent and young adult males, there is evidence that cancer has detrimental effects on erection, ejaculation, and orgasm. Among adolescent and young adult females, cancer is associated with decreased desire, but there appear to be mixed findings with respect to arousal, orgasm, and satisfaction. Directions for future research are discussed.
Implications for cancer survivors:
A better understanding of the effects of cancer and its treatment during adolescence and young adulthood on sexual function could increase attention paid to sexual health in oncology settings and lead to improved psychosexual services for this population.
... It seems that APR is significantly associated with higher sexual dysfunction rates than RAR. In a prospective study, Sendur et al. (11) presented a post-operative erectile dysfunction rate after colorectal neoplastic surgery of 83%. Risk factors already described are increased age, presence of stoma, radiotherapy, technique applied (11), tumor stage and surgeon's experience (12). ...
... The type of surgery itself was already predictable to be a risk factor. Also the tumor level, since it influences directly the surgery approach, coincident to what other groups revealed (11). A difference in these results is mainly the importance of comorbidities for the outcome of this surgery. ...
Introduction:
The development of new surgical techniques and medical devices, like therapeutical multimodal approaches has allowed for better outcomes on patients with rectal cancer (RCa). Owing to that, an increased awareness and investment towards better outcomes regarding patients' sexual and urinary function has been recently observed.
Aim:
Evaluate and characterize the sexual dysfunction of patients submitted to surgical treatment for RCa.
Materials and methods:
An observational retrospective study including all male patients who underwent a surgical treatment for RCa between January 2011 December 2014 (n=43) was performed, complemented with an inquiry questionnaire to every patient about its sexual habits and level of function before and after surgery.
Discussion:
All patients were male, with an average of 64yo. (range 42-83yo.). The surgical procedure was a rectum anterior resection (RAR) in 22 patients (56%) and an abdominoperineal resection (APR) in 19(44%). Sixty three percent described their sexual life as important/very important. Sexual function worsening was observed in 76% (65% with complains on erectile function, and 27% on ejaculation). Fourteen patients (38%) didn't resume sexual activity after surgery. Increased age (p=0.007), surgery performed (APR) (p=0.03) and the presence of a stoma (p=0.03) were predictors of ED after surgery. A secondary analysis found that the type of surgery (APR) (p=0.04), lower third tumor's location (p=0.03) and presence of comorbidities (p=0.013) (namely, smokers and diabetic patients) were predictors of de novo ED after surgery.
Conclusions:
This study demonstrated the clear negative impact in sexual function of patients submitted to a surgical treatment for RCa. Since it is a valued feature for patients, it becomes essential to correctly evaluate/identify these cases in order to offer an adequate therapeutical option.
... Similarly, Sendur and colleagues [32] found that three quarters (72.4%) of men treated for colorectal cancer reported some degree of ED. According to the IIEF, 41.3% of patients reported mild ED, 20.6% reported moderate ED, and 10.3% reported severe ED. ...
... Given the range of assessment tools used in these studies, the generalizability of these findings may be somewhat limited. Fourth, the studies varied in the amount of time between diagnosis/treatment and assessment, ranging from a mean of 6 months post-treatment [21,32] to a median of 70 months post-treatment [27]. In certain cases, patients who were assessed multiple years after receiving their initial diagnoses no longer fell within the AYA age range. ...
... A few other experiments included both AYAs and older participants; in one such study [34], more AYAs than older individuals met for sexual dysfunction (8 vs. 6); however, increased age was associated with greater overall sexual problems in a different study [25]. Sendur and colleagues [32] found that older participants met for severe ED more frequently than did AYAs (37.5 vs. 13.6%), but more AYAs than older participants endorsed moderate ED (20.7 vs. 12.5%). ...
Presented at the 2017 Annual Meeting of the International Society for the Study of Women’s Sexual Health
