New Research Examines Sexual Function after Stem-Cell Transplant
Affected by cancer or diseases of the blood, many people undergo treatment and show the promise of long-term survival. One often-overlooked result of treatment is its effect on sexuality.
In a prospective study examining the effects of specialized cancer treatment, researchers found that women are likely to report continuing problems with sexual functioning after 5 years of specialized cancer treatment (HCT, or hematopoietic cell transplantation). Men also report sexual problems, but are more likely to return to pre-treatment sexual activity and functioning over time. This long-term study, the first of its kind, indicates that sexual function and activity diminishes for the recipients of a type of stem cell transplant used for the treatment of diseases of the blood, bone marrow, or certain types of cancer such as leukemia and lymphoma.
The study was designed and directed by Dr. Karen L. Syrjala at the Fred Hutchinson Cancer Research Center in Seattle, Washington, with support from the National Cancer Institute.
Dr. Julia R. Heiman, co-author of the study and director of The Kinsey Institute, comments: "Medicine has done well to improve survival. This study indicates that cancer survivors often wish to return to sexual capacity as part of their lives."
Participants ranged in age from 22-64 years (with an average age of 41), and included a nearly even mix of men and women. Patients were followed irrespective of sexual orientation or partner status. The five-year overall completion rate for relapse-free survivors (92 of of 161 participants) was 84%.
HCT recipients completed an assessment of their sexual health before the transplant, and responded again six-months later, as well as after one, two, three, and five years. At five years, patient assessments were compared against a control group consisting of siblings, friends, or community members within five years of the participant's age and of the same gender, ethnicity, race, and educational background.
Sexual dysfunction in transplant patients is thought to be caused by systemic therapies, such as total body irradiation and chemotherapy drugs known as alkylating agents. These are known to permanently damage the endocrine glands, which play a critical role in the development and regulation of the reproductive system.
Another common complication is chronic graft-versus-host disease (GVHD), experienced by 65 percent of patients in the study. GVHD may cause hormonal and tissue changes, contributing to diminished libido and sexual dysfunction in both men and women.
One goal of the research was to examine whether sexual dysfunction improves, stabilizes, or declines with continued recovery after HCT. The study was also designed to identify reasons survivors do not return to sexual activity, and to define long-term sexual problems so that treatments can be designed for them.
Results show that women are less likely to regain sexual function. At the six-month mark, both sexes reported decreased sexual activity, but by one year, sexual activity for the majority of the men (74 percent) had recovered to levels seen at the beginning of the study.
For women, just over half (55 percent) returned to pre-transplant levels of activity or function after two years. Though sexual activity was restored, 46 percent of the men and 80 percent of the women who were sexually active at the five-year mark reported having problems that disrupted sexual function and satisfaction.
Heiman adds: “To seriously address survivor’s needs for sexual intimacy requires careful attention and resources. As health care providers and researchers, we owe them some help in this area.”
Karen L. Syrjala, Brenda F. Kurland, Janet R. Abrams, Jean E. Sanders and Julia R. Heiman are research co-authors. Results of the study are published online in a Blood First Edition Paper (September 2007). Blood is the official journal of the American Society of Hematology.
Syrjala, K.L., Kurland, B.F., Abrams, J.R., Sanders, J.E., and Heiman, J.R. (2008). Sexual function changes during the 5 years after high-dose treatment and hematopoietic cell transplantation for malignancy, with and hematopoietic cell transplantation for malignancy, with case-matched controls at 5 years. Blood, 111 (3), 989-996.
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