Hematopoietic cell transplantation (HCT) can have a negative effect on patients’ sexual health, according to researchers from City of Hope in California, USA.
HCT is used to treat patients with blood cancer, including leukemia, lymphoma, and myeloma. The procedure involves “replacing” damaged cells with healthy ones, which may be autologous (from the patient’s blood or bone marrow) or allogeneic (from a matched donor).
Survival rates for patients undergoing HCT have improved, but few studies have assessed the sexual function of a large group of patients beyond one year of follow up.
For this study, the researchers examined data from 131 allogeneic and 146 autologous HCT patients. One hundred fifty-two men and 125 women participated. The median age of all study subjects was 48. All patients had received HCT treatment at City of Hope.
Two questionnaires were used to evaluate sexual function: The Derogatis Interview for Sexual Function-Self Report (DISF-SR) and the Derogatis Sexual Functioning Inventory. The DISF-SR addressed the domains of cognition/fantasy, sexual arousal, sexual behavior/experience, orgasm, and drive/relationship. A third questionnaire addressing quality of life was also used.
The participants completed all of the questionnaires before treatment and again after treatment at intervals of 6 months, 1 year, 2 years, and 3 years.
Before treatment, 61% of the men and 37% of women reported being sexually active during the previous month. After three years, the rate for men dropped to 54%. But the rate for women increased to 52%.
In spite of this increase, women had worse sexual functioning in all domains when compared to the men. The researchers suggested that the women’s increased activity might have been related to improved psychological quality of life after HCT.
Overall sexual satisfaction declined for both men and women. On average, both groups said they had “adequate” satisfaction before treatment. At the 6-month follow up point, the rating changed to “somewhat adequate.” It did not improve by the 3-year mark.
Chronic graft-versus-host disease (GvHD), in which transplanted cells attack the patient’s original cells, also played a role in for patients who received allogeneic HCT. Past studies have shown that chronic GvHD is associated with painful intercourse, vaginal irritation, and problems with lubrication in women. For men, GvHD can lead to genital inflammation, scarring in blood vessels, lower libido, and erectile dysfunction (ED).
Total body irradiation (TBI), a procedure done before HCT, had negative sexual side effects for men, but not for women. The researchers noted that men and women have “physiologic differences in the pathogenesis of sexual dysfunction” that might explain these results.
The authors encouraged communication between clinicians and patients about the sexual side effects of HCT.
“It is not often that the transplant team and patient will have a conversation about how this procedure could impact their sex life, even after recovery; however, we hope these findings will help encourage patients and their doctors to openly discuss concerns related to sexual dysfunction and address them with specialists who can help,” said lead author Dr. F. Lennie Wong in a news release.
The study was published online before print in October in Blood, the journal of the American Society of Hematology.
Resources
American Society of Hematology
“Study Ties Bone Marrow Transplant To Negative Sexual Side Effects”
(News release. October 24, 2013)
http://www.hematology.org/News/2013/11568.aspx
Blood
Wong, F. Lennie, et al.
“Longitudinal trajectory of sexual functioning after hematopoietic cell transplantation: impact of chronic graft vs. host disease and total body irradiation”
(Full-text. Published online before print: October 24, 2013)
http://bloodjournal.hematologylibrary.org/content/early/2013/10/24/blood-2013-05-499806