Colorectal cancer is among the most prevalent cancers globally, affecting the rectum and colon (large intestine). Approximately 1 in 24 men and 1 in 26 women will be diagnosed with colorectal cancer. While most of these cases consist of adults 50 years old and older, cases in younger people are rising by 1-2% every year.

Symptoms of colorectal cancer include:

• Diarrhea,
• Constipation,
• Bloody poop,
• Abdominal pain,
• Unexplained weight loss,
• Fatigue, and
• Low iron.

The risk of colorectal cancer is often dependent on lifestyle choices (like diet, exercise, and substance use), family history of colorectal cancer, personal history of colon or rectal issues, and older age.

Treatment for colorectal cancer is not conservative. Patients may need surgery to remove tumors, and additional radiation, chemotherapy, or immunotherapy to kill any remaining cancer. Surgery and treatment will be specific to the location and severity of the tumor(s). For colon cancer specifically, a colectomy or prostatectomy may be the solution. It is important to note that all surgeries, while necessary, often result in unspoken sexual health issues.

All research on sexual health with colorectal cancer care notes that both male and female patients had experienced lower rates of sexual desire (libido), fewer orgasms, and had been having sex less than patients without cancer.

Effects of Surgery on Sexual Health

One study focusing on female sexual function during treatment noted that many patients experienced anxiety and depression around their ostomy bag, which can be the result of certain colorectal surgeries. While there are several options for surgery with only temporary ostomy placement, this can still cause low libido from anxiety around body image and function with an ostomy bag.

It should be noted, however, that patients with an ostomy bag were more likely to receive sexual health counselling than those without an ostomy, and more than older patients (55+).

Some men may require a prostatectomy, the surgical removal of the prostate gland. Nearly all prostatectomies result in erectile dysfunction (ED) and anejaculation (dry orgasm). Additionally, a prostatectomy could reduce testosterone and other sex hormone levels, which causes issues with libido and erectile function as well.

Overall, the burden of cancer and results of radical surgical procedures often lead to an increase in depression and anxiety in cancer patients, which are mental health issues strongly associated with sexual dysfunction.

Additional Treatments and Sexual Health

Treatments following surgery may harm sexual health as well. For example, radiation therapy is often applied directly to the pelvic area. This can damage the nerves, tissues, and blood vessels in this area, often causing ED, ejaculatory disorders, vaginal dryness, and painful sex (dyspareunia).

Chemotherapy is known to cause fatigue (extreme tiredness) and hormonal changes, which can impact libido, and testosterone and estrogen levels, sometimes causing premature menopause in women. Other sexual side effects of chemo include ED, ejaculatory disorders, vaginal dryness and atrophy (thinning vaginal wall), and dyspareunia.

Key Takeaways

• Colorectal cancer is one of the most prevalent cancers globally, and the second leading cause of cancer-related deaths.
• Symptoms and treatment can cause debilitating side effects, impacting both quality of life and sexual health and function in all patients.
• The burden of disease in general can cause depression and anxiety, which are strongly associated with sexual dysfunction.
  • Treatments like surgery and radiation therapy may add to rates of depression, anxiety, and sexual dysfunction. These may cause painful sex and vaginal dryness in women, ED and ejaculatory disorders in men, and lower sex hormone levels, affecting everyday life.
• While colorectal cancer primarily affects those 50 years old and older, 1-2% more younger patients are being diagnosed annually.
  • It is important to be aware of your family’s history, keep up with healthy lifestyle choices, and get screened when there is a higher risk.
• Patients with colorectal cancer should speak with their care team about options for their sexual health.

Resources:

• Almont, T., Bouhnik, A.-D., Ben Charif, A., Bendiane, M.-K., Couteau, C., Manceau, C., Mancini, J., & Huyghe. (2019). Sexual health problems and discussion in colorectal cancer patients two years after diagnosis: A national cross-sectional study. The Journal of Sexual Medicine, 16(1), 96–110. https://doi.org/10.1016/j.jsxm.2018.11.008
• Averyt, J. C., & Nishimoto, P. W. (2014). Addressing sexual dysfunction in colorectal cancer survivorship care. Journal of Gastrointestinal Oncology, 5(5), 388–394. https://doi.org/10.3978/j.issn.2078-6891.2014.059
• Feier, C. V., Paunescu, I. A., Faur, A. M., Cozma, G. V., Blidari, A. R., & Muntean, C. (2024). Sexual functioning and impact on quality of life in patients with early-onset colorectal cancer: A systematic review. Diseases, 12(4), 66. https://doi.org/10.3390/diseases12040066
• Stal, J., Yi, S. Y., Cohen-Cutler, S., Gallagher, P., Barzi, A., Freyer, D. R., Kaslander, J. N., Anto-Ocrah, M., Lenz, H.-J., & Miller, K. A. (2024). Sexual dysfunction among early-onset colorectal cancer survivors: Sex-specific correlates of sexual health discussions between patients and providers. Cancer Causes & Control, 35(1), 111–120. https://doi.org/10.1007/s10552-023-01772-1