A long term study found
that a type of stem cell transplant used for patients with life threatening
diseases, such as leukemia and lymphoma, results in decreased sexual
function and activity for recipients. Further, males are likely to recover
from these changes over time, while the sexuality of female patients
remains compromised. In addition, neither male nor female long-term cancer
survivors regained levels of sexual activity and function equal to those of
their peers who have not had cancer, according to a Blood First Edition
Paper prepublished online today. Blood is the official journal of the
American Society of Hematology.

“Survival without a sex life should not be what cancer survivors settle
for or what health-care professionals consider a successful outcome of
cancer treatment,” stated lead study author, Karen Syrjala, PhD,
co-director of the Survivorship Program at the Fred Hutchinson Cancer
Research Center. “Sexual dysfunction in survivors of cancer needs to become
a priority for research funding and a routine topic of discussion between
doctors and their patients after cancer treatment.”

In an allogeneic hematopoeitic stem cell transplantation, patients with
diseases of the blood, bone marrow, or certain types of cancers receive an
infusion of new stem cells from a sibling or tissue-matched unrelated donor
to replace the damaged or destroyed cells in their bone marrow needed for
the production of blood cells. Before the transplant, high-dose
chemotherapy is administered to kill residual cancer cells and to suppress
the immune system so that the patient’s body will not reject the new
tissue.

The results of questionnaires on sexual function were reported for 161
patients scheduled to receive this procedure at the Fred Hutchinson Cancer
Research Center in Seattle. The patients ranged in age from 22-64 years
with an average age of 41 and a nearly even split by gender.

Before the transplant, study participants completed an assessment of
their sexual health at the clinic, and, after the procedure, surveys were
mailed to the patients to complete at the six-month interval and after one,
two, three, and five years. The response rate to the questionnaire averaged
84 percent with all participants completing one or more surveys during the
five-year period.

The surveys included 37 questions in the areas of interest, desire,
arousal, orgasm, satisfaction, activity, relationship, masturbation, and
sexual problems. The male and female versions had the same content except
for variations in the problems section according to sex. In addition, those
who were not sexually active were provided with a list of possible reasons
and asked to mark as many as applied.

At five years, the assessments were compared against a control group
consisting of siblings or friends of the study patients that were within
five years of the participant’s age and who were of the same gender,
ethnicity, race, and educational background. If a local match was not
available, the researchers recruited volunteers from the community that fit
the criteria.

At the six-month mark, both genders had decreased sexual activity, but,
by one year, sexual activity for the majority of the men (74 percent) had
recovered to the levels seen at the beginning of the study. For women,
recovery of sexual activity took longer, with just over half (55 percent)
returning to sexual activity after two years. Though sexual activity was
restored for these patients, for those who were sexually active at the
five- year mark, 46 percent of the men and 80 percent of the women reported
problems that disrupted sexual function.

According to the researchers, sexual dysfunction in transplant patients
is likely caused by systemic therapies, such as total body irradiation and
chemotherapy drugs known as alkylating agents, which are known to
permanently damage endocrine glands that play a critical role in the
development and regulation of the reproductive system.

In addition, chronic graft-versus-host disease (GVHD), a common
complication of transplantation experienced by 65 percent of the patients
in this study, may cause shrinkage of the vaginal tissues and changes to
the vaginal lining that can contribute to sexual dysfunction in women. For
males, testosterone levels and the cavernosal arteries of the penis are
affected, eroding libido and erectile function.

Lack of interest or libido explained sexual inactivity in part for
nearly 20 percent of female survivors at both six months and five years,
suggesting that this problem did not improve over time. In contrast, for
males, lack of interest or libido as a reason for inactivity declined from
14 percent to 6 percent between six months and five years.

At the five-year mark, the rates of sexual activity and sexual function
for both male and female patients were below those of the control group,
suggesting that they did not fully recover from the effects of the cancer
itself or cancer treatments. Further studies are needed to determine if
hormone treatments for both sexes or other therapies will help these
patients achieve the same sexual function and activity as their peers.

The researchers also recommend that patients undergoing stem cell
transplantation be made aware of potential changes in their sexuality and
given resources to address these needs to help improve long-term quality of
life. Men may benefit from reassurance that erectile function and sexual
desire should improve by one to two years after treatment, but that methods
such as testosterone replacement, erectile-function medications, and other
adaptive strategies can be considered if problems continue. For women,
methods that focus on communication with their partners about changes in
sensation, strategies for enhancing libido, and use of vaginal lubricants,
dilators, or vibrators to assist with adapting to genital changes may help
to maintain sexual responsiveness.

This work was supported by grants from the National Cancer Institute.

The American Society of Hematology (hematology) is the
world’s largest professional society concerned with the causes and
treatment of blood disorders. Its mission is to further the understanding,
diagnosis, treatment, and prevention of disorders affecting blood, bone
marrow, and the immunologic, hemostatic, and vascular systems, by promoting
research, clinical care, education, training, and advocacy in hematology.

Blood, the official journal of the American Society of Hematology, is
the most cited peer-reviewed publication in the field. Blood is issued to
Society members and other subscribers twice per month, available in print
and online at bloodjournal.

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