The decline of male sexual activity and function after surgical treatment for rectal cancer

Background and purpose: The prevalence of sequelae following rectal cancer (RC) treatment is high. We investigate the prevalence and temporal change in sexual dysfunction among male RC patient, along with their counselling and treatment needs and associations between sexual dysfunction and clinical factors. Patient/materials and methods: Patient-reported outcome measures were completed 3 and 12 months after RC surgery. We used the five-item International Index of Erectile Function score to measure sexual function in sexually active patients and ad hoc items to explore their sexual activity level, causes of disrupted sexual life, and self-rated sexual function. Clinical data were obtained from the Danish Colorectal Cancer Group database Results: In total, 364 of 490 (74%) eligible male patients were included. Their mean age (standard deviation [SD]) at surgery was 68.3 (11) years. Forty-one percent reported being sexually inactive at the time of diagnosis. Among sexually active men, 44% had resigned from sexual activity at 12 months, mainly due to erectile dysfunction (ED), as reported by 55%. Only 16% experienced improvement; 19% experienced a worsening of their ED category in the 12-month observation time. Stoma was associated with both ED (odds ratio [OR] 5.6; 95% confidence interval [CI] [1.8, 17.4]) and low self-rated sexual function (OR 3.5 95% CI [1.8 , 6.7]). Phone contact to discuss sexual problems was requested by 29%; 19% were referred to professional treatment. Interpretation: Sexual dysfunction is common following RC, without improvement over time. Systematic screening enables identification of patients needing professional help.