Stem Cell Transplantation May Impair Sexual Health

F. Lennie Wong, PhD

Both men and women report a significant decline in sexual satisfaction after hematopoietic cell transplantation (HCT) that is sustained at 3-year follow-up, new research indicates.

The data are from a prospective longitudinal study that documented trends in sexual activity, satisfaction, and function in autologous and allogeneic HCT recipients.

Results also showed a deleterious effect of chronic graft-versushost disease (GVHD) on sexual satisfaction among women and multiple domains of sexual function in both men and women.

F. Lennie Wong, PhD, City of Hope National Medical Center in Duarte, California, and colleagues analyzed the results of surveys completed by 277 adults who underwent HCT for hematologic diseases at their institution over a recent 4-year period.

With survival continuing to improve among HCT recipients, quality of life (QOL) has become increasingly important, the investigators point out. Sexual wellbeing is an important aspect of QOL, however there has been little information on the longitudinal course of sexual wellbeing as well as the sociodemographic and clinical factors that may alter this course over time.

What’s more, longitudinal studies thus far have included mostly non-Hispanic Caucasian patients and allogeneic HCT recipients and have also been limited by their small sample size and short time span.

Wong et al assessed patients using the Derogatis Interview for Sexual Function-Self Report and Derogatis Global Sexual Satisfaction Index before their HCT and at 6 months, and 1, 2, and 3 years afterward.

The study found that 61% of men and 37% of women were sexually active before HCT. Individuals were deemed sexually active if they had intercourse at least once in the prior month. Prevalence rates for sexual activity decreased to 51% in men and increased to 48% in women 3 years post-HCT.

Sexual Side Effects Associated With Chronic GVHD After HCT^a

P

Lower sexual cognition in men

.003

Decreased orgasm in men

.006

Decreased sexual arousal in women

.05

Descreased sexual satisfaction in women

.005

^aResults based on data from 277 adults who underwent HCT for hematologic diseases. GVHD indicates graft-versus-host disease; HCT, hematopoietic cell transplantation

After HCT, both sexes reported a decrease in sexual satisfaction, P <.001. Sexual function was worse in women compared with men across all domains, P ≤.001. The study found that chronic GVHD was associated with lower Sexual Cognition/Fantasy (P = .003) and Orgasm (P = .006) in men and Sexual Arousal (P = .05) and sexual satisfaction (P = .005) in women.

Exposure to total body irradiation (TBI) decreased sexual satisfaction and all domains of sexual function in men (P <.05) but not in women. While TBI has been reported to promote gonadal damage, no prior studies have documented an association between TBI and patient-reported sexual dysfunction in men.

Wong et al wrote that their study is notable in that it included an ethnically heterogeneous population of both allogeneic and autologous HCT recipients that was large and followed for a longer period of time than in earlier studies of sexual function after HCT.

At the same time, the authors suggested that their findings should be interpreted carefully given some important study limitations. For example, they used census data to estimate missing data on patients’ education and income, which may have lessened the effects of socioeconomic status (SES). They noted, however, that aggregated census data have been reported to be a sound proxy for SES data in health outcomes research.

Wong FL, Francisco L, Togawa K, et al. Longitudinal trajectory of sexual functioning after hematopoietic cell transplantation: impact of chronic graft vs. host disease and total body irradiation [published online ahead of print October 24, 2013]. Blood. doi:10.1182/blood-2013-05-499806.