title: Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer.
abstract: OBJECTIVE
  To measure sexual function and quality of life (QOL) after rectal cancer treatment.
  
  
  BACKGROUND
  Previous studies on sexual function after rectal cancer treatment have focused on males and have not used validated instruments.
  
  
  METHODS
  Patients undergoing curative rectal cancer surgery from 1980 to 2003 were administered a questionnaire, including the Female Sexual Function Index (FSFI) or International Index of Erectile Function (IIEF), and the EORTC QLQ-C30/CR-38. Multiple logistic regression was used to test associations of clinical factors with outcomes.
  
  
  RESULTS
  Eighty-one women (81.0%) and 99 men (80.5%) returned the questionnaire; 32% of women and 50% of men are sexually active, compared with 61% and 91% preoperatively (P < 0.04); 29% of women and 45% of men reported that "surgery made their sexual lives worse." Mean (SD) FSFI and IIEF scores were 17.5 (11.9) and 29.3 (22.8). Specific sexual problems in women were libido 41%, arousal 29%, lubrication 56%, orgasm 35%, and dyspareunia 46%, and in men libido 47%, impotence 32%, partial impotence 52%, orgasm 41%, and ejaculation 43%. Both genders reported a negative body image. Patients seldom remembered discussing sexual risks preoperatively and seldom were treated for dysfunction. Current age (P < 0.001), surgical procedure (P = 0.003), and preoperative sexual activity (P = 0.001) were independently associated with current sexual activity. Gender (male, P = 0.014), surgical procedure (P = 0.005), and radiation therapy (P = 0.0001) were independently associated with the outcome "surgery made sexual life worse." Global QOL scores were high.
  
  
  CONCLUSIONS
  Sexual problems after surgery for rectal cancer are common, multifactorial, inadequately discussed, and untreated. Therefore, sexual dysfunction should be discussed with rectal cancer patients, and efforts to prevent and treat it should be increased.
authors.affiliation: Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Samantha K
authors.initials: SK
authors.lastname: Hendren
authors.forename: Brenda I
authors.initials: BI
authors.lastname: O'Connor
authors.forename: Maria
authors.initials: M
authors.lastname: Liu
authors.forename: Tracey
authors.initials: T
authors.lastname: Asano
authors.forename: Zane
authors.initials: Z
authors.lastname: Cohen
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Swallow
authors.forename: Helen M
authors.initials: HM
authors.lastname: Macrae
authors.forename: Robert
authors.initials: R
authors.lastname: Gryfe
authors.forename: Robin S
authors.initials: RS
authors.lastname: McLeod
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D015995:Prevalence; D011788:Quality of Life; D012004:Rectal Neoplasms / Q000601:surgery*; D020018:Sexual Dysfunctions, Psychological / Q000453:epidemiology* / Q000209:etiology; D011795:Surveys and Questionnaires