title: Urinary and sexual dysfunction in women after resection with and without preoperative radiotherapy for rectal cancer: a population-based cross-sectional study.
abstract: OBJECTIVE
  Knowledge of urinary and sexual dysfunction in women after rectal cancer treatment is limited. This study addresses this in relation to the use of preoperative radiotherapy, type of surgery and the presence of bowel dysfunction.
  
  
  METHODS
  All living female patients who underwent abdominoperineal excision (APE) or low anterior resection (LAR) for rectal cancer in Denmark between 2001 and 2007 were identified. Validated questionnaires (the ICIQ-FLUTS and the SVQ) on urinary and sexual function were completed by 516 (75%) and 482 (72%) recurrence-free patients in 2009.
  
  
  RESULTS
  Urgency and incontinence were reported by 77 and 63% of respondents, respectively. Vaginal dryness, dyspareunia and reduced vaginal dimensions occurred in 72, 53 and 29%, respectively, and 69% reported that they had little/no sexual desire. Preoperative radiotherapy was associated with voiding difficulties (OR = 1.63, 95% CI 1.09-2.44), reduced vaginal dimensions (OR = 4.77, 95% CI 1.97-11.55), dyspareunia (OR = 2.76, 95% CI 1.12-6.79), lack of desire (OR = 2.22, 95% CI 1.09-4.53) and reduced sexual activity (OR = 0.55, 95% CI 0.30-0.98). Patients undergoing APE had a higher risk of dyspareunia (OR = 2.61, 95% CI 1.00-6.85). Bowel dysfunction after LAR was associated with bladder storage difficulties (OR = 1.64, 95% CI 1.01-2.65), symptoms of incontinence (OR = 2.17, 95% CI 1.35-3.50), lack of sexual desire (OR = 2.69, 95% CI 1.21-5.98), sexual inactivity (OR = 0.48, 95% CI 0.24-0.96) and sexual dissatisfaction (OR = 0.40, 95% CI 0.20-0.82).
  
  
  CONCLUSIONS
  Urinary and sexual problems are common in women after treatment for rectal cancer. Preoperative radiotherapy interferes with several aspects of urinary and sexual functioning. Bowel dysfunction after LAR is associated with urinary dysfunction and a reduction in sexual desire, activity and satisfaction.
authors.affiliation: Surgical Research Unit, Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Bregendahl
authors.forename: K J
authors.initials: KJ
authors.lastname: Emmertsen
authors.forename: J C
authors.initials: JC
authors.lastname: Lindegaard
authors.forename: S
authors.initials: S
authors.lastname: Laurberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003718:Denmark; D004414:Dyspareunia / Q000209:etiology; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D011300:Preoperative Care; D012004:Rectal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D012725:Sexual Behavior; D012735:Sexual Dysfunction, Physiological / Q000209:etiology*; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000209:etiology; D014555:Urination Disorders / Q000209:etiology*; D014621:Vagina / Q000528:radiation effects
keywords: Rectal cancer; abdominoperineal excision; low anterior resection; preoperative radiotherapy; sexual dysfunction; urinary dysfunction