title: Prevalence of Physiologic Sexual Dysfunction Is High Following Treatment for Rectal Cancer: But Is It the Only Thing That Matters?
abstract: BACKGROUND
  Although several studies have reported high rates of sexual dysfunction in patients treated for rectal cancer, most studies have been limited by retrospective design, failure to use validate instruments, and a limited number of female patients.
  
  
  OBJECTIVE
  The objectives of this study were to 1) prospectively assess changes in sexual function before and after treatment for rectal cancer and 2) identify potential areas for improved care of patients who have rectal cancer with sexual dysfunction.
  
  
  METHODS
  This study is a prospective, longitudinal survey.
  
  
  METHODS
  This study was conducted at 4 tertiary care academic hospitals.
  
  
  METHODS
  The patients included had newly diagnosed rectal cancer.
  
  
  METHODS
  Subjects completed the European Organization for Research and Treatment Quality of Life Cancer Module and Colorectal Cancer Module, International Index of Erectile Function, and Female Sexual Function Index questionnaires before the start of treatment, after the completion of preoperative chemoradiotherapy, and 1 year after surgery.
  
  
  RESULTS
  Forty-five patients completed the study, and the overall results showed significant sexual dysfunction in both male and female subjects that continued to increase from baseline up to 1 year after surgery. In male subjects, sexual activity, interest, and enjoyment remained relatively stable, despite increasing sexual problems. However, for female patients, although sexual activity and interest remained relatively stable, sexual enjoyment worsened as sexual problems increased.
  
  
  CONCLUSIONS
  The study closed before reaching the target sample size owing to lower than anticipated accrual rates. Post hoc analysis included qualitative interviews with patients to explore reasons for low recruitment.
  
  
  CONCLUSIONS
  The results of this study show that sexual problems continue to increase up to 1 year after surgery. Despite this, sexual interest in both male and female patients remained relatively unchanged suggesting that other aspects of sexuality, not just physiologic function, also need to be evaluated. Future studies to assist and educate physicians on how to initiate a discussion about sexuality and identify patients in "distress" because of sexual problems are important.
authors.affiliation: 1 Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada 2 Zane Cohen Centre for Digestive Diseases, Toronto, Ontario, Canada 3 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada 4 Department of Diagnostic Assessment, Grand River Hospital, Kitchener, Ontario, Canada 5 Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada 6 Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada 7 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Marisa
authors.initials: M
authors.lastname: Leon-Carlyle
authors.forename: Selina
authors.initials: S
authors.lastname: Schmocker
authors.forename: J Charles
authors.initials: JC
authors.lastname: Victor
authors.forename: Barbara-Anne
authors.initials: BA
authors.lastname: Maier
authors.forename: Brenda I
authors.initials: BI
authors.lastname: O'Connor
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Baxter
authors.forename: Robin S
authors.initials: RS
authors.lastname: McLeod
authors.forename: Erin D
authors.initials: ED
authors.lastname: Kennedy
mesh_terms: D000368:Aged; D059248:Chemoradiotherapy; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures; D018450:Disease Progression; D007172:Erectile Dysfunction / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D015995:Prevalence; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000628:therapy*; D012007:Rectum / Q000601:surgery*; D012737:Sex Factors; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D011795:Surveys and Questionnaires