Erectile Dysfunction in Male Survivors of Childhood Cancer-A Report From the Childhood Cancer Survivor Study.
With survival rates higher than 80%, the number of survivors from pediatric cancer continues to increase. Late effects resulting from cancer and cancer therapy are being characterized, but little information exists on sexual health for men who have survived childhood cancer.



To assess erectile dysfunction (ED) in men who survived childhood and adolescent cancers and to identify potential risk factors for ED.



In total, 1,622 men and 271 eligible brothers in the Childhood Cancer Survivor Study cohort completed the Male Health Questionnaire, which provided information on sexual practices and sexual function. Combined with demographic, cancer, and treatment information from medical record abstraction, results of the Male Health Questionnaire were analyzed using multivariable modeling. The International Index of Erectile Function was used to identify ED in subjects.



International Index of Erectile Function.



Survivors (mean age = 37.4 years, SD = 7.3 years) reported significantly lower sexual activity in the year before the survey than the brothers (mean age = 38.8 years, SD = 8.5 years) without cancer. ED was reported by 12.3% (95% CI = 10.4-14.3) of survivors and 4.2% (95% CI = 2.0-7.9) of brothers. Survivors showed significantly higher relative risk (RR) for ED (RR = 2.63, 95% CI = 1.40-4.97). In addition to older age, survivors who were exposed to higher-dose (≥10 Gy) testicular radiation (RR = 3.55, 95% CI = 1.53-8.24), had surgery on the spinal cord or nerves (RR = 2.87, 95% CI = 1.36-6.05), prostate surgery (RR = 6.56, 95% CI = 3.84-11.20), or pelvic surgery (RR = 2.28, 95% CI = 1.04-4.98) were at higher risk for ED.



Men who have survived childhood cancer have a greater than 2.6-fold increased risk for ED and certain cancer-specific treatments are associated with increased risk. Attention to sexual health, with its physical and emotional implications, and opportunities for early detection and intervention in these individuals could be important.
Department of Urology, Emory University School of Medicine, Atlanta, GA, USA. Electronic address: criteno@emory.edu.
Chad W M
CW
Ritenour
Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Kristy D
KD
Seidel
Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Clinical Statistics Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Wendy
W
Leisenring
The Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
Ann C
AC
Mertens
The Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
Karen
K
Wasilewski-Masker
Division of Pediatric Urology, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
Margarett
M
Shnorhavorian
Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
Charles A
CA
Sklar
Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
John A
JA
Whitton
Department of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
Marilyn
M
Stovall
Departments of Radiation Oncology and Pediatrics, University of Rochester, Rochester, NY, USA.
Louis S
LS
Constine
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.
Gregory T
GT
Armstrong
Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.
Leslie L
LL
Robison
The Aflac Cancer and Blood Disorders Center at Children's Healthcare of Atlanta, Atlanta, GA, USA; Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
Lillian R
LR
Meacham
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D007172:Erectile Dysfunction / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D012307:Risk Factors; D012725:Sexual Behavior; D011795:Surveys and Questionnaires; D015996:Survival Rate; D017741:Survivors; D055815:Young Adult
Cancer Survivorship; Erectile Dysfunction; Pediatric Cancer; Sexual Dysfunction