Sexual function changes during the 5 years after high-dose treatment and hematopoietic cell transplantation for malignancy, with case-matched controls at 5 years

Abstract

This prospective study evaluated sexual function through 5 years after myeloablative allogeneic hematopoietic cell transplantation (HCT) for cancer to determine sexual function recovery and residual problems. Adults completed measures before HCT (N = 161), with survivors followed at 6 months and at 1, 2, 3, and 5 years. At 5 years case-matched controls also completed assessments. Analyses indicated that men and women differed in rates of being sexually active across time (P < .001) and in overall sexual function (P < .001). Both sexes declined in sexual activity rates and sexual function from before HCT to 6 months afterward (P < or = .05). Activity rates recovered for men by 1 year (74%) and for women by 2 years (55%). Men improved from their 6-month nadir in sexual function by 2 years (P = .02), whereas women did not improve by 5 years (P = .17). Both male and female survivors were below controls in rates of sexual activity and sexual function at 5 years. Most women reported sexual problems (80% of survivors vs 61% of controls, P = .11); in contrast for men 46% of survivors versus 21% of controls (P = .05) reported problems. Thus, despite some recovery, sexual dysfunction remained a major problem for men and women after HCT. Aggressive efforts are needed to treat these deficits.

Figure 1

Flow diagram of patients through the study. Note that the 5-year relapse-free survival rate overall is 57% (92 of 161). The overall completion rate on SFQ for relapse-free survivors was 84%. HCT indicates hematopoietic cell transplantation; and SFQ, Sexual Function Questionnaire.

Figure 2

Percentage of males and females who were sexually active, among responding relapse-free-survivors (RFSs) from before transplantation (N = 109) to 5 years after transplantation (n = 80). Rates are also graphed for non-RFS patients before transplantation (n = 49) and controls at 5 years (n = 77). Both men and women declined in rates of being sexually active from before transplantation to 6 months afterward (P = .05). On average, men improved by 1 yea compared with 6-month levels (P = .02); women improved by 2 years (P = .03), but both remained below their respective controls at 5 years.

Figure 3

Sexual function means for responding male and female relapse-free survivors (RFSs) from before transplantation (N = 109) to 5 years after transplantation (n = 80), measured on the same scale, although with different problem items. Means are also graphed for non-RFS patients before transplantation (n = 49) and controls at 5 years (n = 77). Both men and women declined in average sexual function from before transplantation to 6 months afterward (P < .01). Women did not improve from 6-month post-transplantation levels by 5 years (P = .17) and remained below matched controls (P = .03). Men improved by 2 years (P = .02) but remained below their respective controls at 5 years (P = .01).