Sexual health outcomes among adolescent and young adult cancer patients: a systematic review and meta-analysis

Abstract

Background: Sexual health outcomes (SHO), which entail the physical, emotional, mental, and social impacts, are an important consideration for adolescent and young adults (AYA, ages 15-39) affected by cancer. The objective of this systematic review and meta-analysis is to summarize the current literature and evaluate AYA cancer impact on SHO.

Methods: EMBASE and MEDLINE were searched from January 1, 2000 to September 28, 2022 to identify epidemiologic studies that used an analytic observational design, included individuals with AYA cancer and non-cancer control participants, and evaluated SHO. Odds ratios and prevalence ratios were calculated; random effects models were used to obtain pooled measures where possible.

Results: Of 2621 articles, 8 were included that investigated 23 SHO in 9038 AYA cancer patients. Based on the sexual response cycle, outcomes were categorized as those occurring among males (desire = 1, arousal = 1, orgasm = 4, other = 3) and females (desire = 2, arousal = 1, orgasm = 2, pain = 6, other = 3). It was feasible to conduct meta-analysis for 3 female SHO and 5 male SHO. There were associations between AYA cancer and 3 SHO: vaginal dryness (pooled odds ratio = 3.94; 95% confidence interval (CI) = 2.02 to 7.70), ejaculatory dysfunction (pooled odds ratio = 3.66; 95% CI = 2.20 to 6.08), and testosterone level (pooled mean difference = -2.56 nmol/liter; 95% CI = -3.46 to -1.66; P = .00001).

Conclusion: This study found increased ejaculatory dysfunction and reduced testosterone levels in male AYA cancer patients and increased vaginal dryness in female AYA cancer patients, highlighting the need for sexual health resources in this population.

Figure 1.

Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) flow chart of search results.

Figure 2.

Sex-based framework of current literature on adolescent and young adults cancer patients and their sexual health outcomes.

Figure 3.

Forest plots of pooled odds ratios of female sexual health outcomes. A) (30,31), B) (29,30), C) (29-31); (n = 3).

Figure 4.

Funnel plots of pooled odds ratios of female sexual health outcomes. A) (30,31), B) (29,30), C) (29-31); (n = 3). SE = standard error; OR = odds ratio.

Figure 5.

Forest plots of pooled odds ratios (A–D) and mean difference (E) of male sexual health outcomes. A) (27,30), B) (27,30,33), C) (27,30), D) (27,30), E) (28,33); (n = 5).

Figure 6.

Funnel plots of pooled odds ratios (A–D) and mean difference (E) of male sexual health outcomes. A) (27,30), B) (27,30,33), C) (27,30), D) (27,30), E) (28,33); (n = 5). SE = standard error; OR = odds ratio; MD = mean difference.