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Sometimes the emotional factors of cancer may have sexual side effects in addition to the physical changes you may undergo during treatment. Whether you're a woman facing vaginal reconstruction, dryness, or pain during intercourse, or a man dealing with erectile dysfunction. Dr. Joel Tepper of the University of North Carolina School of Medicine has information that can help you return to, or find your new, "normal" and start enjoying intimacy once again.
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Welcome!
Sex After Rectal Cancer Part of Fight Colorectal Cancer’s Monthly Patient Webinar Series
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Fight Colorectal Cancer
1. Tonight’s speaker: Dr. Joel Tepper
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Fight Colorectal Cancer
www.FightColorectalCancer.org877-427-2111
Dr. Joel Tepper, MD, PhDHector MacLean Distinguished Professor
of Cancer Research in Radiation Oncology
Rectal Cancer: Sexual Dysfunction
Joel E. Tepper, MD
Department of Radiation Oncology
UNC Lineberger Comprehensive Cancer Center
Rectal Cancer
• Occurs in pelvis close to many components of the reproductive system
• Organs, nerves and vasculature are at risk from tumor and therapy
• Can be effected by surgery, radiation therapy and chemotherapy
Anatomy of the Female Pelvis
Pelvic Nerve Anatomy
Sexual Dysfunction- Tumor
• Rectal cancer does not commonly directly effect the reproductive system or its functions
• Invasion of vagina, uterus, ovaries, prostate all can occur– Vaginal involvement most common site of
invasion in rectal cancer– Proximity of anterior rectal wall to the posterior
vaginal wall
Rectal Cancer
• Baseline sexual activity is variable• One study showed that 80% of male
patients and 50% of female patients were sexually active at the time of diagnosis– Age is the strongest factor
• A high percentage of female patients are post-menopausal, so reproductive capability is not important
Sexual Function
• Can be effected by emotional factors as well as physical factors– Reduced self esteem– Lessened body image– Fatigue– Depression– Change in inter-personal relationships
Sexual activity of (A) male and (B) female patients who were sexually active preoperatively.
Marijnen C A et al. JCO 2005
Males
• 1/3 of male patients did not become sexually active after therapy
• Primary sexual issues are erectile dysfunction and ejaculatory problems
• Strongly associated with older age and developing an anastomotic leak– Peri-operative blood loss also related
• Worsening of erectile function is common
Females
• Approximately 60% sexual dysfunction after therapy (surgery, RT, chemo)
• Dyspareunia and vaginal dryness most prominent symptoms
• Decreased libido, altered orgasms• Vaginal stenosis• Loss of ovarian function
Surgery
• Tumors located lower in the pelvis are more likely to have post-surgical SD
• Surgical resection of pelvic organs can occur for an extensive tumor, but this is uncommon– Vagina, uterus, prostate
• Organ resection and nerve injury are the most likely surgical causes of sexual dysfunction
• TME produces less surgical toxicity than prior operations
MRI-Phased Array Coil
T3N1Beets-Tan, Lancet-2001
LAR Specimen Assessment
Shiny Visceral
Mesorectal Fascia
A. Cohen, Univ of Kentucky
Surgery- Males
• Erectile dysfunction• Ejaculation disorders
Radiation Therapy
• Studies in the literature have focused heavily on radiation effects
• Known impact of radiation therapy on multiple areas that could impact sexual function
Classical AP-PA field
Classical lateral fields
Radiation Therapy- Females
• Cessation of ovarian function in young patients
• Incompetent uterus for child-bearing• Vaginal dryness• Vaginal stenosis
Radiation Therapy- Males
• Difficulties with erection• Decreased sperm count• Decreased semen production• Altered testosterone production• Ejaculatory difficulties
Chemotherapy
• Difficult to sort out independent role of chemotherapy in treatment as almost all patients have received both radiation therapy and surgery
• Oxaliplatin can cause testicular dysfunction• Temporary or permanent loss of menstruation• Early ovarian failure• Supportive medications can impact sexual
function
Prevention of SD
• Defining appropriate therapy- don’t over-treat
• Have surgery done by an experienced colorectal surgeon
• Use radiation therapy when needed, by an experienced radiation oncologist
Management of SD
• Erectile dysfunction can be helped by medications
• Mechanical devices for ED• Vaginal lubricants• Low dose vaginal estrogens• Vaginal dilators
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www.FightColorectalCancer.org877-427-2111
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