Bone Marrow Transplant Linked to Negative Sexual Side Effects in Both Men and Women
New research ties preparative procedures and complications associated with blood or bone marrow transplant with diminished sexual health in both men and women who have undergone the procedure. Study data, published today in Blood, confirm chronic graft-vs-host disease as a potential source of sexual dysfunction and are the first to demonstrate an association between total-body irradiation and sexual dysfunction in men. This study is one of the longest and is the most inclusive to date evaluating sexual well-being in stem cell transplant survivors using rigorous, well-validated sexual function assessment tools.
Stem cell transplant is an increasingly effective form of treatment for patients with hematologic disorders such as leukemia, lymphoma, and myeloma. Although the procedure was once associated with high mortality, survival rates have steadily increased, prompting research seeking to study and maximize survivors’ quality of life.
“Thanks to improved transplant survival rates, we have now been able to focus our efforts on examining how the procedure affects key aspects of recipients’ overall quality of life, including sexual health,” said lead study author F. Lennie Wong, PhD, of City of Hope in Duarte, California. “Previous findings point to the unfortunate fact that, while recipients may physically recover, their sexual health might not rebound as much or as quickly. Data have been limited to this point, prompting us to take a closer look at this issue in a larger, more diverse group of autologous and allogeneic transplant survivors over an extended period.”
Study Details
To further investigate long-term effects of stem cell transplant on the sexual health of survivors, a team of researchers led by senior author Smita Bhatia, MD, MPH, surveyed 277 adult patients (152 men and 125 women; median age, 48) who underwent stem cell transplant at City of Hope for blood cancer between February 2001 and January 2005 about their sexual activity.
Participants completed two questionnaires that together evaluated specific areas of sexual function (sexual cognition/fantasy, sexual arousal, sexual behavior/experience, orgasm, and drive/relationship) as well as sexual satisfaction at a median time of 17 days pretransplant and at 6, 12, 24, and 36 months post-transplant. A third questionnaire assessed overall health-related quality of life.
Investigators’ analysis of questionnaire results (led by Dr. Wong) confirmed previous studies in demonstrating a definitive impact of stem cell transplant on survivors’ post-transplant sexual activity. During the 3-year post-transplant analysis period, the percentage of men who self-reported being “sexually active” (defined as having sex with a partner at least once in the preceding month) declined by 7%, with 61% of men reporting sexual activity pretransplant and 54% reporting activity post-transplant. The opposite—a 15% increase in sexually active individuals—was observed in women, with 37% reporting sexual activity pretransplant and 52% reporting activity post-transplant.
In addition to further crystallizing transplantation’s impact on survivors’ sexual health, study data specifically associated diminished sexual function and satisfaction with transplant-related total-body irradiation in men. Chronic graft-vs-host disease was associated with diminished sexual function in men and both sexual function and satisfaction in women.
Impact of Radiation
Investigators observed a nearly 18% decline in sexual function in men surveyed who had received total-body irradiation. The same group also reported an approximate 32% decrease in sexual satisfaction, a 26% decrease in sexual behavior/experience, a 26% decrease in quality of orgasm, and 17% decrease in sex drive/relationship since their transplant. Despite these effects in men, radiation had no such reported effect in women, an effect that investigators hypothesize may be explained by inherent physiologic differences in the pathogenesis of sexual dysfunction among men and women.
Impact of Graft-vs-Host Disease
In addition to documenting concrete effects of radiation on sexual function and satisfaction, investigators also observed negative sexual effects among those surveyed who had experienced chronic graft-vs-host disease. Men surveyed who had developed the dangerous post-transplant complication reported a 21% decrease in sexual cognition/fantasy and a 24% decrease in the quality of orgasm since their transplant. Similarly, investigators observed a 27% decline in post-transplant sexual satisfaction among women surveyed who had experienced chronic graft-vs-host disease, with survey respondents also indicating a 27% decline in sexual arousal.
When compared to men, the women surveyed suffered significantly worse effects overall, despite the fact that their sexual activity increased over the 3-year survey period. Investigators concluded that this increase in activity may be explained by a corresponding improvement in female psychological quality of life post transplant.
From this research, the investigators concluded that nearly half of stem cell transplant survivors are sexually inactive at 3 years post-transplant and suggest that patients may benefit from speaking with their doctors about sex.
“It is not often that the transplant team and patient will have a conversation about how this procedure could impact their sex life, even after recovery; however, we hope these findings will help encourage patients and their doctors to openly discuss concerns related to sexual dysfunction and address them with specialists who can help,” said Dr. Wong.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
