Sexual Health Problems and Discussion in Colorectal Cancer Patients Two Years After Diagnosis: A National Cross-Sectional Study

Abstract

Background: Colorectal cancer (CRC) is accompanied by specific treatment-related physical (ostomy, incontinence) and psychosexual (body image, depression) consequences on sexual health.

Aim: To assess sexual health of patients with CRC 2 years after diagnosis.

Methods: We selected all patients with CRC from a French nationwide longitudinal study. Data sources included patient questionnaires, medical questionnaires, and medico-administrative databases.

Main outcome measure: We evaluated sexual health using the Relationship and Sexuality Scale and assessed self-reported rates of discussion about sexuality with health care providers.

Results: Across the 487 patients, 258 were men and 229 were women; 77% were diagnosed with colon cancer and 23% with rectal cancer. Overall, 54% of patients reported a decrease in sexual desire, 61% a decrease in frequency of intercourse, and 48% a decrease in the possibility to reach an orgasm. Patients still experiencing fecal incontinence 2 years after diagnosis had decreases in all sexual desire, intercourse, orgasm, and satisfaction Relationship and Sexuality Scale items. Patients with rectal cancer had significantly more frequent troubles with desire and orgasm than did patients with colon cancer (P = .003 and P = .014, respectively). Regarding the discussion about sexuality, only 20% of men, 11% of women, 11% of patients with colon cancer, and 33% of patients with rectal cancer recalled having discussed sexuality with the medical team. Factors independently increasing the chance to have discussed sexuality with the medical team were younger age (odds ratio [OR] = 2.77 [1.31; 5.84]; P = .007), having an ostomy (OR = 2.93 [1.27; 6.73]; P = .011), and radiotherapy (OR = 2.78 [1.23; 6.27]; P = .014).

Clinical implications: These results highlight the need for developing interventions to improve information delivery at cancer announcement and for managing sexual troubles during survivorship in patients with CRC, particularly those experiencing fecal incontinence.

Strength & limitations: Strengths are the sample size and the national representation using the data of a large-scale nation-wide survey, with the possibility of comparing colon and rectal cancers. Limitations are the assessment of sexuality 2 years after diagnosis and using only self-reported measures.

Conclusion: This study highlights the lack of discussion about sexuality with the oncology team and the need for specific sexual rehabilitation interventions, especially for patients with rectal cancer and fecal incontinence. Developing these aspects may help patients with CRC improve their sexual prognosis. Almont T, Bouhnik A-D, Charif AB, et al. Sexual Health Problems and Discussion in Colorectal Cancer Patients Two Years After Diagnosis: A National Cross-Sectional Study. J Sex Med 2019;16:96-110.

Keywords: Colorectal Cancer; Discussion About Sexuality; Oncosexology; Sexual Quality of Life; Supportive Care; VICAN Survey.