This article is more than 5 years old. Information may no longer be current.
Early decline in sexual functioning common among male pediatric ALL survivors
Click Here to Manage Email Alerts
Long-term male survivors of childhood acute lymphoblastic leukemia experienced poorer sexual functioning compared with healthy men, according to study results.
Further, depression symptoms, age and relationship status predicted decreased sexual satisfaction.
Karen L. Syrjala
“The most surprising result that survivors reported was the magnitude — and impact — of the problem to establish sustained, intimate relationships,” Kirsi Jahnukainen, MD, told HemOnc Today. “The major factor that decreased their sexual life was that they simply did not have anyone to have sex with. It indicates that sexual problems among childhood cancer patients have more complicated etiology than just testicular toxicity or problems with physical sexual function. Psychosocial and neurocognitive effects may play more significant roles.”
Research has shown that childhood ALL treatments can lead to infertility, poor semen quality and gonadal dysfunction in male survivors.
Jahnukainen and colleagues sought to better characterize adult sexual functioning in male ALL survivors and to identify factors that may predict early sexual decline.
The researchers analyzed survey data and medical records from 52 survivors (median age, 28.5 years; range, 25-38) who were 10 years or more past diagnosis. The analysis also included a control group of 56 age-matched men without a history of cancer.
All participants completed the Derogatis Interview for Sexual Functioning self-report.
Researchers noted that significantly fewer ALL survivors were married or cohabitating (50% vs. 80% P = .001) and fewer had biologic children (17% vs. 43%, P = .006).
Survivors reported similar rates of interest in sex as the control group and engaged in sexual fantasies as often as the control group. They also reported similar frequency of masturbation and engagement in erotic or romantic media, as well as erection during fantasies and masturbation, despite reporting fewer erections during sex (P = .025) and sexual acts (P ≤ .001).
However, ALL survivors reported being less content with their ability to orgasm and the duration of orgasm (P = .012), as well as with the intensity and the amount seminal fluid ejaculated during orgasm (P < .001).
Survivors reported being less satisfied with their current sexual functioning (P = .005), and less satisfied with their current personal relationships and sexual partners (P = .038).
Researchers then analyzed survivors in subgroups based on cancer treatment history. Patients who had not received gonadotoxic therapies — such as testicular irradiations or doses of cyclophosphamide higher than 20 g/m2 (n = 31) — still reported less frequent sexual behavior (P = .007) and poorer orgasms (P = .024). The sexual function did not significantly differ among survivors who had and had not received gonadotoxic therapies.
“We expected to see significant testicular toxicity in a subpopulation of survivors who were exposed to testicular irradiation and extremely high doses of alkylating agents,” Jahnukainen said. “Because sexual function is known to be affected by cancer therapy among adult patients, we wanted to evaluate the effects of childhood cancer therapy. What we found was a bit different than what we expected. We could not associate the decreased sexual functioning with testosterone levels or need of testosterone supplementation.
“Instead, sexual problems were more widely observed in the entire survivor population,” Jahnukainen added. “Even those survivors with normal endocrine and spermatogenetic function scored lower than controls.”
Regression analyses conducted among only ALL survivors showed factors that predicted decreased sexual functioning included Beck depression inventory-21 scores, RAND-36 physical functioning, as well as age at assessment, relationship status, employment status, central nervous system irradiation history, testicular size, and follicle stimulating hormone and inhibin B levels.
The strongest predictive factors for decreased sexual function were lack of a relationship, older age and the presence of depressive symptoms.
Jahnukainen and colleagues acknowledged that because no longitudinal data were collected, they were unable to confirm the decline in sexual functioning as patients aged.
Researchers are conducting national register studies to evaluate factors that predict whether young male survivors of childhood cancer leave their family home and get married, Jahnukainen said.
“Survivors may have normal testicular function, but without a sexual relationship, fertility is impossible,” Jahnukainen said. “This means that problems with partnerships have direct effects on the total fertility of survivor cohorts. In follow-up studies, fertility is often used as a strong measure of testicular toxicity. The present study suggests that fertility is more complicated issue than that. Childhood cancer therapy can affect fertility in many ways.”
The sexuality needs among survivors of hematologic malignancies differ from those of survivors of prostate and testicular cancers, Karen L. Syrjala, PhD, professor at University of Washington School of Medicine and director of biobehavioral sciences in the clinical research division of Fred Hutchinson Cancer Research Center, wrote in an accompanying editorial
“Longitudinal research is sorely needed to develop risk models and define assessments that capture the dimensions of sexual development in these young men so that interventions can be targeted to their needs,” Syrjala wrote. “Standardized screening tools are necessary, along with improved training in screening together with methods for in-depth evaluation and treatment of sexual function in young men, so that these become a standard of care for male survivors.
Finally, new treatment approaches are needed that address their hormone and functional deficits along with integrating personal self-image and relationship needs into their care.” – by Nick Andrews
For more information:
Kirsi Jahnukainen, MD, can be reached at division of hematology-oncology and stem cell transplantation, Children’s Hospital, PL 281, FIN-00029 Helsinki,
Finland; email: kirsi.jahnukainen@ki.se.
Disclosure: The researchers and Haavisto report no relevant financial disclosures.
Click Here to Manage Email Alerts