Erectile Dysfunction in Male Survivors of Childhood Cancer-A Report From the Childhood Cancer Survivor Study

• Authors: Chad Ritenour, Emory University; Kristy D. Seidel, Fred Hutchinson Cancer Research Center; Wendy Leisenring, Fred Hutchinson Cancer Research Center; Ann Mertens, Emory University; Karen Wasilewski-Masker, Emory University; Margarett Shnorhavorian, University of Washington; Charles A. Sklar, Memorial Sloan Kettering Cancer Center; John A. Whitton, Fred Hutchinson Cancer Research Center; Marilyn Stovall, University of Texas M.D. Anderson Cancer Center; Louis S. Constine, University of Rochester; Gregory T. Armstrong, St Jude Children's Research Hospital; Leslie L. Robison, St Jude Children's Research Hospital; Lillian Meacham, Emory University
• Journal Title: Journal of Sexual Medicine
• Volume: Volume 13, Number 6
• Publisher: Elsevier | 2016-04-21, Pages 945-954
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.jsxm.2016.03.367
• Subjects: Health Sciences, Epidemiology; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Urology & Nephrology; Cancer Survivorship; Sexual Dysfunction; Erectile Dysfunction; Pediatric Cancer; EMERGING ADULT SURVIVORS; ROMANTIC RELATIONSHIPS; INTERNATIONAL INDEX; PEDIATRIC CANCER; HEALTH; IMPACT; EXPERIENCE; SEX

Abstract

Introduction: With survival rates higher than 80%, the number of survivors from pediatric cancer continues to increase. Late effects resulting from cancer and cancer therapy are being characterized, but little information exists on sexual health for men who have survived childhood cancer. Aim: To assess erectile dysfunction (ED) in men who survived childhood and adolescent cancers and to identify potential risk factors for ED. Methods: In total, 1,622 men and 271 eligible brothers in the Childhood Cancer Survivor Study cohort completed the Male Health Questionnaire, which provided information on sexual practices and sexual function. Combined with demographic, cancer, and treatment information from medical record abstraction, results of the Male Health Questionnaire were analyzed using multivariable modeling. The International Index of Erectile Function was used to identify ED in subjects. Main Outcome Measure: International Index of Erectile Function. Results: Survivors (mean age = 37.4 years, SD = 7.3 years) reported significantly lower sexual activity in the year before the survey than the brothers (mean age = 38.8 years, SD = 8.5 years) without cancer. ED was reported by 12.3% (95% CI = 10.4-14.3) of survivors and 4.2% (95% CI = 2.0-7.9) of brothers. Survivors showed significantly higher relative risk (RR) for ED (RR = 2.63, 95% CI = 1.40-4.97). In addition to older age, survivors who were exposed to higher-dose (≥10 Gy) testicular radiation (RR = 3.55, 95% CI = 1.53-8.24), had surgery on the spinal cord or nerves (RR = 2.87, 95% CI = 1.36-6.05), prostate surgery (RR = 6.56, 95% CI = 3.84-11.20), or pelvic surgery (RR = 2.28, 95% CI = 1.04-4.98) were at higher risk for ED. Conclusion: Men who have survived childhood cancer have a greater than 2.6-fold increased risk for ED and certain cancer-specific treatments are associated with increased risk. Attention to sexual health, with its physical and emotional implications, and opportunities for early detection and intervention in these individuals could be important.