Sexual dysfunction common in young adult survivors of childhood cancer

About one-quarter of young Chinese adults who have survived childhood cancer experience sexual dysfunction, a recent study in Hong Kong has shown.

Among 200 young adults (mean age, 25.4 years; 45.5 percent female) with a history of childhood cancer who were disease-free for more than 3 years, 24 percent reported at least one sexual problem when surveyed using self-administered questionnaires. [Hong Kong Med J 2019;25:372-381]

The cross-sectional study, conducted at the Prince of Wales Hospital (PWH) between August 2015 and September 2017, also showed that cancer-related sexual dysfunction was more common in men, in patients diagnosed with cancer at an older age, and in those who were married or had a history of sexual experiences.

The study participants, who were diagnosed with cancer at a mean age of 7.8 years and attended follow-up at the PWH paediatric oncology clinic, predominantly had a history of haematological malignancies (66.5 percent; acute lymphoid leukaemia, 46 percent). Their overall sexual functioning score was 28.3 on the Medical Outcomes Study Sexual Functioning Scale of 0–100 (a higher score indicates more sexual problems).

“Overall, the most common sexual problems were difficulties in relaxing and enjoying sex [19.5 percent], and difficulties in achieving an erection or orgasm [18.5 percent],” reported the researchers led by Professor Chi-Fai Ng of the SH Ho Urology Centre, Chinese University of Hong Kong.

More men than women reported an inability to relax or enjoy sex (21.1 percent vs 17.6 percent) and a lack of sexual interest (16.5 percent vs 8.8 percent). A similar proportion of male and female participants experienced problems in becoming sexually aroused (13.8 percent vs 13.2 percent) and in achieving an erection or orgasm (18.3 percent vs 18.7 percent).

Sexual problems were more commonly reported by male vs female participants (60.4 percent vs 39.6 percent). Male participants also experienced more sexual problems than females (sexual functioning score, 32.3 vs 23.6; p=0.002). 

A history of surgery (p=0.004) and a history of surgery with visible external effects (odds ratio, 6.09; p=0.001) were found to be significantly associated with the presence of sexual problems. Age at cancer diagnosis (p=0.037), as well as being married (p=0.004) or having a history of sexual experiences (p=0.008), were significantly positively correlated with an increased number of sexual problems.

However, a history of radiation therapy or chemotherapy was not significantly associated with the presence of sexual problems.

“Participants with sexual problems generally had lower physical well-being scores, lower self-esteem scores, higher body image scale scores, and an increased number of depressive symptoms, compared with participants without sexual problems,” the researchers noted.

“These results suggest that physicians and medical staff should consider aspects of life beyond disease condition and physical function in adult survivors of childhood cancer, to support their holistic recovery,” they suggested.