Sexual Dysfunction Is Significant for Women Post-Transplant

HAMBURG, Germany—Sexual dysfunction is a significant problem for women who have undergone bone marrow transplants, Dr. Karen Syrjala said at the Fourth International Congress of Psychooncology. A clinical psychologist from Fred Hutchinson Cancer Research Center, Dr. Syrjala reported results of a longitudinal study that followed 118 men and women for more than 3 years following transplantation.

No Improvement After First Year

Women’s satisfaction with their sexual functioning decreased sharply from pretransplant to 1 year post-transplant, she said, and although the change in functioning from 1 year to 3 years was not significant, the slope is not in the direction of improvement. “There has been no improvement in sexual functioning for the women after that first year post-transplant,” she said.

Dr. Syrjala said that 60% of the women in the study had sexual problems at 1 year post-transplant, and 88% of these women continued to report at least as many problems 3 years later. “No medical or psychological variables, either at 1 year post-transplant or pretransplant, predicted which women would report problems with sexual functioning 3 years after transplant,” she said.

Although physicians often counsel time as the healer, these data indicate that “postponing a return to sexuality is unlikely to be helpful in eradicating any problems that might exist,” she said.

Hormone Replacement Therapy

 Dr. Syrjala noted that the study showed a positive impact of hormone replacement therapy on sexual functioning. “Although at 1 year there was no difference in sexual functioning between women receiving or not receiving hormone replacement, the average reported sexual satisfaction, on a scale of 1 to 100, was 8 for women not on hormone replacement vs 60 for women on replacement therapy, a dramatic difference.”

Realizing the severity of the sexual dysfunction after transplant, Dr. Syrjala’s team began to study a second group of 114 women, most of whom had received tranplants for either chronic or acute leukemia. All of the women without con-traindications were started on hormone replacement therapy by 100 days post-transplant. Of the women who reported being sexually active at 1 year, 80% were receiving hormone replacement therapy.

In looking at those women who were on hormone replacement therapy, 62% reported being sexually active, compared with 38% of women not receiving hormone replacement therapy. In general, at 1 year the women who were sexually active were more likely to be receiving hormone replacement therapy. The only medical factor that predicted sexual activity was total body irradiation (women who had received total body irradiation were less likely to be sexually active).

Despite this level of sexual activity, Dr. Syrjala said, 83% of women said that their sexual functioning was worse than pretransplant. “We again found that the level of sexual satisfaction prior to transplant did not predict sexual satisfaction post-transplant or at 1 year,” she said.

Although hormone replacement did not improve overall reported sexual functioning, it was significantly related to the arousal component of sexual functioning, she said. “We found that early treatment with hormone replacement therapy is the most effective immediate step we are able to take to help these women improve their sexual functioning, but it clearly does not, in and of itself, assure sexual health.”

A question remains about those women who are not able to take hormone replacement therapy. “We need to consider the interaction between sexual functioning and hormones in these survivors and also need to be very cautious in using androgen replacement.” Researchers have hypothesized that the effect of chemotherapy and radiation is more dramatic on the ovaries than the adrenal glands, “but we don’t know this,” she said. It is possible that both estrogen and androgen precursors, which also come, in part, from the adrenal glands, may be important in both sexual functioning and in mood and cognitive components.

“Even if use of estrogen in and of itself does not explain improvements in sexual satisfaction,” she said, “clearly there is some relationship, but we still have a very open question about the role of androgens and the interaction of hormones in women and whether the lack of androgens is related to lower levels of sexual desire. We need to understand a great deal more before we can really state the influence of endocrinology on the quality of life of these women.”