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Longitudinal trajectory of sexual functioning after hematopoietic cell transplantation: impact of chronic graft vs. host disease and total body irradiation

F. Lennie Wong, Liton Francisco, Kayo Togawa, Heeyoung Kim, Alysia Bosworth, Liezl Atencio, Cara Hanby, Marcia Grant, Fouad Kandeel, Stephen J. Forman, Smita Bhatia

Key points

  • Before HCT, 61% of men and 37% of women were sexually active; the 3-year prevalence declined to 54% for men but increased to 52% for women.

  • Chronic GvHD in both sexes and TBI in men contribute to sexual dysfunction and dissatisfaction over the 3 years following HCT.

Abstract

This prospective study described the trajectory of sexual well-being from before hematopoietic cell transplantation (HCT) to 3 years after in 131 allogeneic and 146 autologous HCT recipients and identified the predictors of post-HCT sexual dysfunction. Assessments were made pre-HCT, 6 months, 1, 2, and 3 years post-HCT using the Derogatis Interview for Sexual Function-Self Report and Derogatis Global Sexual Satisfaction Index. Sixty-one percent of men and 37% of women were sexually active pre-HCT; the prevalence declined to 51% (P=.01) in men and increased to 48% (P=.02) in women at 3 years post-HCT. After HCT, sexual satisfaction declined in both sexes (P<.001), as did Orgasm (P=.002) and Drive/Relationship (P<.001) in men, but Sexual Cognition/Fantasy (P=.01) and Sexual Behavior/Experience (P=.01) improved in women. All sexual function domains were worse in women compared to men (P≤.001). Older age negatively impacted sexual function post-HCT in both sexes (P<.01). Chronic graft vs. host disease was associated with lower Sexual Cognition/Fantasy (P=.003) and Orgasm (P=.006) in men and Sexual Arousal (P=.05) and sexual satisfaction (P=.005) in women. All male sexual functions declined with exposure to total body irradiation (P<.05). Multidisciplinary interventional strategies are needed to help vulnerable sub-populations recover sexual quality of life after HCT.

  • Submitted May 6, 2013.
  • Accepted August 11, 2013.