Sexual health diminished after bone marrow transplant

Preparative procedures and complications associated with blood or bone marrow transplantation (stem cell transplantation, SCT) have been tied to diminished sexual health in both men and women, according to new research. Chronic graft-versus-host disease (GVHD), which is a serious complication that occurs when donor cells attack the recipient's cell, is a potential source of sexual dysfunction. Nearly half of SCT survivors are sexually inactive at 3 years posttransplant.

This study, published in Blood (2013; doi:10.1182/blood-2013-05-499806), is the first to demonstrate an association between total body irradiation and sexual dysfunction in men. This study is one of the longest and is the most inclusive to date evaluating sexual well-being in SCT survivors using rigorous, well-validated sexual function assessment tools. SCT is an increasingly effective form of treatment for patients with blood cancer such as leukemia, lymphoma, and myeloma.

"Thanks to improved transplant survival rates, we have now been able to focus our efforts on examining how the procedure affects key aspects of recipients' overall quality of life, including sexual health," said lead study author F. Lennie Wong, PhD, of City of Hope in Duarte, California. "Previous findings point to the unfortunate fact that, while recipients may physically recover, their sexual health might not rebound as much or as quickly. Data have been limited to this point, prompting us to take a closer look at this issue in a larger, more diverse group of autologous and allogeneic transplant survivors over an extended period."

To further investigate long-term effects of SCT on the sexual health of survivors, a team of researchers surveyed 277 adult patients (152 men and 125 women; median age 48 years) about their sexual activity. These patients underwent SCT at City of Hope for blood cancer between February 2001 and January 2005.

Investigators' analysis of questionnaire results confirmed previous studies in demonstrating a definitive impact of SCT on survivors' posttransplant sexual activity. During the 3-year posttransplant analysis period, the percentage of men who self-reported being sexually active (defined as having sex with a partner at least once in the preceding month) declined 7 percentage points, with 61% of men reporting sexual activity pretransplant and 54% reporting activity posttransplant. The opposite—a 15 percentage point increase in sexually active persons—was observed in women, with 37% reporting sexual activity pretransplant and 52% reporting activity posttransplant.

When compared to men, the women surveyed suffered significantly worse effects overall, despite the fact that their sexual activity increased over the 3-year survey period. Investigators concluded that this increase in activity may be explained by a corresponding improvement in female psychological quality of life posttransplant.

"It is not often that the transplant team and patient will have a conversation about how this procedure could impact their sex life, even after recovery; however, we hope these findings will help encourage patients and their doctors to openly discuss concerns related to sexual dysfunction and address them with specialists who can help," said Wong.

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