Introduction

Women who survive rectal cancer may experience sexual difficulties or dysfunction during and after treatment. Chemotherapy, radiotherapy, and rectal surgery can impact urinary, bowel, and sexual function. According to previous studies, 60% of women report an increase in vaginal dryness and dyspareunia (painful intercourse) after rectal cancer treatment. There is also a high incidence of reduced sexual desire and decline in frequency of sexual activity for rectal cancer survivors.

Past research has demonstrated that androgens play a role in female sexual function. Testosterone treatment has been shown to significantly increase desire, pleasure, arousal, orgasm, and satisfactory sexual event frequency in postmenopausal women with low sexual desire.

The aim of this study was to determine if androgens could play a role in the sexual function of women treated for rectal cancer.

Methods

This study included 99 women with rectal cancer from five Swedish referral centers for rectal cancer surgery. The women’s hormone levels, including serum levels of total testosterone (T), free testosterone, androstenedione (A-4), and dehydroepiandrosterone sulphate (DHEAS), were measured through blood samples taken before undergoing rectal cancer treatment and again one year postoperatively.   

Study participants also completed two questionnaires for the purpose of assessing sexual function and psychological well-being at three points throughout the study: baseline, one year after treatment, and two years after treatment. The two questionnaires were:

• The Female Sexual Function Index (FSFI), which measures sexual function through six domains: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain/discomfort. For the purposes of this study, a total FSFI score of 26.55 or below was considered the cut-off for female sexual dysfunction (FSD).
• The Psychological General Well-being Index (PGWBI), which assesses the psychological well-being of an individual through six domains and results in a total score ranging from 0 to 100.

Results & Discussion

The median age of the 99 women included in this study was 61 years. Eighty percent of the participants (79/99) had a partner at baseline, 76% (63/83) had a partner at the 1-year follow-up, and 76% (48/63) had a partner at the 2-year follow-up. Measures of androgen levels and sexual function were as follows:

• Median serum levels of androgens decreased from baseline to the 1-year follow-up. Median total T levels went from 0.6 nmol/L at baseline to 0.5 nmol/L at the 1-year follow-up, median free T levels went from 8.7 pmol/L to 7.7 pmol/L, median A-4 levels went from 1.6 nmol/L to 1.4 nmol/L, and median DHEAS levels went from 2.9 µmol/L to 2.4 µmol/L.
• Median total FSFI scores decreased throughout the study from 21.9 at baseline, to 16.4 at the 1-year follow-up, to 11.5 at the 2-year follow-up.
• All FSFI domain scores decreased over the course of the study.
• The proportion of participants considered to have FSD increased from 66% (61/92), to 79% (64/81), to 93% (54/58) at baseline, 1 year, and 2 years after treatment, respectively.

After adjusting for age, partner, psychological well-being, and postoperative follow-up treatments, the researchers found that total T and A-4 levels were significantly associated with total FSFI score. Furthermore, total T was found to be significantly associated with the domains of lubrication and orgasm, free T was associated with lubrication, and A-4 was associated with arousal, lubrication, orgasm, and pain/discomfort.

Conclusion

The authors concluded, “Testosterone and androstenedione were associated with sexual function in female rectal cancer patients. The results are of interest for future intervention studies and contribute to the understanding of sexual problems, which is an essential component of the rehabilitation process in pelvic cancer survivors.”

Nevertheless, they acknowledged that their study had some limitations, principally the lack of laboratory information at the 2-year follow-up, which could have further clarified the association between androgen levels and sexual function of women who have been treated for rectal cancer.

Resources:

• Röjvall, A.S., Buchli, C., Rådestad, A.F., Martling, A., Segelman, J. (2021). Impact of Androgens on Sexual Function in Women With Rectal Cancer – A Prospective Cohort Study. The Journal of Sexual Medicine, 18(8), 1374-1382. DOI: https://doi.org/10.1016/j.jsxm.2021.05.018.