In the Journals Plus

Childhood cancer survivors may be at increased risk for erectile dysfunction

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October 4, 2018

Twenty-nine percent of adult male childhood cancer survivors reported erectile dysfunction, according a retrospective, single-institution study.

“Male sexual dysfunction and its association with psychological and physical well-being have been underreported in childhood cancer survivors,” Laura van Iersel, MD, of St. Jude Children’s Research Hospital, and colleagues wrote. “To our knowledge, this study provides the first data on a large population of systematically and clinically assessed childhood cancer survivors, enumerating the prevalence and consequences of erectile dysfunction and identifying potential targets for intervention.”

van Iersel and colleagues studied 1,021 men (median age, 31.3 years; range, 18.8-61.5) who were childhood cancer survivors diagnosed at least 10 years earlier.

Investigators used the 6-item version of the International Index of Erectile Function to assess dysfunction. Among sexually active participants (n = 873), researchers defined mild to severe erectile dysfunction as scores of 25 or less.

For nonsexually active participants, researchers used responses to items about problems achieving and sustaining an erection to characterize erectile dysfunction.

Participants also reported psychological distress, body image dissatisfaction and health-related quality of life using the Brief Symptom Inventory, the Body Image Scale and the 36-item Short-Form Health Survey.

Of the 956 participants with available erectile dysfunction scores, 29% (95% CI, 26.1-31)reported erectile dysfunction.

Among sexually active participants, certain characteristics appeared to be independent risk factors for erectile dysfunction, including:

Hispanic or other race/ethnicity (RR = 1.94; 95% CI, 1.05-3.61);

younger age at the time of the study (RR = 0.98; 95% CI, 0.96-1); and

testosterone levels of less than 250 ng/dL (RR = 1.70; 95% CI, 1.2-2.41).

Among both sexually active and nonsexually active participants, black race also appeared to be an independent risk factor for erectile dysfunction (RR = 1.51; 95% CI, 1.14-2.02).

“The reasons for this association are not clear and need further exploration in populations enriched for racial/ethnic minorities,” the researchers wrote.

Those with greater body image dissatisfaction (RR = 1.32; 95% CI, 1.08-1.63) and low lean muscle mass (RR = 1.36; 95% CI, 1-1.86) appeared more likely to report erectile dysfunction.

The limitations of this study included potential selection bias and misclassification of erectile dysfunction.

“The association between erectile dysfunction and greater body image dissatisfaction may be bidirectional and emphasizes that erectile dysfunction requires multidisciplinary treatment that combines psychological counseling and medical treatment,” the researchers wrote.

“Although the results from these analyses are hypothesis generating and need validation in an independent cohort, our data support the hypothesis that erectile dysfunction may be a modifiable condition in childhood cancer survivors.” – by Cassie Homer

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Disclosures: The authors report no relevant financial disclosures.