Will Rectal Cancer Treatment Affect My Sexuality?


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Sometimes the emotional factors of cancer may have sexual side effects in addition to the physical changes you may undergo during treatment. Whether you're a woman facing vaginal reconstruction, dryness, or pain during intercourse, or a man dealing with erectile dysfunction.

Dr. Joel Tepper of the University of North Carolina School of Medicine has information that can help you return to, or find your new, "normal" and start enjoying intimacy once again.

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Will Rectal Cancer Treatment Affect My Sexuality?

  1. 1. Welcome! Sex After Rectal Cancer Part of Fight Colorectal Cancer’s Monthly Patient Webinar Series Our webinar will begin shortlywww.FightColorectalCancer.org877-427-2111
  2. 2. Fight Colorectal Cancer1. Tonight’s speaker: Dr. Joel Tepper2. Archived webinars: Link.FightCRC.org/Webinars3. Follow up survey to come via email. Get a free Blue Star ofHope pin when you tell us how we did tonight.4. Ask a question in the panel on the right side of your screen5. Or call the Fight Colorectal Cancer Answer Line at 877-427-2111 www.FightColorectalCancer.org 877-427-2111
  3. 3. Fight Colorectal Cancer Upcoming Webinar Talking Turkey and Lynch Syndrome Variety of speakers November 14, 2012 8-9:30PM EasternTime Register at www.FightColorectalCancer.org 1-877-427-2111
  4. 4. Fight Colorectal Cancer Funding Research Directly Lisa Dubow Fundhttp://fightcolorectalcancer.org/research/lisa-fund
  5. 5. Fight Colorectal CancerDisclaimerThe information and services provided by Fight ColorectalCancer are for general informational purposes only.The information and services are not intended to be substitutesfor professional medical advice, diagnosis, or treatment.If you are ill, or suspect that you are ill, see a doctorimmediately. In an emergency, call 911 or go to the nearestemergency room.Fight Colorectal Cancer never recommends or endorses anyspecific physicians, products or treatments for any condition.www.FightColorectalCancer.org877-427-2111
  6. 6. Fight Colorectal Cancer Dr. Joel Tepper, MD, PhD Hector MacLean Distinguished Professor of Cancer Research in Radiation Oncologywww.FightColorectalCancer.org877-427-2111
  7. 7. Rectal Cancer: Sexual Dysfunction Joel E. Tepper, MD Department of Radiation OncologyUNC Lineberger Comprehensive Cancer Center
  8. 8. Rectal Cancer• Occurs in pelvis close to many components of the reproductive system• Organs, nerves and vasculature are at risk from tumor and therapy• Can be effected by surgery, radiation therapy and chemotherapy
  9. 9. Anatomy of the Female Pelvis
  10. 10. Pelvic Nerve Anatomy
  11. 11. Sexual Dysfunction- Tumor• Rectal cancer does not commonly directly effect the reproductive system or its functions• Invasion of vagina, uterus, ovaries, prostate all can occur – Vaginal involvement most common site of invasion in rectal cancer – Proximity of anterior rectal wall to the posterior vaginal wall
  12. 12. Rectal Cancer• Baseline sexual activity is variable• One study showed that 80% of male patients and 50% of female patients were sexually active at the time of diagnosis – Age is the strongest factor• A high percentage of female patients are post-menopausal, so reproductive capability is not important
  13. 13. Sexual Function• Can be effected by emotional factors as well as physical factors – Reduced self esteem – Lessened body image – Fatigue – Depression – Change in inter-personal relationships
  14. 14. Sexual activity of (A) male and (B) female patients who were sexually active preoperatively. Marijnen C A et al. JCO 2005
  15. 15. Males• 1/3 of male patients did not become sexually active after therapy• Primary sexual issues are erectile dysfunction and ejaculatory problems• Strongly associated with older age and developing an anastomotic leak – Peri-operative blood loss also related• Worsening of erectile function is common
  16. 16. Females• Approximately 60% sexual dysfunction after therapy (surgery, RT, chemo)• Dyspareunia and vaginal dryness most prominent symptoms• Decreased libido, altered orgasms• Vaginal stenosis• Loss of ovarian function
  17. 17. Surgery• Tumors located lower in the pelvis are more likely to have post-surgical SD• Surgical resection of pelvic organs can occur for an extensive tumor, but this is uncommon – Vagina, uterus, prostate• Organ resection and nerve injury are the most likely surgical causes of sexual dysfunction• TME produces less surgical toxicity than prior operations
  18. 18. MRI-Phased Array CoilT3N1 Beets-Tan, Lancet-2001
  19. 19. LAR Specimen Assessment Shiny Visceral Mesorectal Fascia A. Cohen, Univ of Kentucky
  20. 20. Surgery- Males• Erectile dysfunction• Ejaculation disorders
  21. 21. Radiation Therapy• Studies in the literature have focused heavily on radiation effects• Known impact of radiation therapy on multiple areas that could impact sexual function
  22. 22. Classical AP-PA field
  23. 23. Classical lateral fields
  24. 24. Radiation Therapy- Females• Cessation of ovarian function in young patients• Incompetent uterus for child-bearing• Vaginal dryness• Vaginal stenosis
  25. 25. Radiation Therapy- Males• Difficulties with erection• Decreased sperm count• Decreased semen production• Altered testosterone production• Ejaculatory difficulties
  26. 26. Chemotherapy• Difficult to sort out independent role of chemotherapy in treatment as almost all patients have received both radiation therapy and surgery• Oxaliplatin can cause testicular dysfunction• Temporary or permanent loss of menstruation• Early ovarian failure• Supportive medications can impact sexual function
  27. 27. Prevention of SD• Defining appropriate therapy- don’t over-treat• Have surgery done by an experienced colorectal surgeon• Use radiation therapy when needed, by an experienced radiation oncologist
  28. 28. Management of SD• Erectile dysfunction can be helped by medications• Mechanical devices for ED• Vaginal lubricants• Low dose vaginal estrogens• Vaginal dilators
  29. 29. Fight Colorectal Cancerwww.FightColorectalCancer.org877-427-2111
  30. 30. Fight Colorectal Cancer CONTACT US Fight Colorectal Cancer 1414 Prince Street, Suite 204 Alexandria, VA 22314 (703) 548-1225 Toll-Free Answer Line: 1-877-427-2111 www.FightColorectalCancer.orgEmail us: Info@FightColorectalCancer.org