In patients with colorectal cancer, especially those with rectal cancer, quality of life can be affected by bowel, bladder and sexual problems. Erectile dysfunction (ED) is often reported among men who have been treated for rectal cancer. It may result mainly from injury to pelvic nerves by surgery, radiation or chemotherapy. In addition, in every patient, individual risk factors have to be considered (age, co-morbidities).
In a recent study, Dowswell and colleagues assessed 28 men aged 34 to 80 years who had been treated for colorectal cancer. Despite some limitations (e.g., small group, descriptive approach), the study provides several interesting pieces of information. In survivors of colorectal cancer, ED is frequent. However, many patients do not seek help for ED for various reasons (e.g., unawareness of the association between experienced symptoms and colorectal cancer or cancer therapy, lack of knowledge about the possible treatment for ED, embarrassment, lack of confidence, perception of ED as a subject which is inappropriate for the medical office).
Even more importantly, among those who sought help for ED, almost none were receiving adequate, effective and affordable care. The patients emphasized lack or inadequacy of information about the risk of ED, inability or unwillingness of health care providers to speak about sexual function or even unintentionally offensive remarks, especially in regard to older men. In some cases, patients did not obtain any help from professional healthcare providers and sought medication on the internet.
Thus, from the practical point of view, three points are important. First, neither information about ED nor treatment for ED are incorporated into routine care of men with colorectal cancer. Second, in these men, it may be necessary to explore problem of sexual function sensitively but routinely. Third, in case of older men, making assumptions about their sexual behavior or motivation (in particular, about lack thereof) may be inadvertently offensive.
Dowswell G, Ismail T, Greenfield S, Clifford S, Hancock B, Wilson S. Men’s experience of erectile dysfunction after treatment for colorectal cancer: qualitative interview study. BMJ. 2011 Oct 18;343:d5824. doi: 10.1136/bmj.d5824.