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Holistic sexual health care in recipients of high dose chemotherapy or chemo-radiotherapy and bone marrow transplantation for haematological malignancy presenting with sexual dysfunction - contraception-esc.com

Holistic sexual health care in recipients of high dose chemotherapy or chemo-radiotherapy and bone marrow transplantation for haematological malignancy presenting with sexual dysfunction

Holistic sexual health care in recipients of high dose chemotherapy or

chemo-radiotherapy and bone marrow transplantation for haematological malignancy

presenting with sexual dysfunction

R. Chatterjee (1), H.H. McGarrigle (1), P.D. Kottaridis (2)

Departments of Obstetrics and Gynaecology, UCL, London, UK (1); Department

of Haematology, UCL, London, UK (2)

Introduction: The long term survival of recipients of high dose

chemotherapy (HDC) with or without total body irradiation (TBI) and bone marrow

transplantation (BMT) for haematological and other cancers have improved in the

last decade. Thus sexual morbidity has become apparent affecting 70–80% of

survivors.

Aims of study: To test the hypothesis that holistic sexual health care

implemented by a multidisciplinary team (MDT) of specialists using polytherapy

with sex hormones, counselling and erectogenic drugs can improve the quality of

life of cancer patients.

Design and Methods: We studied 110 patients aged 26–62 (median 41)

years presenting over a l0 year period with features of hypogonadism and sexual

dysfunction, who had HDC and allogeneic with TBI or autologous BMT for a variety

of haematological malignancies. Sexual response was assessed before and at 6 and

12 months of polytherapy by using clinical (IIEF scoring and NIH criteria) and

endocrine parameters. A MDT of specialists (oncologists, reproductive endocrine

and sexual health specialist, counsellors) was involved to offer holistic sexual

health care to the cancer patients. Patients presenting hypogonadism with

diminished libido were treated with Testosterone replacement therapy (TRT) (4

weekly intramuscular injections of testosterone propionate), ED and low libido

were treated sildenafil (50–100 mg twice weekly) and TRT and others had

counselling and support only.

Results: At the onset of study, 49 (44%) patients presented with

diminished libido, 88 (80%) had diminished libido and ED, and 25 (23%) had

ejaculatory and orgasmic problems. All patients with diminished libido were

treated with TRT and only 40 (82%) had correction of libido both clinically and

biochemically. Of the 88 patients with diminished libido and ED who were treated

with TRT and sildenafil, only 50 (57%) had a good response as evident from IIEF

score and NIH criteria. Psychological support and counselling offered to 80/110

(73%) patients and 60/80 (75%) showed good results.

Conclusion: Our data suggest that a holistic approach to cancer care

provided by a multidisciplinary team of specialists using polytherapy may

improve the sexual morbidity of the cancer survivors.

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