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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Sex After Rectal Cancer
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6. Fight Colorectal Cancer
Dr. Joel Tepper, MD, PhD
Hector MacLean Distinguished Professor
of Cancer Research in
Radiation Oncology
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7. Rectal Cancer:
Sexual Dysfunction
Joel E. Tepper, MD
Department of Radiation Oncology
UNC Lineberger Comprehensive Cancer Center

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. Anatomy of the Female Pelvis

10. Pelvic Nerve Anatomy

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. 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. 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. Sexual activity of (A) male and (B) female patients
who were sexually active preoperatively.
Marijnen C A et al. JCO 2005

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. 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. 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

19. MRI-Phased Array Coil
T3N1
Beets-Tan, Lancet-2001

21. LAR Specimen Assessment
Shiny Visceral
Mesorectal Fascia
A. Cohen, Univ of Kentucky

22. Surgery- Males
• Erectile dysfunction
• Ejaculation disorders

23. 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

24. Classical AP-PA field

25. Classical lateral fields

27. Radiation Therapy- Females
• Cessation of ovarian function in young
patients
• Incompetent uterus for child-bearing
• Vaginal dryness
• Vaginal stenosis

28. Radiation Therapy- Males
• Difficulties with erection
• Decreased sperm count
• Decreased semen production
• Altered testosterone production
• Ejaculatory difficulties

29. 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

30. 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

31. Management of SD
• Erectile dysfunction can be helped by
medications
• Mechanical devices for ED
• Vaginal lubricants
• Low dose vaginal estrogens
• Vaginal dilators

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