Blood and bone marrow transplants have been done for decades and have always had risks of complications, like virtually any treatment for serious diseases, but a new study has found an additional one for the list: sexual health.

The authors confirm chronic graft-versus-host disease (GVHD), a serious complication that occurs when donor cells attack the recipient's cells, as a potential source of sexual dysfunction and say they are the first to demonstrate an association between total body irradiation and sexual dysfunction in men. They further say that this study is one of the longest and is the most inclusive to date evaluating sexual well-being in blood or bone marrow transplantation (stem cell transplantation, SCT) survivors using rigorous, well-validated sexual function assessment tools.

Stem cell transplantation is an increasingly effective form of treatment for patients with blood cancer such as leukemia, lymphoma, and myeloma. The procedure involves the transplantation of cells taken either from a patient's own blood or bone marrow (autologous transplantation) or from a matched donor (allogeneic transplantation) which effectively "replaces" damaged cells with healthy cells. As blood or bone marrow transplantation survival rates have steadily increased, researchers are seeking to study and maximize survivors' quality of life. 

"Thanks to improved transplant survival rates, we have now been able to focus our efforts on examining how the procedure affects key aspects of recipients' overall quality of life, including sexual health," said lead study author F. Lennie Wong, PhD, of City of Hope in Duarte, California. "Previous findings point to the unfortunate fact that, while recipients may physically recover, their sexual health might not rebound as much or as quickly. Data have been limited to this point, prompting us to take a closer look at this issue in a larger, more diverse group of autologous and allogeneic transplant survivors over an extended period."

To further investigate long-term effects of SCT on the sexual health of survivors, a team of researchers led by senior author Smita Bhatia, MD, MPH, surveyed 277 adult patients (152 men and 125 women; median age 48) who underwent SCT at City of Hope for blood cancer between February 2001 and January 2005 about their sexual activity. Participants completed two questionnaires that together evaluated specific areas of sexual function (sexual cognition/fantasy, sexual arousal, sexual behavior/experience, orgasm, and drive/relationship) as well as sexual satisfaction at a median time of 17 days pre-transplant and at six, 12, 24, and 36 months post-transplant. A third questionnaire assessed overall health-related quality of life.

Investigators' analysis of questionnaire results (led by Dr. Wong) confirmed previous studies in demonstrating a definitive impact of SCT on survivors' post-transplant sexual activity. During the three-year post-transplant analysis period, the percentage of men who self-reported being "sexually active" (defined as having sex with a partner at least once in the preceding month) declined 7 percentage points, with 61 percent of men reporting sexual activity pre-transplant and 54 percent reporting activity post-transplant. The opposite – a 15 percentage point increase in sexually active individuals – was observed in women, with 37 percent reporting sexual activity pre-transplant and 52 percent reporting activity post-transplant.

In addition to further crystallizing transplantation's impact on survivors' sexual health, study data specifically associated diminished sexual function and satisfaction with transplant-related total body radiation in men and chronic GVHD with diminished sexual function in men and both sexual function and satisfaction in women.

Investigators observed a nearly 18 percent decline in sexual function in men surveyed who had received total body radiation. The same group also reported an approximate 32 percent decrease in sexual satisfaction, a 26 percent decrease in sexual behavior/experience, a 26 percent decrease in quality of orgasm, and 17 percent decrease in sex drive/relationship since their transplant. Despite these effects in men, radiation had no such reported effect in women, an effect that investigators hypothesize may be explained by inherent physiologic differences in the pathogenesis of sexual dysfunction among men and women.

In addition to documenting concrete effects of radiation on sexual function and satisfaction, investigators also observed negative sexual effects among those surveyed who had experienced chronic GVHD. Men surveyed who had developed the dangerous post-transplant complication reported a 21 percent decrease in sexual cognition/fantasy and a 24 percent decrease in the quality of orgasm since their transplant. Similarly, investigators observed a 27 percent decline in post-transplant sexual satisfaction among women surveyed who had experienced chronic GVHD, with survey respondents also indicating a 27 percent decline in sexual arousal.

When compared to men, the women surveyed suffered significantly worse effects overall, despite the fact that their sexual activity increased over the three-year survey period. Investigators concluded that this increase in activity may be explained by a corresponding improvement in female psychological quality of life post transplant.

From this research, investigators conclude that nearly half of SCT survivors are sexually inactive at three years post transplant and suggest that patients may benefit from speaking with their doctors about sex.

"It is not often that the transplant team and patient will have a conversation about how this procedure could impact their sex life, even after recovery; however, we hope these findings will help encourage patients and their doctors to openly discuss concerns related to sexual dysfunction and address them with specialists who can help," said Dr. Wong.

Citation: F. Lennie Wong, Liton Francisco, Kayo Togawa, Heeyoung Kim, Alysia Bosworth, Liezl Atencio, Cara Hanby, Marcia Grant, Fouad Kandeel, Stephen J. Forman, and Smita Bhatia, 'Longitudinal trajectory of sexual functioning after hematopoietic cell transplantation: impact of chronic graft vs. host disease and total body irradiation', Blood October 24, 2013 DOI: 10.1182/blood-2013-05-499806