Danish researchers recently found that patients who underwent stem cell transplantation frequently experienced sexual dysfunction, sometimes for extended periods of time after transplantation.  Patients who experienced reduced sexual function also reported lower quality of life.

Given the frequency of sexual dysfunction in these patients, the researchers concluded that there is a strong need for treatment studies in this area.

“Sexuality and sexual function is a quality of life variable that is in particular need of further research and attention in the clinical setting,” said Dr. Kristina Thygesen of Rigshospitalet University in Copenhagen, Denmark. “Hopefully, this will lead to preventive interventions that may improve quality of life in [stem cell transplant] patients,” she added.

In multiple myeloma, stem cell transplantation using the patient’s own stem cells is considered a standard of care for patients who are able to tolerate the treatment. During this procedure, the patient’s stem cells are harvested prior to high-dose chemotherapy and re-infused afterward to replenish the destroyed stem cells. Stem cells can also be provided by a donor. However, this procedure is less common in myeloma.

Researchers have previously determined that patients may experience sexual dysfunction after radiation treatment or chemotherapy. However, according to the Danish researchers, there has so far been little discussion about the impact of stem cell transplantation on sexuality.

The Danish researchers therefore conducted a systematic literature review on the topic and identified 14 studies relating stem cell transplantation and sexuality. In five of the studies, patients received stem cells from a donor; patients received their own stem cells in two studies; and in the remaining seven studies, patients received either their own cells or cells from a donor.

The researchers found that following transplantation, 48 percent of patients reported dissatisfaction with their quality of sexual life, which extended up to six months after transplantation.

Patients who underwent stem cell transplantation experienced significantly lower sexual functioning, compared to patients treated with chemotherapy only. After stem cell transplantation, patients reported decreases in the following aspects of sexual functioning: sexual activity (38 percent), ability to have sex (36 percent), pleasure from sex (31 percent), and interest in sex (28 percent).

Both female and male patients experienced specific sexual problems after transplantation, including vaginal dryness, painful sexual intercourse, and erectile dysfunction.

In one study, 38 percent of men experienced a delay or absence of orgasm and ejaculation more frequently than prior to transplantation. In addition, 74 percent experienced erectile dysfunction more often following transplantation, including 25 percent who always or often experienced this side effect.

The researchers compared the sexual activity of patients who underwent transplantation with that of healthy people. They found that male patients who survived five years after transplantation had significantly lower sexual activity than the healthy men. In females, 40 percent of the surviving patients were not sexually active up to five years after transplantation, compared to 21 percent of healthy women.

The researchers also found several gender-related differences in sexuality. Female patients reported significantly more problems over time, whereas male patients maintained a consistent level of problems. Female patients also reported a higher number of problems and lower rates of sexual activity than male patients at all of the follow-up periods after transplantation.

At one year after transplantation, male patients had problems with physical appearance and obtaining an erection, ejaculation, and orgasm. Female patients had problems with lack of sexual interest, appearance, vaginal dryness, and painful intercourse.

At three years after transplantation, 80 percent of female patients reported sexual problems, compared to 29 percent of male patients.

In one study, patients who received stem cells from a donor reported more changes in sexual function and experienced more hormonal disorders, compared to patients who received their own harvested stem cells. However, two other studies found no difference in the ability to have sex between these two treatment groups.

Another study found that patients who received stem cells from a donor also experienced more difficulties related to erectile dysfunction, compared to patients who received maintenance chemotherapy.

Several of the studies included in the review showed conflicting data on the relationship between sexual dysfunction and graft-versus-host disease, a common transplant-related complication in which the newly infused stem cells view the patient’s cells as foreign and attack them. 

In one study, the researchers found no significant association between graft-versus-host-disease and reduced sexual function. However, a greater percentage of patients who experienced sexual dysfunction also had graft-versus-host-disease. According to the authors of the review, this finding indicates that graft-versus-host-disease increases sexual dissatisfaction. 

“There was no significant correlation between sexual dysfunction and graft-versus-host-disease, even though graft-versus-host-disease can manifest in the genital area. Therefore, future research needs to investigate [topic],” said Dr. Thygesen.

Two studies found a significant association in patients who received donated stem cells between chronic graft-versus-host-disease and lower emotional well-being, less sexual satisfaction, and arousal/orgasm problems.

Patients who experienced reduced sexual function also reported increased fatigue and lower quality of life. Patients who received stem cells from a donor reported poorer quality of life than patients who received their own stem cells.

For more information, please refer to the article in Bone Marrow Transplantation (abstract).