Interventions for sexual dysfunction following treatments for cancer

This review evaluated the effectiveness of randomised controlled trials (RCTs) of interventions of any kind for sexual dysfunction following cancer treatments. Sexual dysfunction (SD) is a potential complication of cancer treatment in both men and women. Eleven RCTs were identified that evaluated the effectiveness of an intervention to treat SD following treatment for cancer. Although the quality of these trials was poor, there was sufficient evidence that oral phosphodiesterase inhibitors are an effective treatment for SD in men following treatments for prostate cancer. There was insufficient evidence for the effectiveness of other identified interventions for SD following cancer treatment. There was a relative absence of trials of treatments for SD secondary to cancer treatments in women.

Authors' conclusions: 

PDE5 inhibitors are an effective treatment for SD secondary to treatments for prostate cancer. Other interventions identified need to be tested in further RCTs. The SD interventions in this review are not representative of the range available for men and women. Further evaluations are needed for these interventions for SD following cancer treatments.

Read the full abstract...
Background: 

The proportion of people living with and surviving cancer is growing. This has led to increased awareness of the importance of quality of life including sexual function in people with cancer. Sexual dysfunction (SD) is a potential long-term complication of cancer treatments.

Objectives: 

Evaluate effectiveness of interventions for SD following treatments for cancer and their adverse effects.

Search strategy: 

The Cochrane Pain, Palliative & Supportive Care Register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycInfo, AMED, CINAHL, Dissertation Abstracts and NHS Research Register were searched. Search ran in January 2007.

Selection criteria: 

Randomised controlled trials (RCTs) were included that assessed the effectiveness of a treatment for SD. The trial population comprised of adults of either sex who at trial entry had developed SD as a consequence of cancer treatment.

Data collection and analysis: 

Two review authors independently extracted the data and assessed trial quality. Meta-analysis was considered for trials with comparable key characteristics.

Main results: 

Eleven RCTs with a total of 1743 participants were identified. The quality of the trials was poor. Ten trials explored interventions for SD in men following treatments for non-metastatic prostate cancer. One trial explored effectiveness in women of a lubricating vaginal cream following radiotherapy for cervical cancer.

The strongest evidence (from four trials) was on oral phosphodiesterase type 5 (PDE5) inhibitors for erectile dysfunction (ED) following radiotherapy of the prostate or radical prostatectomy. The results using validated measures in all trials significantly favoured those in the PDE5 inhibitor group(s). The combined results of two trials indicated a significantly greater improvement in ED in the PDE5 inhibitor groups (odds ratio (OR) 10.09 95% confidence interval (CI) 6.20 to 16.43). Negative effects were few and usually mild to moderate headaches or flushing. One trial reported more clinically serious events including six events of tachycardia and six of chest pain.

Following prostate cancer treatments there was some evidence that PDE5 inhibitors are more effective in combination with acetyl-L-carnitine and propionyl-L-carnitine and that sexual counselling improves self-administration of prostaglandin intra-cavernous injection for SD. There was some evidence following treatment for prostate cancer that transurethral alprostadil and vacuum constriction devices reduce SD, although in both trials negative effects were fairly common. There is some evidence that vaginal lubricating creams reduce SD.