Sexual Function After Surgery for Prostate or Bladder Cancer

Alejandro J. Miranda-Sousa, MD; Hugo H. Davila, MD; Jorge L. Lockhart, MD; Raul C. Ordorica, MD; Rafael E. Carrion, MD

Disclosures

Cancer Control. 2006;13(3):179-187. 

In This Article

Therapy for Female Sexual Dysfunction

Several problems can arise that have a negative effect on sexual function in women. Some of these involve problems with libido, arousal, orgasm, and dyspareunia.

Low Libido

Interest is increasing in androgens and their ability to alleviate problems of low desire.[78,79,80] Some studies report that androgen treatment increases sexual desire and fantasies.[81] In a prospective, 2-year, single-blinded, randomized trial of 34 postmenopausal women, a combination of estrogen and testosterone therapy led to greater improvements in multiple measures of sexuality than achieved by estrogen therapy alone.[78] Moreover, other studies[80] have found testosterone replacement to be successful in restoring desire and sexual responsiveness in patients who had a marked decrease in their desires as a result of surgery or chemotherapy. In addition to its benefit as a sexual motivator, testosterone maintains bone mass in both men and women. Virilizing side effects are rare but can include acne, hirsutism, and deepening of the voice.[78] Widespread use of testosterone replacement remains controversial for menopausal women, particularly in perimenopausal women.[82,83]

Arousal

The success of vasodilating medications in male erectile dysfunction triggered the interest in its use for female sexual arousal disorders. The involvement of vascular congestion and the physiologic and biochemical similarities between the penis and the clitoris strengthened this interest and triggered several research projects. This included studies evaluating oral medications such as sildenafil citrate[84] and topical vasodilators.[85] Initially, the target population included all women with female sexual dysfunction in the hope that the broad-spectrum efficacy in male erectile dysfunction could be reproduced in female sexual dysfunction. A multicenter, placebo-controlled, randomized, doubleblind study was conducted with women using estrogen who were experiencing sexual dysfunction that included arousal disorder.[84] Results indicated that sildenafil administered on an as-needed basis for 12 weeks did not improve the sexual response in this population. Most studies on the efficacy of sildenafil citrate in female sexual arousal disorder fail to show any significant improvement, and no efforts are being made to seek approval by the US Food and Drug Administration for sildenafil citrate as a treatment option for female sexual dysfunction.

Orgasm

Treatment of orgasmic dysfunction is best managed in patients with reversible causes. One of these causes involves patients taking oral selective serotonin release inhibitors (SSRIs). Side effects of SSRIs can be managed with a number of strategies: dose adjustment, medication changes, drug holidays, drug augmentation,and most recently,administration of sildenafil citrate and other vascular drugs. Many patients who take SSRIs suffer from depression that is intrinsically or directly related to their female sexual dysfunction. Some may even suffer from depression secondary to their female sexual dysfunction. Women suffering from anorgasmia may have strong negative attitudes about sexuality and their bodies, and they may be unwilling to touch their own genitalia. Sex therapy plays a primary role in these conditions. The vibrator is the single most frequently used mechanical device with sex therapy.[86,87] This device delivers a powerful erotic stimulus when applied to the clitoris and may be helpful for women with anorgasmia.[87]

Dyspareunia

The first step in treating dyspareunia (painful coitus) is to address potential reversible causes such as vaginitis, endometriosis, and anatomic abnormalities. Topical or oral estrogens and lubricants can be used to relieve dyspareunia in patients with poor lubrication following procedures such as pelvic radiation.[88] Estrogen therapy can help alleviate symptoms such as vasomotor instability, minor psychologic disturbance, and sexual difficulties. Patients with atrophic vaginitis (fragile, thin tissues with decreased elasticity) and with poor lubrication are readily amenable to treatment with estrogen.[79]

Generally, a multidisciplinary approach with input from sex therapists, psychologists, psychiatrists, urologists, and gynecologists who specialize in the field can optimize the efficacy of any treatment plan for women suffering from sexual dysfunction.

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