Unmentioned Side Effects
The review article (1) does not mention a crucial aspect of side effects associated with treatment, and in our own clinical experience, this topic is often not broached with women with anal carcinoma: sexual dysfunction after pelvic radiotherapy.
Obviously, sexual dysfunction is always a multicausal and multidimensional problem, but radiochemotherapy of the pelvis is an unambiguous risk factor for the development of physiological and anatomical exchanges to the genital area, which may materially affect sexual functioning even years after the treatment was administered.
It has been well known for 60 years, from retrospective (2) as well as prospective (3) data collections, that radiotherapy of cervical cancers leads to sexual dysfunction. About 50% of women thus affected are no longer sexually active (in contrast to 26% in the control group of healthy women). The most common symptoms were dyspareunia, stenosis of the vaginal canal, a tendency to bleed, anorgasmia, and vaginal dryness. Clinically, the same sequelae have also been observed in anal cancer.
The LENT SOMA Score (Late Effects of Normal Tissues; SOMA = Subjective, Objective, Management and Analytic Categories) (4) is a suitable instrument in persons with sexual dysfunction for determining symptoms before and after treatment and to determine the therapeutic need. Unfortunately this is done too rarely in routine clinical practice. We can only assume that feelings of shame on the part of both patients and doctors is responsible for this omission.
Informing women about the regular use of vaginal dilators, as early as possible and also, if possible, during treatment, but at the latest after the inflammation has subsided results in a notable decrease in sexual dysfunction.
PD Dr. med. Carsten Ziske
Praxisnetzwerk Hämatologie/Internistische Onkologie,
Onkologie St. Josef Hospital Troisdorf
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||Raptis D, Schneider I, Matzel KE, Ott O, Fietkau R, Hohenberger W: The differential diagnosis and interdisciplinary treatment of anal carcinoma. Dtsch Arztebl Int 2015; 112: 243–9 MEDLINE|
|2.||Andersen BL, Van der Does J: Surviving gynecologic cancer and coping with sexual morbidity: an international problem. Int J Gynecol Cancer 1994; 4: 225–40.|
|3.||Bergmark K, Avall-Lundquist E, Dickman PW, et al.: Vaginal changes and sexuality in women with a history of cervical cancer. N Engl J Med 1999; 340: 1383–9 MEDLINE|
|4.||Seegenschmiedt MH (ed.): Nebenwirkungen in der Onkologie. Internationale Systematik und Dokumentation. Berlin, Heidelberg: Springer 1998.|