Pallotti Francesco, Petrozzi Alessandra, Cargnelutti Francesco, Radicioni Antonio Francesco, Lenzi Andrea, Paoli Donatella, Lombardo Francesco
Laboratory of Seminology-Sperm Bank Loredana Gandini, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
Hormone Laboratory, Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
Front Endocrinol (Lausanne). 2019 Apr 2;10:196. doi: 10.3389/fendo.2019.00196. eCollection 2019.
The diagnosis of testicular cancer (TC) can have a considerable and persistent impact on a patient's sexuality, especially given its location. The high prevalence of TC in young adults, and the good prognosis, explain the great interest in sexual dysfunction and its influence on post-treatment quality of life. The aim of this study was to evaluate the impact of the diagnosis and treatments (inguinal orchiectomy and chemotherapy) on sex life. For this purpose, we recruited 241 TC patients attending the Laboratory of Seminology-Sperm Bank "Loredana Gandini" for sperm cryopreservation (mean age 31.3 ± 6.9 years) and 223 cancer-free healthy men who were undergoing andrological screening (mean age 32.0 ± 7.7 years). The IIEF-15 questionnaire was administered at the baseline (post-orchiectomy, pre-chemotherapy-T0) and at 6 (T1), 12 (T2), 18 (T3), 24 (T4), 48 months (T5) and >5 years (T6, median 96 months) after chemotherapy to all patients, to evaluate the following domains: erectile function (EF), orgasmic function (OF), sexual desire (SD), intercourse satisfaction (IS) and overall satisfaction (OS). A subgroup of patients also underwent blood sex hormone analysis for further correlations with IIEF scores. At the baseline, 37.7% of patients had erectile dysfunction (EF score <26) and all IIEF domains except OF showed significantly lower scores than in controls ( < 0.001). Long-term follow-up revealed persistently lower scores in TC survivors than in controls for EF, SD, IS, and OS. Furthermore, most IIEF domains did not improve significantly in TC patients during the duration of the follow-up, with the exception of EF, which showed a significant improvement from T2. Finally, no significant correlation was found between hormone levels (gonadotropin and testosterone) and IIEF-15 scores. In conclusion, TC and its treatment have a significant effect on sexuality. The absence of a clear correlation with biochemical hypogonadism suggests that this may to a large extent be due to the surgical procedure itself, or to the psychological impact of a cancer diagnosis.
睾丸癌（TC）的诊断可能会对患者的性功能产生相当大且持续的影响，尤其是考虑到其发病部位。TC在年轻成年人中的高发病率以及良好的预后，解释了人们对性功能障碍及其对治疗后生活质量的影响的极大兴趣。本研究的目的是评估诊断和治疗（腹股沟睾丸切除术和化疗）对性生活的影响。为此，我们招募了241名前往精液学-精子库“洛雷丹娜·甘迪尼”进行精子冷冻保存的TC患者（平均年龄31.3±6.9岁）以及223名正在接受男科筛查的无癌健康男性（平均年龄32.0±7.7岁）。在基线时（睾丸切除术后、化疗前-T0）以及化疗后的6个月（T1）、12个月（T2）、18个月（T3）、24个月（T4）、48个月（T5）和>5年（T6，中位数96个月），对所有患者进行国际勃起功能指数-15（IIEF-15）问卷评估，以评估以下领域：勃起功能（EF）、性高潮功能（OF）、性欲（SD）、性交满意度（IS）和总体满意度（OS）。一组患者还进行了血液性激素分析，以进一步与IIEF评分进行相关性分析。在基线时，37.7%的患者存在勃起功能障碍（EF评分<26），除OF外，所有IIEF领域的评分均显著低于对照组（<0.001）。长期随访显示，TC幸存者在EF、SD、IS和OS方面的评分持续低于对照组。此外，在随访期间，TC患者的大多数IIEF领域没有显著改善，但EF除外，EF从T2开始有显著改善。最后，未发现激素水平（促性腺激素和睾酮）与IIEF-15评分之间存在显著相关性。总之，TC及其治疗对性功能有显著影响。与生化性腺功能减退缺乏明确相关性表明，这在很大程度上可能是由于手术本身，或癌症诊断的心理影响。
