Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Surgery, GI Oncology Unit, St Göran's Hospital, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Pelvic Cancer, GI Oncology and Colorectal Surgery Unit, Stockholm, Sweden.
J Sex Med. 2021 Aug;18(8):1374-1382. doi: 10.1016/j.jsxm.2021.05.018. Epub 2021 Jul 18.
Women treated for rectal cancer are at risk of sexual dysfunction and impaired ovarian androgen production.
To investigate a possible association between serum levels of endogenous androgens and sexual function in women with rectal cancer.
Women diagnosed with stage I-III rectal cancer were consecutively included and prospectively followed with the Female Sexual Function Index (FSFI) questionnaire from baseline to 2 years postoperatively and blood samples for hormone analyses, baseline to 1 year. Androgens were measured with liquid chromatography-mass spectrometry and electrochemiluminescence. The associations between the 4 measured androgens (testosterone, free testosterone, androstenedione, and dehydroepiandrosterone sulphate) and sexual function were assessed with generalized least squares random effects regression analysis in sexually active women.
The primary outcome measure was the mean change observed in the FSFI total score when the serum androgen levels changed with one unit. Secondary outcomes were the corresponding mean changes in the FSFI domain scores: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain/discomfort.
In the 99 participants, the median FSFI total score decreased from 21.9 (range 2.0 - 36.0) to 16.4 (3.5 - 34.5) and 11.5 (2.0 to 34.8) at 1 and 2-years follow-up. After adjustment for age, partner, psychological well-being, preoperative (chemo)radiotherapy, and surgery, total testosterone and androstenedione were significantly associated with FSFI total score (β-coefficients 3.45 (95% CI 0.92 - 5.97) and 1.39 (0.46 - 2.33) respectively). Testosterone was significantly associated with the FSFI-domains lubrication and orgasm, free testosterone with lubrication, androstenedione with all domains except desire and satisfaction, and dehydroepiandrosterone sulphate with none of the domains.
This is the first study investigating whether androgen levels are of importance for the impaired sexual function seen in women following rectal cancer treatment. The prospective design allows for repeated measures and the use of the FSFI for comparisons across studies. No laboratory data were collected at the 2-year follow-up, and the missing data could have further clarified the studied associations.
Testosterone and androstenedione were associated with sexual function in female rectal cancer patients. The results are of interest for future intervention studies and contribute to the understanding of sexual problems, which is an essential component of the rehabilitation process in pelvic cancer survivors. Svanström Röjvall A, Buchli C, Flöter Rådestad A, et al. Impact of Androgens on Sexual Function in Women With Rectal Cancer - A Prospective Cohort Study. J Sex Med 2021;18:1374-1382.
接受直肠癌治疗的女性存在性功能障碍和卵巢雄激素产生受损的风险。
调查女性直肠癌患者血清内源性雄激素水平与性功能之间的可能关联。
连续纳入并前瞻性随访女性直肠癌 I-III 期患者，使用女性性功能指数（FSFI）问卷从基线到术后 2 年，以及在基线到 1 年期间进行激素分析。采用液相色谱-质谱联用和电化学发光法检测雄激素。在有性行为的女性中，使用广义最小二乘随机效应回归分析评估 4 种测量雄激素（睾酮、游离睾酮、雄烯二酮和硫酸脱氢表雄酮）与性功能之间的关系。
在 99 名参与者中，FSFI 总分从 21.9（范围 2.0-36.0）降至 16.4（3.5-34.5）和 11.5（2.0-34.8），分别在 1 年和 2 年随访时。在调整年龄、伴侣、心理健康、术前（放）化疗和手术等因素后，总睾酮和雄烯二酮与 FSFI 总分显著相关（β 系数分别为 3.45（95%CI 0.92-5.97）和 1.39（0.46-2.33））。睾酮与 FSFI 领域的润滑和性高潮显著相关，游离睾酮与润滑相关，雄烯二酮与除欲望和满意度以外的所有领域相关，硫酸脱氢表雄酮与所有领域均不相关。
这是第一项研究，调查了雄激素水平对女性直肠癌治疗后性功能障碍的重要性。前瞻性设计允许重复测量，并使用 FSFI 进行跨研究比较。在 2 年随访时未收集实验室数据，缺失数据可能进一步阐明了所研究的关联。
睾酮和雄烯二酮与女性直肠癌患者的性功能相关。这些结果对未来的干预研究很有意义，并有助于理解性问题，这是骨盆癌幸存者康复过程中的一个重要组成部分。Svanström Röjvall A、Buchli C、Flöter Rådestad A 等人。雄激素对直肠癌女性性功能的影响-一项前瞻性队列研究。J 性医学 2021；18：1374-1382。
