Download PDF
Clin Colon Rectal Surg
DOI: 10.1055/s-0045-1807737
Review Article

Sexual Dysfunction after Colorectal Surgery

Sophia Zigouras
1   Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York
,
James P. Taylor
2   Division of Colon and Rectal Surgery, Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Medical Arts Pavillion, Bronx, New York
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Abstract

Sexual health is a key component of well-being and quality of life. Following colorectal surgery, many patients experience sexual dysfunction in the form of difficulty with libido, arousal, pain, and fertility. Autonomic nerve damage can explain many of these symptoms and may be a result of surgical trauma, tumor invasion, chemotherapy and radiotherapy, or pelvic inflammation and infection. An understanding of pelvic neuroanatomy can help prevent direct nerve damage during surgical dissection, but the effects of postsurgical inflammation and ischemia may be unavoidable. Despite the availability of tools for assessing patient-reported sexual health, data to support an informed consent discussion including risks to sexual health, and a multidisciplinary team of sexual health providers who can be involved in management, sexual dysfunction in colorectal surgery patients remains underdiagnosed and inadequately addressed in clinical practice. This represents a key area for quality improvement in delivering holistic and empathic care to the colorectal patient population.

Keywords

sexual dysfunction - autonomic nerves - colorectal surgery - quality of life


Publication History

Article published online:
16 April 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999; 281 (06) 537-544
    CrossrefPubMedSearch in Google Scholar
  • 2 Longo WE, Virgo KS, Johnson FE. et al. Risk factors for morbidity and mortality after colectomy for colon cancer. Dis Colon Rectum 2000; 43 (01) 83-91
    CrossrefPubMedSearch in Google Scholar
  • 3 Towe M, Huynh LM, El-Khatib F, Gonzalez J, Jenkins LC, Yafi FA. A review of male and female sexual function following colorectal surgery. Sex Med Rev 2019; 7 (03) 422-429
    PubMedSearch in Google Scholar
  • 4 Traa MJ, De Vries J, Roukema JA, Rutten HJ, Den Oudsten BL. The sexual health care needs after colorectal cancer: the view of patients, partners, and health care professionals. Support Care Cancer 2014; 22 (03) 763-772
    PubMedSearch in Google Scholar
  • 5 Hendren SK, O'Connor BI, Liu M. et al. Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg 2005; 242 (02) 212-223
    CrossrefPubMedSearch in Google Scholar
  • 6 Keller DS, Ky-Miyasaka JA. Sexual Function After Colorectal Surgery in Women. In: Steele SR, Hull TL, Hyman N, Maykel JA. Read TE and Whitlow CB, eds. The ASCRS Textbook of Colon and Rectal Surgery. 4th ed.. New York, NY: Springer Science and Business Media; 2022: 1055-1066
    Search in Google Scholar
  • 7 Mantilla N, McNevin S. Male Genitourinary Dysfunction as a Consequence of Colorectal Surgery. In: Steele SR, Hull TL, Hyman N, Maykel JA, Read TE, Whitlow CB. eds. The ASCRS Textbook of Colon and Rectal Surgery. 4th ed.. New York, NY: Springer Science and Business Media; 2022: 1067-1075
    Search in Google Scholar
  • 8 White ID. Sexual difficulties after pelvic radiotherapy: improving clinical management. Clin Oncol (R Coll Radiol) 2015; 27 (11) 647-655
    PubMedSearch in Google Scholar
  • 9 Li K, He X, Tong S, Zheng Y. Risk factors for sexual dysfunction after rectal cancer surgery in 948 consecutive patients: A prospective cohort study. Eur J Surg Oncol 2021; 47 (08) 2087-2092
    PubMedSearch in Google Scholar
  • 10 Jensen PT, Froeding LP. Pelvic radiotherapy and sexual function in women. Transl Androl Urol 2015; 4 (02) 186-205
    PubMedSearch in Google Scholar
  • 11 Celentano V, Cohen R, Warusavitarne J, Faiz O, Chand M. Sexual dysfunction following rectal cancer surgery. Int J Colorectal Dis 2017; 32 (11) 1523-1530
    CrossrefPubMedSearch in Google Scholar
  • 12 Lindsey I, Guy RJ, Warren BF, Mortensen NJ. Anatomy of Denonvilliers' fascia and pelvic nerves, impotence, and implications for the colorectal surgeon. Br J Surg 2000; 87 (10) 1288-1299
    PubMedSearch in Google Scholar
  • 13 Havenga K, Enker WE, McDermott K, Cohen AM, Minsky BD, Guillem J. Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum. J Am Coll Surg 1996; 182 (06) 495-502
    PubMedSearch in Google Scholar
  • 14 Hicks CW, Hodin RA, Savitt L, Bordeianou L. Does intramesorectal excision for ulcerative colitis impact bowel and sexual function when compared with total mesorectal excision?. Am J Surg 2014; 208 (04) 499-504.e4
    CrossrefPubMedSearch in Google Scholar
  • 15 Albaugh JA, Tenfelde S, Hayden DM. Sexual dysfunction and intimacy for ostomates. Clin Colon Rectal Surg 2017; 30 (03) 201-206
    PubMedSearch in Google Scholar
  • 16 Sun V, Grant M, Wendel CS. et al. Sexual function and health-related quality of life in long-term rectal cancer survivors. J Sex Med 2016; 13 (07) 1071-1079
    CrossrefPubMedSearch in Google Scholar
  • 17 Stal J, Yi SY, Cohen-Cutler S. et al. Sexual dysfunction among early-onset colorectal cancer survivors: Sex-specific correlates of sexual health discussions between patients and providers. Cancer Causes Control 2024; 35 (01) 111-120
    CrossrefPubMedSearch in Google Scholar
  • 18 Adam JP, Denost Q, Capdepont M, van Geluwe B, Rullier E. Prospective and longitudinal study of urogenital dysfunction after proctectomy for rectal cancer. Dis Colon Rectum 2016; 59 (09) 822-830
    PubMedSearch in Google Scholar
  • 19 Izanec J, Nagle D. Impact of proctectomy on continence and sexual function in women. Am J Gastroenterol 2006; 101 (12 suppl): S618-S624
    PubMedSearch in Google Scholar
  • 20 Schover LR, van der Kaaij M, van Dorst E, Creutzberg C, Huyghe E, Kiserud CE. Sexual dysfunction and infertility as late effects of cancer treatment. EJC Suppl 2014; 12 (01) 41-53
    PubMedSearch in Google Scholar
  • 21 Giglia MD, Stein SL. Overlooked long-term complications of colorectal surgery. Clin Colon Rectal Surg 2019; 32 (03) 204-211
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Rajaratnam SG, Eglinton TW, Hider P, Fearnhead NS. Impact of ileal pouch-anal anastomosis on female fertility: meta-analysis and systematic review. Int J Colorectal Dis 2011; 26 (11) 1365-1374
    CrossrefPubMedSearch in Google Scholar
  • 23 Johnson P, Richard C, Ravid A. et al. Female infertility after ileal pouch-anal anastomosis for ulcerative colitis. Dis Colon Rectum 2004; 47 (07) 1119-1126
    PubMedSearch in Google Scholar
  • 24 Bartels SA, DʼHoore A, Cuesta MA, Bensdorp AJ, Lucas C, Bemelman WA. Significantly increased pregnancy rates after laparoscopic restorative proctocolectomy: a cross-sectional study. Ann Surg 2012; 256 (06) 1045-1048
    CrossrefPubMedSearch in Google Scholar
  • 25 Bendifallah S, Roman H, Mathieu d'Argent E. et al. Colorectal endometriosis-associated infertility: should surgery precede ART?. Fertil Steril 2017; 108 (03) 525-531.e4
    PubMedSearch in Google Scholar
  • 26 Savoy M, O'Gurek D, Brown-James A. Sexual health history: Techniques and tips. Am Fam Physician 2020; 101 (05) 286-293
    PubMedSearch in Google Scholar
  • 27 Bordeianou LG, Anger JT, Boutros M. et al. Members of the Pelvic Floor Disorders Consortium Working Groups on Patient-reported Outcomes. Measuring pelvic floor disorder symptoms using patient-reported instruments: Proceedings of the Consensus Meeting of the Pelvic Floor Consortium of the American Society of Colon and Rectal Surgeons, the International Continence Society, the American Urogynecologic Society, and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. Dis Colon Rectum 2020; 63 (01) 6-23
    CrossrefPubMedSearch in Google Scholar
  • 28 Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49 (06) 822-830
    CrossrefPubMedSearch in Google Scholar
  • 29 Rosen R, Brown C, Heiman J. et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 2000; 26 (02) 191-208
    CrossrefPubMedSearch in Google Scholar
  • 30 Gilbert A, Sebag-Montefiore D, Davidson S, Velikova G. Use of patient-reported outcomes to measure symptoms and health related quality of life in the clinic. Gynecol Oncol 2015; 136 (03) 429-439
    PubMedSearch in Google Scholar
  • 31 Brotto LA, Yule M, Breckon E. Psychological interventions for the sexual sequelae of cancer: a review of the literature. J Cancer Surviv 2010; 4 (04) 346-360
    PubMedSearch in Google Scholar
  • 32 Brotto LA, Erskine Y, Carey M. et al. A brief mindfulness-based cognitive behavioral intervention improves sexual functioning versus wait-list control in women treated for gynecologic cancer. Gynecol Oncol 2012; 125 (02) 320-325
    PubMedSearch in Google Scholar
  • 33 Kingsberg SA, Simon JA, Goldstein I. The current outlook for testosterone in the management of hypoactive sexual desire disorder in postmenopausal women. J Sex Med 2008; 5 (Suppl. 04) 182-193 , quiz 193
    PubMedSearch in Google Scholar
  • 34 Schroder M, Mell LK, Hurteau JA. et al. Clitoral therapy device for treatment of sexual dysfunction in irradiated cervical cancer patients. Int J Radiat Oncol Biol Phys 2005; 61 (04) 1078-1086
    PubMedSearch in Google Scholar
  • 35 Johnston SL, Farrell SA, Bouchard C. et al. SOGC Joint Committee-Clinical Practice Gynaecology and Urogynaecology. The detection and management of vaginal atrophy. J Obstet Gynaecol Can 2004; 26 (05) 503-515
    PubMedSearch in Google Scholar
  • 36 Suckling J, Lethaby A, Kennedy R. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev 2006; 18 (04) CD001500
    PubMedSearch in Google Scholar
  • 37 Stal J, Yi SY, Cohen-Cutler S. et al. Fertility preservation discussions between young adult rectal cancer survivors and their providers: Sex-specific prevalence and correlates. Oncologist 2022; 27 (07) 579-586
    PubMedSearch in Google Scholar
  • 38 Tessier L, McKechnie T, Lee Y, Park LJ, Gangam N, Eskicioglu C. Laparoscopic ovarian transposition prior to pelvic radiation in young women with anorectal malignancies: a systematic review and meta-analysis of prevalence. Colorectal Dis 2023; 25 (07) 1336-1348
    PubMedSearch in Google Scholar
  • 39 Azaïs H, Canova CH, Vesale E, Simon JM, Canlorbe G, Uzan C. Laparoscopic uterine fixation to spare fertility before pelvic radiation therapy. Fertil Steril 2018; 110 (05) 974-975
    PubMedSearch in Google Scholar
  • 40 Manderson L. Boundary breaches: the body, sex and sexuality after stoma surgery. Soc Sci Med 2005; 61 (02) 405-415
    PubMedSearch in Google Scholar
  • 41 Krouse R, Grant M, Ferrell B, Dean G, Nelson R, Chu D. Quality of life outcomes in 599 cancer and non-cancer patients with colostomies. J Surg Res 2007; 138 (01) 79-87
    PubMedSearch in Google Scholar
  • 42 Zhu A, Wittmann D. Barriers to sexual recovery in men with prostate, bladder and colorectal cancer. Urol Oncol 2022; 40 (09) 395-402
    PubMedSearch in Google Scholar
  • 43 Damon W, Rosser BR. Anodyspareunia in men who have sex with men: prevalence, predictors, consequences and the development of DSM diagnostic criteria. J Sex Marital Ther 2005; 31 (02) 129-141
    PubMedSearch in Google Scholar
  • 44 Hartman ME, Irvine J, Currie KL. et al. Exploring gay couples' experience with sexual dysfunction after radical prostatectomy: a qualitative study. J Sex Marital Ther 2014; 40 (03) 233-253
    PubMedSearch in Google Scholar