HAMBURG, GermanySexual dysfunction is a significant problem for
women who have undergone bone marrow transplants, Dr. Karen Syrjala
said at the Fourth International Congress of Psychooncology. A
clinical psychologist from Fred Hutchinson Cancer Research Center,
Dr. Syrjala reported results of a longitudinal study that followed
118 men and women for more than 3 years following transplantation.
No Improvement After First Year
Womens satisfaction with their sexual functioning decreased
sharply from pretransplant to 1 year post-transplant, she said, and
although the change in functioning from 1 year to 3 years was not
significant, the slope is not in the direction of improvement.
There has been no improvement in sexual functioning for the
women after that first year post-transplant, she said.
Dr. Syrjala said that 60% of the women in the study had sexual
problems at 1 year post-transplant, and 88% of these women continued
to report at least as many problems 3 years later. No medical
or psychological variables, either at 1 year post-transplant or
pretransplant, predicted which women would report problems with
sexual functioning 3 years after transplant, she said.
Although physicians often counsel time as the healer, these data
indicate that postponing a return to sexuality is unlikely to
be helpful in eradicating any problems that might exist, she
Hormone Replacement Therapy
Dr. Syrjala noted that the study showed a positive impact of
hormone replacement therapy on sexual functioning. Although at
1 year there was no difference in sexual functioning between women
receiving or not receiving hormone replacement, the average reported
sexual satisfaction, on a scale of 1 to 100, was 8 for women not on
hormone replacement vs 60 for women on replacement therapy, a
Realizing the severity of the sexual dysfunction after transplant,
Dr. Syrjalas team began to study a second group of 114 women,
most of whom had received tranplants for either chronic or acute
leukemia. All of the women without con-traindications were started on
hormone replacement therapy by 100 days post-transplant. Of the women
who reported being sexually active at 1 year, 80% were receiving
hormone replacement therapy.
In looking at those women who were on hormone replacement therapy,
62% reported being sexually active, compared with 38% of women not
receiving hormone replacement therapy. In general, at 1 year the
women who were sexually active were more likely to be receiving
hormone replacement therapy. The only medical factor that predicted
sexual activity was total body irradiation (women who had received
total body irradiation were less likely to be sexually active).
Despite this level of sexual activity, Dr. Syrjala said, 83% of women
said that their sexual functioning was worse than pretransplant.
We again found that the level of sexual satisfaction prior to
transplant did not predict sexual satisfaction post-transplant or at
1 year, she said.
Although hormone replacement did not improve overall reported sexual
functioning, it was significantly related to the arousal component of
sexual functioning, she said. We found that early treatment
with hormone replacement therapy is the most effective immediate step
we are able to take to help these women improve their sexual
functioning, but it clearly does not, in and of itself, assure sexual
A question remains about those women who are not able to take hormone
replacement therapy. We need to consider the interaction
between sexual functioning and hormones in these survivors and also
need to be very cautious in using androgen replacement.
Researchers have hypothesized that the effect of chemotherapy and
radiation is more dramatic on the ovaries than the adrenal glands,
but we dont know this, she said. It is possible
that both estrogen and androgen precursors, which also come, in part,
from the adrenal glands, may be important in both sexual functioning
and in mood and cognitive components.
Even if use of estrogen in and of itself does not explain
improvements in sexual satisfaction, she said, clearly
there is some relationship, but we still have a very open question
about the role of androgens and the interaction of hormones in women
and whether the lack of androgens is related to lower levels of
sexual desire. We need to understand a great deal more before we can
really state the influence of endocrinology on the quality of life of