Adverse Sexual Health Outcomes Appear More Likely in Women With CRC

Data revealed that among 25,402 women diagnosed with CRC vs 254,020 without CRC, the rates of dyspareunia were 19.71% and 16.41%, respectively.

Women diagnosed with colorectal cancer (CRC) may experience a greater likelihood of adverse sexual health outcomes, according to results from a cohort study using British Columbia-based administrative health data published in the Journal of the National Cancer Institute.

Data revealed that among 25,402 women diagnosed with CRC vs 254,020 without CRC, the rates of dyspareunia were 19.71% and 16.41%, respectively (HR, 1.67; 95% CI, 1.62-1.73), after a median follow-up of 3.3 years and 7.5 years. Additionally, the respective HRs for women 39 years or younger and those 40 years or older were 1.90 (95% CI, 1.58-2.28) and 1.67 (95% CI, 1.62-1.73) in age-stratified models. Surgery (HR, 1.23; 95% CI, 1.14-1.33), chemotherapy (HR, 1.25; 95% CI, 1.16-1.34), and radiation (HR, 1.24; 95% CI, 1.12-1.37) were all associated with an increased risk of dyspareunia according to sensitivity analyses among female patients diagnosed with CRC.

After a median follow-up of 4.0 years and 8.2 years in patients with or without CRC, respectively, pelvic inflammatory disease occurred in 1.96% and 0.73%, with an HR of 3.42 (95% CI, 3.07-3.81) in a multivariate model. Age-stratified models revealed attenuated risk for patients 39 years or younger (HR, 1.67; 95% CI, 1.08-2.57) and a strong risk for those 40 years or older (HR, 3.66; 95% CI, 3.27-4.09). Additionally, sensitivity analyses showed a higher risk associated with left colon CRC (HR, 1.80; 95% CI, 1.26-2.56) and rectal CRC (HR, 2.21; 95% CI, 1.52-3.23) as well as with radiation therapy (HR, 1.56; 95% CI, 1.21-2.02).

“We found higher risks of dyspareunia, pelvic inflammatory disease, endometriosis, and premature ovarian failure in female [patients with] CRC,” lead author Niki Oveisi, PhD, MPH, of the University of British Columbia Faculty of Pharmaceutical Sciences and from the Collaboration for Outcomes Research and Evaluation in Vancouver, British Columbia, Canada, wrote in the publication with study coinvestigators. “Critically, we found variations in risk when stratifying analyses according to age…which suggest the complex link between CRC and sexual health. Future research focusing on the development of interventions and supports to reduce sexual health impacts in female [patients] with CRC is warranted.”

Further data showed that endometriosis was observed in 0.95% of patients with CRC vs 0.70% in those without (HR, 1.95; 95% CI, 1.69-2.25). Furthermore, age-stratified analyses revealed that no statistically significant association between CRC and endometriosis was observed among women 39 years or younger (HR, 1.21; 95% CI, 0.78-1.89) whereas an association was seen among those 40 years or older (HR, 2.07; 95% CI, 1.78-2.40). Sensitivity analyses revealed that surgery was associated with an elevated risk of endometriosis (HR, 1.80; 95% CI, 1.32-2.45).

Patients selected in the study included women diagnosed with CRC between January 1, 1985, and December 31, 2017, as well as those who did not receive a CRC diagnosis, in the deidentified Population Data British Columbia data resource. Patients in the CRC cohort were matched by age and sex to 10 cancer-free controls. Age, neighborhood income quintile, and residence type were considered demographic features in addition to comorbidities, health care encounters, and CRC characteristics.

Among patients with or without CRC, the mean age in both groups was 69.0 years (SD, 13.1). A total of 1.9% vs 0.4% had inflammatory bowel disease, 15.1% vs 10.9% had doctor visits in the year prior, and the rate of hospitalization was 55.2% vs 20.7%. Women with CRC most often experienced cancer in the left colon (39.8%) and rectum (28.8%), and the most common treatments included surgery (42.9%) and chemotherapy (35.5%).

The end points of the trial included the incidence of dyspareunia, abnormal bleeding, pelvic inflammatory disease, endometriosis, and premature ovarian failure.

In a multivariable model, patients 39 years or younger with CRC had a higher risk of premature ovarian failure than those without CRC (HR, 1.75; 95% CI, 1.40-2.19). Additionally, among those 39 years or younger, chemotherapy was associated with an elevated risk of premature ovarian failure (HR, 2.64; 95% CI, 1.65-4.22).

Reference

Oveisi N, Sayre EC, Brotto LA, et al. Sexual health outcomes after colorectal cancer diagnosis in females: a population-based cohort study. J Natl Cancer Inst. Published online June 1, 2025. doi:10.1093/jnci/djaf120