Rates of Erectile Dysfunction Higher in Childhood Cancer Survivors

September 14, 2018

Linda Jacobs, PhD, CRNP, director of the Cancer Survivorship Center, comments on the incidence of erectile dysfunction in childhood cancer survivors.

Men who have been treated for childhood cancers are at increased risk for the sexual issues that all aging men face, specifically a 2.6-fold increased risk for developing erectile dysfunction. These data are from a study conducted with the Childhood Cancer Survivor Study (CCSS) cohort, examining 1,622 male survivors and 271 eligible unaffected male siblings, which was published in the Journal of Sexual Medicine back in 2016.

Commenting on current data as a follow-up to this study, Linda Jacobs, PhD, CRNP, founding director of the Cancer Survivorship Center at Penn Medicine’s Abramson Cancer Center, said that survival rates for cancer patients of all ages continues to rise, and the population of adolescent and young adult survivors of childhood cancer are facing unique long-term health challenges that are not well understood, including a variety of issues related to sexual function and fertility.

In the study, erectile dysfunction was reported in 12.3% of the childhood cancer survivors, compared with 4.2% of unaffected siblings, with a higher incidence in those with a history of cancer treatments that included high-dose radiation and/or surgery to the testicles, spinal nerve, prostate, or pelvis. Only 5.9% of cancer survivors reported receiving treatment for erectile dysfunction, mainly with oral medications, while 2.3% of unaffected siblings reported receiving treatment.

When asked specific questions related to erectile dysfunction, 23.9% of cancer survivors reported some degree of “difficulty getting an erection” vs 19.8% of unaffected siblings. When asked about “losing an erection during sexual activity,” 31.7% of cancer survivors reported some degree of difficulty, while only 23.4% of unaffected siblings reported this issue.

Jacobs further explained that erectile dysfunction is not evaluated in the general population of young men, and the sensitive nature of the topic may make it difficult for cancer survivors to discuss the problem with their healthcare providers. She added that younger patients (20 to 39 years) are more likely to refuse to seek treatment secondary to embarrassment.

She also noted that treatment for many childhood cancers can result in low testosterone levels; testicular failure; and pituitary changes that impact sexual development, hormone levels, and libido, as well as psychiatric issues that can affect sexual functioning. Consequently, it is important that providers are aware of the possibility of erectile dysfunction in young cancer survivors and discuss and/or screen for this issue with validated questionnaires and laboratory testing.

Jacobs noted that these young men would benefit from targeted education that promotes awareness and better understanding of their cancer diagnoses, their treatment, and the long-term and late effects of treatment that they may be at risk for developing, including sexual dysfunction.