Introduction:

Cancer treatment can have a major impact on sexual function (SF) – reports of sexual dysfunction range from 6-96% across all cancer types. Among cancer survivors, sexual dysfunction has been reported to profoundly impact quality of life.  Bladder cancer (BCa) is the 4^th most common malignancy in the United States, and treatment, particularly for invasive disease, can impact sexual function.  Despite this, many urologists do not discuss possible sexual function changes with patients prior to radical cystectomy (RC), particularly with women. In a recent publication by Gupta, et al. a lack of information about baseline sexual function was a commonly cited barrier to initiating these conversations. Therefore, our aim was to evaluate perioperative sexual function among patients undergoing radical cystectomy. 

Methods:

A prospective cohort of 150 patients undergoing RC for BCa and participating in an internal validation study at a single institution from 2016-2019 were eligible for analysis. The EORTC QLQ – BLM 30 and FACT-BL were administered; those completing the SF subscale of the EORTC QLQ – BLM 30 were included in final analysis. Analysis was performed using descriptive statistics and generalized linear modeling.  The primary outcome was interest or engagement in sexual activity within 4 weeks of survey completion, while the secondary outcome was mean score on EORTC QLQ – BLM 30 SF subscale.

Results:

Overall, 132/150 (88%) of patients were eligible, of whom 82% were male and median age was 68.5.  53% reported at least a little interest in sexual activity and 40% endorsed sexual activity within the last 4 weeks.  Figure 1 shows the mean subscale domain scores for the cohort. Mean SF subscale score was 61.5 ± 25.2.  Women had significantly worse mean scores of 72.9± 27.1 versus 59.1 ± 24.2 for men (p= 0.02). Answers to each SF domain question by gender are shown in Figure 2. On multivariate analysis both age and female gender were independently associated with higher SF domain scores.

Conclusion:

A substantial portion of radical cystectomy patients endorse being sexually active or express interest in sexually activity in the perioperative period; however female gender is associated with worse sexual function domain scores. Given the recent increase in attention given to sexual function outcomes and quality of life, this work supports further efforts to explore this area and develop novel interventions to improve outcomes. 

Funding: N/A