Urinary and sexual dysfunction in women after resection with and without preoperative radiotherapy for rectal cancer: a population‐based cross‐sectional study

<jats:title>Abstract</jats:title><jats:sec><jats:title>Aim</jats:title><jats:p>Knowledge of urinary and sexual dysfunction in women after rectal cancer treatment is limited. This study addresses this in relation to the use of preoperative radiotherapy, type of surgery and the presence of bowel dysfunction.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>All living female patients who underwent abdominoperineal excision (<jats:styled-content style="fixed-case">APE</jats:styled-content>) or low anterior resection (<jats:styled-content style="fixed-case">LAR</jats:styled-content>) for rectal cancer in Denmark between 2001 and 2007 were identified. Validated questionnaires (the <jats:styled-content style="fixed-case">ICIQ</jats:styled-content>‐<jats:styled-content style="fixed-case">FLUTS</jats:styled-content> and the <jats:styled-content style="fixed-case">SVQ</jats:styled-content>) on urinary and sexual function were completed by 516 (75%) and 482 (72%) recurrence‐free patients in 2009.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Urgency and incontinence were reported by 77 and 63% of respondents, respectively. Vaginal dryness, dyspareunia and reduced vaginal dimensions occurred in 72, 53 and 29%, respectively, and 69% reported that they had little/no sexual desire. Preoperative radiotherapy was associated with voiding difficulties (<jats:styled-content style="fixed-case">OR</jats:styled-content> = 1.63, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.09–2.44), reduced vaginal dimensions (<jats:styled-content style="fixed-case">OR</jats:styled-content> = 4.77, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.97–11.55), dyspareunia (<jats:styled-content style="fixed-case">OR</jats:styled-content> = 2.76, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.12–6.79), lack of desire (<jats:styled-content style="fixed-case">OR</jats:styled-content> = 2.22, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.09–4.53) and reduced sexual activity (<jats:styled-content style="fixed-case">OR</jats:styled-content> = 0.55, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.30–0.98). Patients undergoing <jats:styled-content style="fixed-case">APE</jats:styled-content> had a higher risk of dyspareunia (<jats:styled-content style="fixed-case">OR</jats:styled-content> = 2.61, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.00–6.85). Bowel dysfunction after <jats:styled-content style="fixed-case">LAR</jats:styled-content> was associated with bladder storage difficulties (<jats:styled-content style="fixed-case">OR</jats:styled-content> = 1.64, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.01–2.65), symptoms of incontinence (<jats:styled-content style="fixed-case">OR</jats:styled-content> = 2.17, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.35–3.50), lack of sexual desire (<jats:styled-content style="fixed-case">OR</jats:styled-content> = 2.69, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.21–5.98), sexual inactivity (<jats:styled-content style="fixed-case">OR</jats:styled-content> = 0.48, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.24–0.96) and sexual dissatisfaction (<jats:styled-content style="fixed-case">OR</jats:styled-content> = 0.40, 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 0.20–0.82).</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Urinary and sexual problems are common in women after treatment for rectal cancer. Preoperative radiotherapy interferes with several aspects of urinary and sexual functioning. Bowel dysfunction after <jats:styled-content style="fixed-case">LAR</jats:styled-content> is associated with urinary dysfunction and a reduction in sexual desire, activity and satisfaction.</jats:p></jats:sec>