Objective and subjective effects of treatment for testicular cancer on sexual function

Objective To determine whether the treatment of patients with testicular ca ncer, using cisplatin combined with etoposide and bleomycin (BEP) after orc hidectomy in those with disseminated disease, causes changes in sex hormone s and penile vascularization, possibly related to sexual dysfunction, Patients and methods Ten patients treated with BEP were compared with 11 un dergoing orchidectomy alone followed by surveillance. Sex hormone levels we re analysed and cavernosal artery duplex ultrasonography performed before o rchidectomy and at 6 and 12 months afterward. Patients were questioned abou t their sexual function. After 1 pear, a visual erotic stimulation (VES) te st was performed to assess penile rigidity. Results In contrast to the surveillance group, BEP-treated patients had hig her follicle-stimulating hormone (4.6 vs 26.5 U/L) and luteinizing hormone (1.4 vs 8.2 U/L) levels, and lower testosterone levels (21.1 vs 14.7 nmol/L ) at 6 months than at baseline. At 1 year, most patients had compensated hy pergonadotrophic. eugonadism, but Leydig cell function had recovered. Chang es in cavernosal artery peak flow velocities induced by local injection wit h papaverine/phentolamine showed no difference between the groups before an d 6 months after orchidectomy. Loss of libido and erectile dysfunction were reported more frequently by BEP-treated patients, However, 1 year after tr eatment, most reported a satisfying sex life and VES resulted in a rigid er ection in nearly all patients. The reported erectile dysfunction could not be explained by changes in plasma testosterone levels or diminished blood f low velocities, Conclusions After being diagnosed with testicular cancer, sexual morbidity is considerable, but within 1 year some improvement may be expected. BEP in duces transient testicular dysfunction but this recovers. Although BEP is r elated to symptoms of angiopathy, cavernosal blood flow seems to be unaffec ted. These findings and the normal VES-evoked penile rigidity suggest that sexual dysfunction is more psychological than organically induced by BEP.