Sexual functioning after treatment for testicular cancer - Review and meta-analysis of 36 empirical studies between 1975-2000

Literature concerning sexual functioning after treatment for testicular can cer from 1975-2000 is reviewed. After a literature search in Medline and Ps ylit was conducted, as well as a search for cross-references made, a meta-a nalysis was performed. To describe sexual functioning, several aspects of t he sexual response cycle were used: sexual desire, sexual arousal, erection , and orgasm; ejaculatory function, sexual activity, and sexual satisfactio n were used as well. The number of patients included in the studies as well as treatment modalities were taken into account. A total of 36 relevant st udies was screened (28 retrospective and 7 prospective studies), concerning 2,786 cases of testicular cancer. Meta-analysis revealed that ejaculatory dysfunction was reported most frequently and was related to surgery in the retroperitoneal area. Erectile dysfunction was related to irradiation, but was reported least frequently. Other sexual functions were not related to t reatment modality. Meta-analysis revealed no deterioration of sexual functi oning in the course of time, except a decrease in sexual desire and an incr ease in sexual satisfaction. Retrospective studies reported more sexual dys function than did prospective studies. Detailed analysis of separate studie s, however, revealed a wide variation in reported sexual morbidity, as well as in assessment methods. Somatic consequences of disease and treatment ma y reduce ejaculation; however, other aspects of sexual functioning are not clearly related to disease- or treatment-related factors and may instead re fer to a psychological vulnerability caused by one's confrontation with a l ife-threatening, genito-urinary disease, such as testicular cancer.