In a review published in the Journal of Clinical Medicine, researchers described sexual and emotional health impacts following allogeneic hematopoietic stem cell transplantation (allo-HCT), and they summarized recommendations from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC). The review was authored by Tamim Alsuliman, MD, MSc, of Sorbonne Université in Paris, France, and colleagues.
The authors explained in their review that allo-HCT is associated with impacts on sexual and emotional health, with sexual problems reported in 50% of men and 80% of women following allo-HCT. Additionally, when chronic graft vs host disease (GVHD) is present, sexual health is further impacted. The authors reported that recovery from sexual dysfunction typically happens within 2 years, but some complications may persist for 5 to 10 years after allo-HCT. The authors also described research indicating that many patients have felt that information regarding allo-HCT-related effects on fertility or sexuality was not fully addressed with them.
Effects on sexuality are complex and mixed with psychological or physiological health, Dr Alsuliman and colleagues explained. Hormonal and GVHD-related factors can be associated with sexual and emotional complications. Physical aspects of sexual function in patients after allo-HCT may be affected by such factors as premature ovarian failure (in women), genital GVHD in either sex or nonspecific conditions, such as those affecting libido or mood.
Endocrine dysfunction after allo-HCT can affect ovarian function and family planning. The authors described a study in which hypoestrogenism was seen in 86% of female patients who underwent allo-HCT before they were 35 years of age, and premature ovarian failure was seen in 74%. Hypogonadism in male patients has been described in association with allo-HCT in childhood, but impacts in adulthood are not as well understood. However, research described by the authors suggests impacts on sexual health in adult males after childhood allo-HCT, as well as potentially with allo-HCT performed in adulthood.
The SFGM-TC guidelines, the authors explained, indicate that patients should receive pretransplant and follow-up consultations to evaluate clinical and other aspects of health. The guidelines also provide potential questions patients may ask, as well as possible answers. For example, a patient may ask when it is possible to resume intercourse, and an answer may indicate that sexual intercourse can occur as soon as the patient returns home.
“If patients respect the hygiene instructions and the standard antibacterial, antiviral and antifungal prophylaxis that have been provided to them at the end of the transplant, and if there are no active infections in the partner, there is no justification for a restriction on physical contact, nor is there any specific time limit to be observed,” the researchers wrote.
Some other possible questions related to specific fears and requests for information, such as how a female patient may know if she is menopausal or what to do if there is pain during intercourse. “A multidisciplinary approach should be favored to treat the different aspects of the sexual and emotional life of allo-HCT patients,” the authors concluded in their review.
Alsuliman T, Jondreville L, Baylet C, et al. Sexual and emotional health after allogeneic hematopoietic cell transplantation: a comprehensive review and guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC). J Clin Med. 2022;11(5):1196. doi:10.3390/jcm11051196