Male sexual dysfunction

Apart from the effect of chemotherapy on spermatogenesis, many men being treated for Hodgkin’s disease develop sexual dysfunction. Half of the men in one study reported a decrease in libido at the time of diagnosis but this group increased to over 80% during therapy. This may be a consequence of the stress associated with the diagnosis of cancer, although only 10% of men were impotent before therapy commenced. Alternatively, the unpleasant systemic side effects of chemotherapy are likely to lead to a reduction in interest in sexual relations.

Adult women

In contrast to the situation in men, ovarian function does not appear to be adversely affected by Hodgkin’s disease before treatment. The ovarian response to chemotherapy depends on the age of the patient and the type and dose of treatment. In a long-term follow-up study of 28 women treated using the MVPP regimen, 22 became amenorrhoeic with associated oestrogen deficiency. In this group of patients, the ovarian damage was thought to be permanent,
i.e. the patients had become menopausal.

Influence of duration of treatment – health and care medications online from Canada here. Normal ovarian function was retained in 24% of patients receiving six cycles of MVPP chemotherapy but only in 5% of patients who needed seven or more cycles. All patients who received 12 cycles of chemotherapy developed ovarian failure irrespective of age.

Influence of age. Analysis of the effects of patient age and duration of therapy in one study showed that a third of 16 patients who were less than 29 years old developed ovarian failure in response to MVPP therapy for Hodgkin’s disease. This increased to 84% in a group of 25 patients who were 30 years or older. Horning et al. calculated the probability of retaining regular menstruation in women in relationship to age and modality of treatment. The association of chemotherapy and total lymphoid irradiation was more likely to result in ovarian dysfunction than chemotherapy alone. Following chemotherapy alone, a 20-year-old woman had nearly an 80% chance of regular periods after treatment. However this decreased to only approximately 30% in a 30 year old. The obvious correlation of this is that the chances of pregnancy are severely reduced if menstruation is irregular or if the patient becomes amenorrhoeic. Cheap impotence medications online from Canadian health and care mall

It is probable that ovarian damage occurs even in women who do not become amenorrhoeic during therapy. This is manifested by an earlier menopause than would be anticipated naturally. This phenomenon is also age related so that ovarian failure occurred within 1 year of cessation of therapy in all patients over the age of 38 years, whereas in younger patients there was a gradual decrease in menstrual frequency over a period of several years (Schilsky et al., 1981). Therefore, age, number of cycles of treatment and regularity of menstruation can all be used to try to predict the chances of future fertility in women being treated for Hodgkin’s disease.

Ovarian failure obviously prevents the possibility of future conception, but there are more immediate effects that can also be distressing. These are the typical menopausal symptoms, the commonest of which is hot flushes. Many young women find these embarrassing. Low oestrogen levels are also associated with a reduction in vaginal lubrication during coitus and a thinning of the vaginal epithelium, both of which contribute to painful intercourse. It is not surprising that many women experience a profound change in their sexual relationships following ovarian failure induced by chemotherapy: 70% of women claimed to have little or no libido when followed for a mean time of 3 years after combined chemotherapy. It has been estimated that the rate of breakdown of couples in which the woman has developed ovarian failure between the ages of 25 to 30 is four times greater than in the general population.