Sexual satisfaction in survivors of bone marrow transplantation

Of 157 (80%) adult survivors of bone marrow transplantation, 126 responded to a mailed survey 6-149 months after transplant concerning their ability to attain sexual satisfaction. Sixty-five percent of the subjects indicated some degree of sexual satisfaction (with 29% indicating a high degree of satisfaction). Thirteen percent were neutral and 22% were dissatisfied. Gonadal physiological disturbances were present in most subjects as a result of intensive treatments. Fifty-seven percent of women were receiving estrogen replacement, and only 40% had regular menses. Twenty-four percent of men had difficulty with erections and 13% had ejaculatory dysfunction. For men, difficulties with erection (r= 0.54, p < 0.001) or ejaculation (r=0.52, p < 0.001) were associated with inability to attain sexual satisfaction. For women, loss of menses (r=0.34, p=0.008) was associated with inability to attain sexual satisfaction. Although few women had abnormally low serum estradiol (even with hormonal supplementation), and none of the 43 men tested had abnormally low serum testosterone, sexual satisfaction correlated with serum levels of estrogen in women (r=0.42, p=0.04) and serum testosterone in men (r=0.28, p=0.04). Forty-two subjects rated their level of sexual satisfaction before and after transplant. Post-transplant satisfaction was not associated with pretransplant satisfaction (r=0.07, p=0.67). In a multivariate analysis, factors associated with sexual satisfaction were: younger age at the time of transplant [odds ratio (OR)=0.9055 per year of age, p < 0.001], the diagnosis of aplastic anemia rather than malignancy as the reason for transplant (OR=8.013, p=0.009), satisfaction with appearance (OR=5.609, p=0.005), overall life satisfaction (OR=1.372, p=0.017), and a satisfying relationship with spouse or boy(girl)friend (OR=6.193, p=0.002)