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Sexual function after rectal excision.

John P Keating1

  • 1Departments of Surgery and Anaesthesia, Wellington School of Medicine and Health Sciences, Wellington, New Zealand. surgjk@wnmeds.ac.nz

ANZ Journal of Surgery
|March 27, 2004
PubMed
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Rectal surgery can cause sexual dysfunction (SD), but modern techniques have reduced risks. While low anterior resection (LAR) has a lower impotence rate than abdomino-perineal excision (APE), patient age is key for rectal cancer outcomes.

Area of Science:

  • Colorectal surgery
  • Urology
  • Sexual health

Background:

  • Rectal excision surgery poses a risk of autonomic nerve damage, potentially leading to sexual dysfunction (SD).
  • Surgical advancements and improved understanding of sexual anatomy/physiology have decreased SD incidence post-rectal surgery.
  • Quantifying postoperative SD risk is crucial for patient counseling and surgical practice auditing.

Purpose of the Study:

  • To review the evolving understanding of sexual dysfunction following rectal surgery.
  • To assess the current risks of sexual dysfunction after various rectal excision procedures.
  • To provide benchmarks for auditing colorectal surgical practice regarding sexual morbidity.

Main Methods:

  • Comprehensive literature search of the Medline database.

Related Experiment Videos

  • Focused research on anatomy, physiology, and surgical techniques related to sexual function after rectal surgery.
  • Review of recent data in the historical context of rectal disease surgery.

    • Main Results:

    • Permanent impotence rates are low (<2%) after restorative proctocolectomy and proctocolectomy with ileostomy for benign conditions.
    • Abdomino-perineal excision (APE) has a high impotence rate (>40%), whereas low anterior resection (LAR) carries approximately half the risk.
    • Patient age is the primary predictor of sexual dysfunction after rectal cancer surgery.

    Conclusions:

    • Modern rectal surgery, particularly LAR with autonomic nerve preservation, results in low, predictable sexual morbidity.
    • The shift from APE to LAR has likely reduced the overall number of patients experiencing impotence due to rectal cancer surgery.
    • Further research is needed on the impact of adjuvant therapies on sexual function, and surgeons should proactively discuss sexual health implications with patients.