Effect of cytotoxic therapy on sexuality and gonadal function

Many chemotherapeutic agents have been shown to cause variable degrees of gonadal dysfunction in both sexes and in all age groups. The severity of the dysfunction depends on the total drug dose and the age at time of therapy. In general, cytotoxic agents produce gonadal dysfunction in men while they produce premature gonadal failure in women. Men develop azoospermia and compensated Leydig-cell function; women sustain ovarian damage causing impaired fertility in the short term and early ovarian failure later. This dysfunction is associated with sexual and emotional difficulties in many patients. In order to discover these problems the physician must sympathetically ask patients and families about their sexual and emotional health. Endocrine and psychologic evaluation help the physician identify the problem. Appropriate counseling and hormone replacement therapy may ameliorate most symptoms and help the patient emotionally adjust to illness and infertility. Prevention of gonadal damage during cytotoxic therapy may be possible in the future. For those young people who retain fertility after cytotoxic therapy, prognosis should be taken into account when counseling about parenthood is given. There is no evidence of genetic abnormalities in the offspring of people previously treated with chemotherapy or irradiation.