Psychophysiological assessment of sexual function in women after radiotherapy and total mesorectal excision for rectal cancer: a pilot study on four patients.

INTRODUCTION: The potential contribution of psychological and anatomical changes to sexual dysfunction in female patients following short-term preoperative radiotherapy (5 x 5 Gy) and total mesorectal excision (TME) is not clear. Aim. In this study we assessed female sexual dysfunction in patients who underwent radiotherapy and TME for rectal cancer. MAIN OUTCOME MEASURES: Genital arousal was assessed using vaginal videoplethysmography. METHODS: Sexual functioning was examined in four patients who had rectal cancer and underwent radiotherapy and TME. All investigations were done at least 15 months after treatment. The results were compared with an age-matched group of 18 healthy women. RESULTS: The patients and healthy controls showed comparable changes in vaginal vasocongestion during sexual arousal, though three out of four patients showed a lower mean spectral tension (MST) of the vaginal pulse compared with healthy controls. Subjective sexual arousal was equivalent between the two groups. CONCLUSIONS: In this study the changes of genital and subjective sexual arousal after erotic stimulus condition between patients and healthy controls were not different, though lower MST of the vaginal pulse was found in three out of four patients compared with healthy women. Additional work, however, must be performed to clarify the mechanisms of sexual dysfunction following treatment of rectal cancer.

Vaginal pudendal nerve stimulation: a new technique for assessment of pudendal nerve terminal motor latency.

BACKGROUND: To evaluate vaginal stimulation of the pudendal nerve, a new method for investigation of pudendal nerve terminal motor latency (PNTML) and to assess the reproducibility of the method. METHODS: Thirteen healthy women and 11 female patients, median age 31 years (range 21-53 years), participated in the study. Ten patients had sustained an anal sphincter rupture and one had idiopathic anal incontinence. Pudendal nerve terminal motor latency was measured after vaginal stimulation of the pudendal nerve with motor response from the pelvic floor and rectal stimulation with motor response from the anal sphincter using the St. Marks pudendal electrode. The women were stimulated by two observers both vaginally and by the rectum. RESULTS: Vaginal PNTML for observer 1 was 2.06 msec (0.50 msec, 2 s.d.) and 2.04 msec (0.55 msec, 2 s.d.) for observer 2, while rectal PNTML was 1.99 msec (0.56 msec, 2 s.d.) and 1.97 msec (0.54 msec, 2 s.d.) respectively. The difference between vaginal and rectal PNTML was 0.065 msec for observer 1 (p = 0.106) and 0.070 msec for observer 2 (p < 0.05). Degree of agreement between vaginal and rectal PNTML was 80%-116% for observer 1 and 84%-12% for observer 2 (100% represent total agreement between measurements). Interobserver reproducibility for vaginal PNTML was 90%-109% and 86%-113% for rectal PNTML. CONCLUSION: In clinical practice vaginal PNTML may replace rectal PNTML in women. Reproducibility is in the same range as for rectal PNTML.