A prospective study of sexual function after major colorectal surgery

Abstract

Summary Excision of the recto-sigmoid and rectum for cancer or inflammatory disease frequently damages the autonomic nerve supply. The anatomy and function of the autonomic nervous system in the pelvis is reviewed. Thirty-two patients who underwent excision of the rectum have been studied: 28 operations were for carcinoma, 4 for ulcerative colitis. A detailed history of sexual function was obtained preoperatively together with a neurological examination of the genitalia and perineum. Biopsies were taken from the surgical specimens and examined for the presence of nerve tissue. A further sexual history was taken 3 months postoperatively. Ten sexually active men (ages 46–74) who had anterior resections or abdominoperineal excisions for carcinoma tended to show impaired sexual activity if there was excessive nerve tissue in the specimen. Two out of 3 sexually active women (ages 53–68) who had cancer operations had satisfactory sexual function postoperatively. Four patients (ages 28–66) all had satisfactory sexual function after panproctocolectomy for ulcerative colitis. The advantages of avoiding damage to the pelvic autonomic nerves at operation are discussed.