Dyadic Concordance of Sexuality Among Hematopoietic Stem Cell Transplantation Patients and Their Partners

Introduction

Sexual dysfunction after receiving hematopoietic stem cell transplantation (HSCT) deteriorates quality of life (QoL) of both HSCT survivors and their partners. However, previous studies have mainly focused on the patients' medical and psychological factors contributing to sexual dysfunction, rather than on the perspectives of the relationship between the patients and their partners. We conducted a cross-sectional, HSCT survivor-partner matching study to determine the concordance of perception, attitude, and problems raised in their sexual activity after receiving HSCT.

Methods

HSCT survivors and their partners were recruited through the post-HSCT registry from Samsung Medical Center and Korea Blood Cancer Association. HSCT survivors and their partners have separately answered to a set of questionnaire which includes items on their sexual activity, QoL, depression, fear of recurrence and body image. We analyzed the data using McNemar test, paired t-test, kappa coefficients to correct for the amount of agreement and multivariable logistic regression models.

Results

Between September 2013 and March 2015, 175 patients who received HSCT for hematologic malignancies and had no evidence of recurrent disease were recruited. Finally, 91 pairs of HSCT survivors and their partners were analyzed. Sixty (65.9%) patients were male and mean age of patients and their partners were 51.5 and 49.8, respectively. Type of HSCT were autologous in 29 patients (31.9%), allogenic from sibling donor in 27 patients (29.7%), allogenic from unrelated donor in 25 patients (27.5%) and haploidentical HSCT in 9 patients (9.9%). Twenty-six (28.6%) and 51 patients (56.0%) experienced acute graft-versus-host disease (GVHD) and chronic GVHD, respectively. The average period after HSCT was 3.3 years and 23 patients were treated with corticosteroids at the time of study enrollment. The patients and their partners showed discordance in the aspects of importance and satisfaction of sexual activity. The patients scored higher than their partners at the questions of "Adequate sexual activity is important." (2.57 vs. 2.14, difference 0.44±1.12, p<.01, agreement 71.6%, weighted κ 0.17) and "I desire to have sexual activity with my partner." (2.30 vs. 1.89, difference 0.41±1.10, p<.01, agreement 72.7%, weighted κ 0.21). Interestingly, however, the partners answered "rejection of spouse" as a cause of sexual difficulties more than the patients (22.0% vs. 15.4%). Decreased physical stamina after HSCT was the most common answer for the cause of sexual difficulties from both of patients (46.2%) and partners (37.4%), and alteration of body due to GVHD also affected the sexual activity of both patients and healthy partners (25.3% and 20.9%). In multivariate analysis of patient-partner dyad factors, male sex and importance of adequate sexual activity were associated with increased sexual activity for both groups. For the patients, sexual desire disorder was associated with decreased sexual activity (hazard ratio [HR] 0.34, 95% confience interval [CI] 0.12-0.93, p<.05), while partners were predicted to have decreased sexual activity when patients had GVHD with body changes (HR 0.22, 95% CI 0.05-0.89, p<.05).

Conclusions

HSCT survivors considered sexual activity is important, and they desired to engage in sexual activity more than their partners did. Misunderstanding of the patients' demands by their partners can be one of the causes of decreased sexual activity. Adequate educational and interventional programs for HSCT survivors and their partners are needed for improving QoL after receiving HSCT.