Surgery for rectal cancer may decrease the sexual function but the introduction of total mesorectal excision (TME) with autonomic nerve preservation has significantly increased the number of men with preserved post-operative sexual function . In a prospective study of sexual function before and after rectal cancer surgery, TME significantly preserved the ability to achieve orgasm and to ejaculate when compared to standard rectal cancer surgery . In a retrospective evaluation of sexual function following TME, 86% of patients less than 60 years of age and 67% of patients older than 60 years maintained their ability to engage in sexual intercourse, while 87% of all men maintained their ability to have an erection following TME. Retrograde ejaculation occurs rarely but does not diminish the patient's capacity for normal sexual activity . The effects of TME for rectal cancer on female sexual function are less clear.
One study reported maintained female sexual function, with 85% experiencing vaginal lubrication and 91% achieving orgasm . A higher proportion of women patients report sexual inactivity or indifference prior to surgery, resulting in greater difficulty in an accurate evaluation of their post-operative status .
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