Identifying Barriers to Sexual Health in Patients with Hematological Malignancies and Underprivileged Circumstances

Sexual health is crucial for maintaining the well-being of patients with hematological malignancies. However, less is known about the sexual health of persons with hematological malignancies living in low and middle-income countries. This study aimed to evaluate the quality of sexual health and propose care strategies applicable to our setting.

Methods: A prospective single-center study was performed in adults diagnosed with hematological malignancies from March 2023 to June 2024. The EORTC SHQ-22 questionnaire was used at a single time point. The questions include items involving sexual satisfaction, desire, sexual activity, intimacy, communication with the partner, pain involving sexual activity, fear of incontinence, and adverse effects of treatment on self-image and sexual performance. The survey was administered during the follow-up consult in the outpatient clinic. The primary outcome was to measure the quality of sexual health of patients with malignant hematological diseases. The secondary outcome was to describe associations through independent sociodemographic variables, time of diagnosis, and type of hematological neoplasia diagnosed.

Results: 109 patients were evaluated, 45% men and 55% women, with a median age of 39 (18-78). The most common diagnoses were acute lymphoblastic leukemia (34.9%) and acute myeloid leukemia (20.2%), followed by non-Hodgkin lymphoma (14%). Most patients did not have any comorbidities. The prevalent comorbidity was type 2 diabetes mellitus, present in 11% of patients.

Being sexually active was considered important by 38% of patients, and a similar proportion reported low satisfaction in this regard. Furthermore, 61% indicated little sexual activity during treatment, resulting in an average score of 49/100 in sexual satisfaction. Regarding pain, the average score was 18/100, with only 12% showing concern about pain during sexual intercourse. Lack of energy and fatigue affecting sex life was reported by 44%, and 68% mentioned that the treatment negatively impacted their sexual health at some level. Most patients did not receive information about sexual problems from their treating doctors (83%).

The decrease in libido affected all groups, predominating in patients with multiple myeloma and acute lymphoblastic leukemia (p=0.04). Men had significantly decreased libido in comparison to women (38 vs 31, p=0.04). Women showed more fear of urinary incontinence (36 vs. 21, p=0.006) and treatment effect on self-image in comparison to men (14 vs. 5, p= 0.04).

Conclusions: This study reveals a significant gap in communication about sexual health between doctors and patients with hematological diseases. Fatigue and lack of energy affected sexual satisfaction and health, with persons with multiple myeloma being the most impacted. Strategies should be implemented to proactively address sexual health and encourage education on safe practices in this patient group.