Sexual side effects in women with anal carcinoma.

275 J .W., a healthy 50-year-old critical care nurse with no significant medical history, was in her second marriage, postmenopausal, a nonsmoker with remote history of smoking for about one year, and reported occasional alcohol use. She presented to her primary care physician with complaints of an 18-month history of sporadic bright red blood per rectum, particularly when straining to have a bowel movement. J.W. reported having a bowel movement every two to three days and denied anorexia, weight loss, nausea or vomiting, constipation, or diarrhea. A digital rectal examination (DRE) revealed a 1 cm hard anal mass less than 1 cm from the anal verge. The mass was noncircumferential and located predominately at the posterior bowel wall. J.W. agreed that she should have a colonoscopy and gastrointestinal (GI) workup. The colonoscopy revealed an anal lesion that was confirmed by biopsy to be consistent with a nonkeratinizing squamous cell carcinoma. J.W. was referred to a National Cancer Institute (NCI)-designated comprehensive cancer center where she was evaluated by surgical, medical, and radiation oncologists. She denied any anal carcinoma risk factors, such as smoking, multiple sexual partners, anal intercourse, being HIV positive, being positive for human papilloma virus (HPV), or the presence of genital warts. She became very emotional when questioned about her HIV and HPV status. The physical examination revealed a healthy woman in no acute physical distress. Vital signs, routine laboratory tests, and the physical examination were within normal limits and noncontributory. Her carcinoembryonic antigen was 0.7 ng/ml (normal is less than 2.5 ng/ ml in an adult nonsmoker), and HIV screening was nonreactive. Abdominal examination revealed a soft, nontender Sexual Side Effects in Women With Anal Carcinoma