Sexual dysfunction after hematopoietic stem cell transplantation.

409 E ighteen months after undergoing unrelated hematopoietic stem cell transplantation (HSCT) for acute myelogenous leukemia, 28-year-old E.M. was experiencing sexual difficulties. For E.M. and her husband, sexual intimacy had been an integral part of their relationship. However, since the transplantation, on the few occasions that she and her husband had attempted to reinitiate sexual intimacy, the physical discomfort E.M. experienced and her lack of desire resulted in dissatisfaction. This frustrated E.M. and her husband, neither of whom could understand this change. Although most other aspects of her life were returning to normal, E.M.’s sexual dysfunction persisted. Prior to transplantation, E.M. had been informed that the treatment would result in premature ovarian failure, leaving her incapable of having children. Long-term side effects and complications of HSCT were discussed, but the possibility of sexual dysfunction was never addressed. The unexpected loss of her sexuality, of the intimacy that she shared with her husband, was negatively affecting her quality of life (QOL) and relationship. Upon questioning E.M., the nurse identified that a decreased libido combined with vaginal dryness and dyspareunia (pain with intercourse) were major challenges. Treatment options were discussed, and E.M. was started on hormone replacement therapy and the use of vaginal lubricants was suggested. Although these treatments were helpful, E.M.’s sexual responsiveness never returned to the level it was prior to HSCT. The nurse referred E.M. and her husband to couple-based therapy to facilitate behavior interventions. In therapy, E.M. and her husband were able to communicate openly with one another and discuss alternate ways for increasing sexual satisfaction. Those interventions helped E.M. and her husband to gradually return to sexual activity and, although different, they found their renewed intimacy to be rewarding. Sexual Dysfunction After Hematopoietic Stem Cell Transplantation