Digestive diseases, including anorectal cancers and functional gastrointestinal disorders, have a large and often underrecognized impact on sexual health, according to presentations at the Francophone Days of Hepatology, Gastroenterology, and Digestive Oncology 2026, held in Paris.

Claire Lemanski, MD, an oncologist from the Department of Radiation Oncology, Institut de Recherche en Cancérologie de Montpellier Val d’Aurelle, Montpellier, France, discussed sexuality after anorectal cancer. Pauline Jouët, MD, PhD, a gastroenterologist from Ambroise-Paré Hospital, Boulogne-Billancourt, France, addressed sexual dysfunction in functional digestive disorders.

In anorectal cancer, sexual dysfunction is frequent, occurs early, and is often severe. Data from the VICAN study showed that nearly two thirds of patients reported sexual dysfunction 2 years after diagnosis, with similar prevalence at 5 years, showing persistent sequelae without management. These effects are largely treatment-related, including chemotherapy, radiotherapy, and surgery.

Effects of Treatment 

In rectal cancer, management typically includes chemoradiotherapy followed by surgery. Chemotherapy may reduce sexual desire due to fatigue, nausea, and altered body image. Some agents, such as oxaliplatin, may cause persistent neuropathy, leading to long-term sensory impairment, which is a key part of sexual function.

Pelvic radiotherapy primarily causes vascular and nerve damage, resulting in sexual arousal disorders, including erectile dysfunction in men and dyspareunia in women, along with vaginal dryness, stenosis, and reduced lubrication. It may also induce early menopause in younger women or impair fertility.

Rectal surgery increases the risk for damage to the pelvic nerve plexuses, sphincter dysfunction, presence of a stoma, and chronic pelvic pain, all of which may affect sexuality and body image.

Radiotherapy used in the treatment of anal cancer often results in significant, long-term sexual toxicity and in some cases, severe, life-altering sequelae may require permanent colostomy or salvage surgery due to persistent disease, local recurrence, or severe late toxicity.

Chronic diarrhea, bone pain, anal or urinary incontinence, chronic fatigue, and colostomy significantly affect sexual function and body image. These symptoms may make sexual activity difficult or impossible and may reduce self-esteem and desire.

In cancers associated with human papillomavirus, the sexually transmitted nature of the infection may lead to guilt, anxiety, and strain within relationships.

Despite its high prevalence, sexual disorders are rarely discussed during consultations. Sexual health is addressed in only about 18% of men and 4% of women after cancer, although most individuals prefer clinicians to start discussions. Guidelines recommend assessing sexual health at all stages of care using open-ended questions rather than complex scales.

Management requires a comprehensive approach, including the treatment of functional sequelae, hormone therapy in cases of induced menopause, early use of vaginal dilators to prevent stenosis, management of erectile dysfunction, pelvic floor rehabilitation, stoma care, and sex therapy when needed. Early intervention is associated with greater effectiveness before irreversible damage occurs.

Therefore, sexual health should be integrated into supportive cancer care. Current priorities include systematic assessment and multidisciplinary management involving oncologists, gastroenterologists, gynecologists, urologists, physiotherapists, stoma therapists, and sexologists.

Lemanski noted, “Addressing sexual health in anorectal cancer care does not require specific expertise, but simply the willingness to ask the question.”

Gut-Brain Interaction 

Disorders of gut-brain interaction, including irritable bowel syndrome (IBS), functional dyspepsia, and chronic constipation, are also associated with impaired quality of life, including sexual health. Although limited, the available data show a high prevalence of sexual dysfunction in individuals with functional digestive disorders.

In IBS, sexual dysfunction affects about two thirds of women and more than half of men. Studies have reported reduced sexual desire, pain during intercourse, and avoidance of sexual activity because of digestive symptoms. Reduced libido was the most frequent symptom in both sexes. Additional conditions include dyspareunia in women, erectile dysfunction in men, and worsening sexual symptoms during digestive symptom flares.

Other functional gastrointestinal disorders, such as chronic constipation and gastroesophageal reflux, are also associated with sexual dysfunction. Anal incontinence is associated with reduced sexual activity, lower satisfaction, and increased pain during intercourse.

Contributing factors include physical factors, such as chronic pain, fatigue, pelvic floor dysfunction, and medications, particularly antidepressants, as well as psychological factors, including anxiety, depression, altered body image, shame related to digestive symptoms, and prior trauma. The dynamics of relationships and the effect of disease on partners are also relevant.

Management first focuses on improving digestive symptoms, which may lead to a secondary improvement in sexual quality of life. Interventions targeting the gut-brain axis, including hypnosis, meditation, and cognitive-behavioral therapy, may benefit both digestive symptoms and sexual function.

A multidisciplinary approach is often needed and may include the management of pain, sleep disorders, and psychiatric comorbidities.

Patients often expect clinicians to start discussion of sexual health; however, this is still rare. Routine assessment during consultation is strongly recommended.

Self-administered questionnaires, including the International Index of Erectile Function in men and the Female Sexual Function Index in women, can be used.

This story was translated from Univadis France, part of the Medscape Professional Network.