Sexual and reproductive health after surgical procedures – the importance of multidisciplinary collaboration

Czech version

Authors: M. Broul ^1,2 ; A. Hujová ² ; R. Maleček ³; M. Vančo ⁴; J. Banýrová ⁵ ; M. Liegertová ⁶
Authors‘ workplace: Sexuologické oddělení, Krajská zdravotní, a. s. – Masarykova nemocnice v Ústí nad Labem, o. z. ¹; Fakulta zdravotnických studií UJEP v Ústí nad Labem ²; Chirurgické oddělení, Krajská zdravotní, a. s. – Masarykova nemocnice v Ústí nad Labem, o. z. ³; Gynekologicko-porodnická klinika FZS UJEP a Krajská zdravotní, a. s. – Masarykova nemocnice v Ústí nad Labem, o. z. ⁴; Fakulta tělesné výchovy a sportu, UK, Praha ⁵; Přírodovědecká fakulta UJEP v Ústí nad Labem ⁶
Published in: Rozhl. Chir., 2026, roč. 105, č. 2, s. 62-67.
Category: Review
doi: https://doi.org/10.48095/ccrvch202662

Overview

Introduction: Sexual and reproductive health remains under-recognized in surgical care despite its decisive impact on quality of life and overall outcomes.

Methods: Narrative synthesis of recent guidance (EAU 2025, AUA 2024, ISSM/ESSM, NCCN/ASCO) and clinical evidence on sexual and reproductive sequelae after colorectal, vascular, and spinal procedures.

Key findings: Core mechanisms include autonomic denervation, vascular/hormonal factors, pain/scarring, and altered body image. Pelvic oncologic surgeries (low anterior resection, radical prostatectomy/cystectomy) are high-risk procedures. High-value interventions include early penile rehabilitation (PDE5 inhibitors ± vacuum device) and fertility preservation (gamete cryopreservation), local estrogens/lubricants and pelvic-floor physiotherapy in women, and psychosexual support within coordinated multidisciplinary care across both sexes.

Conclusion: Embedding sexual and reproductive health into standard perioperative pathways (six-step algorithm: education, risk stratification, fertility preservation, nerve-sparing, discharge instructions, 6–12-week follow-up) is feasible in Czech practice and improves functional outcomes and patient satisfaction.

Keywords:

reproductive health – Erectile dysfunction – dyspareunia – postoperative complications – fertility preservation

Sources

1. Salonia A, Capogrosso P, Boeri L et al. European Association of Urology Guidelines on Male Sexual and Reproductive Health: 2025 update on male hypogonadism, erectile dysfunction, premature ejaculation, and Peyronie’s disease. Eur Urol 2025; 88(1): 76–102. doi: 10.1016/j.eururo.2025.04.010.

2. American Urological Association. Sexual and reproductive health guidelines. [online]. Dostupné z: https://www.auanet.org/guidelines-and-quality/guidelines/non-oncology-guidelines/sexual-and-reproductive-health.

3. ISSM. Clinical guidelines. [online]. Dostupné z: https://www.issm.info/publications/clinical-guidelines.

4. ESSM. ESSM position statements on sexual medicine [online]. Dostupné z: https://www.essm.org/publications/essm-position-statements/.

5. Bhinder JK, Kennedy SK, Faouk Al Aadah C et al. 2024 SOGC, 2024 NCCN, 2022 ESO-ESMO, and 2018 ASCO: a comparison of female cancer survivorship guidelines for the management of sexual health concerns. Support Care Cancer 2025; 33(7): 584. doi: 10.1007/s00520-025-09640-1.

6. Carter J, Lacchetti C, Andersen BL et al. Interventions to address sexual problems in people with cancer: American Society of Clinical Oncology Clinical Practice Guideline Adaptation of Cancer Care Ontario Guideline. J Clin Oncol 2018; 36(5): 492–511. doi: 10.1200/JCO.2017.75.8995.

7. Feng D, Liu S, Yang Y et al. Generating comprehensive comparative evidence on various interventions for penile rehabilitation in patients with erectile dysfunction after radical prostatectomy: a systematic review and network meta-analysis. Transl Androl Urol 2021; 10(1): 109–124. doi: 10.21037/tau-20-892.

8. Uçaner B, Buldanli MZ, Çimen Ş et al. Investigation of postoperative erectile dysfunction in colorectal surgery patients and comparison of results. Medicine (Baltimore) 2024; 103(21): e38281. doi: 10.1097/MD.0000000000038281.

9. Ishiyama Y, Hirano Y, Tsukada Y et al. Longitudinal follow-up of sexual function after surgery for ultra-low rectal cancers located within 5 cm of the anal verge: a multicentre collaborative study. Colorectal Dis 2025; 27(4): e70092. doi: 10.1111/codi.70092.

10. Notarnicola M, Celentano V, Gavriilidis P et al. PDE-5i management of erectile dysfunction after rectal surgery: a systematic review focusing on treatment efficacy. Am J Mens Health 2020; 14(5): 1557988320969061. doi: 10.1177/1557988320969061.

11. Broul M, Kučerová P, Žižková K et al. Dyspareunie. Urol Praxi 2024; 25(3): 156–159. doi: 10.36290/uro.2024.061.

12. Tangjitgamol S, Manusirivithaya S, Hanprasertpong J et al. Sexual dysfunction in Thai women with early -⁠ -stage cervical cancer after radical hysterectomy. Int J Gynecol Cancer 2007; 17(5): 1104–1112. doi: 10.1111/j.1525-1438.2007.00907.x.

13. Hansen SB, Fonnes S, Oggesen BT et al. High prevalence of erectile dysfunction within the first year after surgery for rectal cancer: a systematic review and meta-analysis. Eur J Surg Oncol 2024; 50(12): 108662. doi: 10.1016/j.ejso.2024.108662.

14. Gökçe AH, Özkan H. Erectile dysfunction after surgery for rectal cancer: a prospective study. Turk J Surg 2019; 35(4): 293–298. doi: 10.5578/turkjsurg.4397.

15. Ma B, Gao P, Wang H et al. What has preoperative radio(chemo)therapy brought to localized rectal cancer patients in terms of perioperative and long-term outcomes over the past decades? A systematic review and meta-analysis based on 41,121 patients. Int J Cancer 2017; 141(5): 1052–1065. doi: 10.1002/ijc.30805.

16. Regnier P, Lareyre F, Hassen-Khodja R et al. Sexual dysfunction after abdominal aortic aneurysm surgical repair: current knowledge and future directions. Eur J Vasc Endovasc Surg 2018; 55(2): 267–280. doi: 10.1016/j.ejvs.2017.11.028.

17. Xenos ES, Stevens SL, Freeman MB et al. Erectile function after open or endovascular abdominal aortic aneurysm repair. Ann Vasc Surg 2003; 17(5): 530–538. doi: 10.1007/s10016-003-0058-2.