Sexual dysfunction following radical surgery for cancer of the rectum

Summary and Conclusions

Sexual impotence is a common complication after abdominoperineal excision of cancer of the rectum, varying from 53 to 100 per cent in the recent experience of ten prominent surgeons. This contrasts sharply with the incidence of less than 10 per cent of impotence after rectal excision for ulcerative colitis.

Ejaculation is controlled by the lumbar sympathetic system, probably the first lumbar ganglia. Control of erection is a function of the pelvic parasympathetic nerves originating from the second, third and fourth sacral nerves, the presacral plexus, and the pelvic parasympathetic multiple nerve fibers that travel around the lateral perirectal tissues and go to the area of the prostate gland. Probably these nerves are divided in the course of radical lateral dissections associated with operations for malignancy, and are a necessary price that has to be paid for thorough pelvic lymphatic dissection.