TABLE 1.

Risk Factors for Sexual Dysfunction and its Consequences and Possible Interventions

Risk factors	Effects	Consequences on sexual function	Possible interventions
TBI	-gonadal failure -infertility -vulvar or vaginal dryness -penile dryness	decreased libido, arousal and orgasm, discomfort during intercourse erectile dysfunction in males performance stress vulvar or vaginal dryness -penile dryness	hormonal replacement erectile dysfunction medication management of stress and relationship issues vulvar or vaginal dryness -penile dryness
GVHD	-vulvar or vaginal dryness -penile dryness -inflammatory changes -vaginal narrowing, -vulvar or vaginal scarring, stenosis	pain during intercourse; abnormal ejaculation in males pain during intercourse; abnormal ejaculation in males pain; at extreme, impossibility to have intercourse	lubrication during intercourse local therapy use of vaginal dilator therapy, ultralow dose estrogen vaginal ring
Medications and drug interactions	-antidepressants -antipsychotic medications -beta-blockers	negative effect on libido, arousal and orgasm vaginal dryness	consider options for reducing the dose or finding an effective alternative medication
Chronic medical problem (burden of health conditions)	-CV complications -diabetes -chronic GVHD -secondary cancer -fatigue	decrease of sexual interest erectile dysfunction in males	treatment of underlying medical problems
Psychological distress	-personal well-being and partner relationship -feeling unattractive after HSCT	decrease of sexual interest, negative effect on libido, arousal and orgasm	psychotherapy sex therapy

Abbreviations: CV: cardiovascular; GVHD, graft-versus-host disease; HSCT, hematopoietic stem cell transplantation; TBI, total body irradiation.