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Men’s experience of erectile dysfunction after treatment for colorectal cancer: qualitative interview study

BMJ 2011; 343 doi: (Published 18 October 2011) Cite this as: BMJ 2011;343:d5824
  1. George Dowswell, research fellow1,
  2. Tariq Ismail, consultant surgeon2,
  3. Sheila Greenfield, senior lecturer1,
  4. Sue Clifford, trial manager1,
  5. Beverley Hancock, research fellow1,
  6. Sue Wilson, professor of clinical epidemiology1
  1. 1Cancer and Chronic Disease Team, Primary Care Clinical Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
  2. 2University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
  1. Correspondence to: S Greenfield s.m.greenfield{at}
  • Accepted 9 August 2011


Objectives To examine the experiences of men after treatment for colorectal cancer, identify barriers to accessing services, and suggest improvements to providing information in primary and secondary care.

Design Semistructured, qualitative interview study with purposive sampling and thematic analysis.

Participants 28 patients treated for colorectal cancer.

Setting West Midlands.

Results Most men treated for colorectal cancer experience erectile dysfunction as a consequence. Not all, however, want the same response from health professionals. Although, erectile dysfunction is profoundly stressful for most men, affecting self image, behaviour, and relationships, some do not regard it as a health priority. Many of the men were uninformed about erectile dysfunction and were unprepared for it, and the majority neither helped themselves nor asked for help. Almost none were receiving adequate, effective, and affordable care. Evidence of ageism was strong.

Conclusions Unlike patients with prostate cancer, men with colorectal cancer are not routinely offered information and treatment for erectile dysfunction. Greater coordination of care and consistent strategies are needed to tackle the unmet needs of this widely diverse patient group. Currently, clinicians are inadvertently neglecting, misleading, and offending such patients; better training could improve this situation, as might the reorganisation of services. Further research is needed to determine whether trained clinical nurse specialists in colorectal cancer units could coordinate ongoing care.


  • We thank Kesavapilla Subramonian (urologist), Annette Leyland (colorectal nurse specialist), Christine Gratus (lay member), and N Suggett (colorectal surgeon) who all contributed to steering group meetings and supported the study, and the men who participated in this study.

  • Contributors: TI had the idea for the study. TI, SW, and SG developed the study concept and design and obtained funding. All authors refined the study design through trial steering group meetings. TI provided clinical advice. SC and BH collected the data. SG, BH, and GD analysed the data. GD drafted the manuscript. All authors critically revised and approved the manuscript. SG is the guarantor.

  • Funding: This paper presents independent research commissioned by the National Institute for Health Research under the research for patient benefit programme (PB-PG-0407-13245). The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study was approved by the Warwickshire Research Ethics Committee (08/H1211/122).

  • Data sharing: No additional data available.

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