Antonella Leonetti ^1,2* Guglielmo Puglisi ^1,2 Lorenzo Gay ¹ Luca Viganò ² Marco Rossi ^1,2 Marco Conti Nibali ¹ Tommaso Sciortino ¹ Luca Fornia ² Gabriella Cerri ² Lorenzo Bello ^1,3

• ¹ Neurosurgical Oncology Unit, IRCCS Galeazzi - Sant'Ambrogio Milan, Italy, Milano, Italy
• ² Laboratory of Motor Control, Department of Medical Biotechnologies and Translational Medicine, University of Milan, Italy, Milano, Italy
• ³ Neurosurgical Oncology Unit, Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy

Objective: Sexual functioning is a multifaceted aspect of human life that can be profoundly affected in patients with glioma. Most frequent symptoms include reduced sexual desire, difficulties in sexual arousal or low satisfaction. Such symptoms may cause distress or interpersonal difficulties inevitably resulting in negative outcomes on different domains of patients’ quality of life. Despite this, sexuality is rarely addressed by medical staff and remains understudied. An important question still unanswered is whether sexual dysfunctions in glioma patients correlate with features of the tumor itself, with its treatment, or with the secondary effects of the tumor on the patient’s psychological status. To answer this question, the present study aims at investigating the incidence of sexual life impairments in a very large population of patients with low and high grade gliomas, focusing on demographic, clinical and treatment factors associated with their occurrence and developments. Methods: 148 patients treated for glioma were evaluated for sexual functioning, i.e. Sexual Dysfunction (SD), Relationship Status (RS) and Intercourse Frequency (IF), and Sexual Satisfaction (SS) by using a specific anonymous questionnaire. Descriptive statistics were utilized to investigate participant characteristics and to evaluate occurrence of sexual problems. Chi-squared tests were performed to detect association between “SS” or “IF” and different clinical/demographic factors as well as between “SS” or “IF” and the “subjective-personal skills judgment”. Results: Results showed no difference between male and female patients, a very low frequency (1,4%) of SD, but a consistent percentage (25%) of subjective deterioration in sexual well-being. Notably, 24% of patients reported to have interrupted their relationship after the diagnosis. Chi square analyses reveal an association between adjuvant treatments (chemotherapy and radiotherapy) and reduction of IF. Interestingly, ''SS” or “IF” were not associated with demographic, clinical, or histomolecular factors. Conclusion: Our study showed that sexual problems in glioma patients are not uncommon, and they are especially linked to SS, relationship status and IF. Specifically, intercourse frequency reduction is associated with the adjuvant treatments. Results highlight the need for improved assessment strategies and interventions tailored to the unique needs of brain tumor patients.