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The aims of the study were to determine the extent of male sexual dysfunction after surgical treatment of rectal cancer and to examine the outcome of treatment with sildenafil.Aprospective study was performed in patients who underwent attempted curative total mesorectal excision (TME) for low rectal cancers. Sexual function scores were determined by questionnairepreoperatively and at 3 and 12 months postoperatively. Outcomes were examined in patients who were sexually activepreoperatively.From 2000 to 2007, 207 patients underwent TME at our institution, of whom 49 (24%) were sexually activepreoperatively. Erectile dysfunction and ejaculatoryproblems werepresent in 80% and 82%, respectively of the 49 patients at 3 months postoperatively, and in 76% and 67%, respectively, at 12 months. Lateral lymph node dissection was a strong risk factor for postoperative sexual dysfunction. The impotency rate was 37%, and 47% patients were unable to ejaculate. Sildenafil was administered to 16 patients who requested the drug during follow-up, and sexual dysfunction was improved in 11 of these patients (69%).Sexual dysfunction occurs frequently after rectal cancer treatment and is mainly caused by damage in lateral lymph node dissection. Sildenafil was effective for treatment of sexual dysfunction.