Vaginal Dilator Use to Promote Sexual Wellbeing After Radiotherapy in Gynaecological Cancer Survivors: A Prospective Observational Study

Author(s):  
Dimitra Charatsi ◽  
Polyxeni Vanakara ◽  
Michail Nikolaou ◽  
Aikaterini Evaggelopoulou ◽  
Dimitrios Korfias ◽  
...  

Background: Since continuing advances in radiotherapy technology broaden the role of radiotherapy in the treatment of gynaecologic malignancies, the use of vaginal dilators has been introduced in order to mitigate the risk of vaginal stenosis. The main aims of this study were to investigate the vaginal dilator use efficacy in the treatment of radiation-induced vaginal stenosis and the vaginal dilator effect on sexual quality of life. Methods: We studied fifty-three patients with endometrial or cervical cancer. The participants were treated with radical or adjuvant external beam radiotherapy and/or brachytherapy. They were routinely examined at four time points post-radiotherapy when also they were asked to fill in a validated sexual function-vaginal changes questionnaire. A p-value less than 0.05 was considered statistically significant. Results: The vaginal stenosis grading score was decreased and the size of the vaginal dilator comfortably insertable was gradually increased throughout the year of vaginal dilator use while radiation-induced vaginal and sexual symptoms were improved throughout the year of VD use. All patients with initial grade 3 showed vaginal stenosis of grade 2 after 12 months of vaginal dilator use and 65.8% of the patients with grade 2 initial vaginal stenosis demonstrated final vaginal stenosis grade 1 while 77.8% of the participants with initial 1st size of vaginal dilators reached the 3rd vaginal dilator size after 12 months. Starting time of dilator therapy <= 3 months after the end of radiotherapy was associated with a significant decrease in vaginal stenosis. Additionally, there was an overall upward trend regarding patients’ satisfaction with their sexual life. Conclusion: Endometrial and cervical cancer survivors should be encouraged to use vaginal dilators for the treatment of vaginal stenosis and sexual rehabilitation after radiotherapy.

2021 ◽  
pp. 1-13
Author(s):  
Dimitra Charatsi ◽  
Dimitra Charatsi ◽  
Polyxeni Vanakara ◽  
Michail Nikolaou ◽  
Aikaterini Evaggelopoulou ◽  
...  

Background: Since continuing advances in radiotherapy technology broaden the role of radiotherapy in the treatment of gynaecologic malignancies, the use of vaginal dilators has been introduced in order to mitigate the risk of vaginal stenosis. The main aims of this study were to investigate the vaginal dilator use efficacy in the treatment of radiation-induced vaginal stenosis and the vaginal dilator effect on sexual quality of life. Methods: We studied fifty-three patients with endometrial or cervical cancer. The participants were treated with radical or adjuvant external beam radiotherapy and/or brachytherapy. They were routinely examined at four time points post-radiotherapy when also they were asked to fill in a validated sexual function-vaginal changes questionnaire. A p-value less than 0.05 was considered statistically significant. Results: The vaginal stenosis grading score was decreased and the size of the vaginal dilator comfortably insertable was gradually increased throughout the year of vaginal dilator use while radiation-induced vaginal and sexual symptoms were improved throughout the year of VD use. All patients with initial grade 3 showed vaginal stenosis of grade 2 after 12 months of vaginal dilator use and 65.8% of the patients with grade 2 initial vaginal stenosis demonstrated final vaginal stenosis grade 1 while 77.8% of the participants with initial 1st size of vaginal dilators reached the 3rd vaginal dilator size after 12 months. Starting time of dilator therapy <= 3 months after the end of radiotherapy was associated with a significant decrease in vaginal stenosis. Additionally, there was an overall upward trend regarding patients’ satisfaction with their sexual life. Conclusion: Endometrial and cervical cancer survivors should be encouraged to use vaginal dilators for the treatment of vaginal stenosis and sexual rehabilitation after radiotherapy.


2017 ◽  
Vol 6 (2) ◽  
pp. 9 ◽  
Author(s):  
Karin B. Dieperink ◽  
Lene Sigaard ◽  
Helle Mona Larsen ◽  
Tina Broby Mikkelsen

Many cervical cancer survivors experience late adverse effects, and rehabilitation may alleviate symptoms. This study describes participants’ experiences with late adverse effects in daily living and with experiences of perceived rehabilitation in hospital, municipal, and a residential setting. Twenty-one cervical cancer survivors aged 40-72 years, curatively treated with concomitant radio-chemotherapy, with moderate/severe incontinence and sexual problems, participated in a 5-day residential rehabilitation intervention. Three focus group interviews were conducted and analyzed. Late adverse effects like incontinence, sexual problems, tinnitus and pain severely restricted everyday life. The participants described rehabilitation in hospital settings as fragmented, but several of the participants benefitted from the physical rehabilitation in municipal settings; however, no participants were offered sexual rehabilitation. In the residential setting, they gained a sense of connectedness and confidence in association with peers. More time to reflect and the anonymity gave opportunity to work with sensitive issues e.g. sexuality. Increased knowledge about late adverse effects and tools to alleviate these made the participants prepared to regain command of their lives. In conclusion, incontinence and tinnitus had especially impact on social life and every day activities. The participants benefitted especially from rehabilitation in two settings (municipal and residential). Intensively psychosocial interventions allowed participants to work with underlying problems. Women with sexual and/or incontinence problems favored the residential rehabilitation due to anonymity.


Author(s):  
Sha Ye ◽  
Xiangcheng Yang ◽  
Guoping He ◽  
Peter Maciek ◽  
Wenjuan Zhou

Background: The attitudes and perceptions of cervical cancer survivors (CCS) toward sexual activity after a diagnosis of cervical cancer and its treatment are unknown. This study describes the experience of CCS in Hunan Chinese about sexuality and sexual function after cervical cancer treatment. Methods: We used descriptive phenomenology to qualitatively assess these experiences. Purposive sampling was used to recruit 20 CCS. Data were collected through in-depth interviews and analyzed according to Colaizzi’s method to explore the essence of the experience in sexuality among CCS after cancer treatment. Results: Uncertainty, fear, and worry dominated the attitudes and behaviors of CCS-related to sexual activity after treatment. Four themes explain these complex emotional responses: 1) needing information; 2) dealing with sexual changes physically and emotionally; 3) communicating with a partner; 4) attribution of fault to her one-lifetime sexual partner. Conclusion: Sexual life was influenced by the physical changes associated with cervical cancer treatment. These changes in combination with inadequate information and limited communication led to uncertainty, fear and worry about engaging in sexual activity and relationship distress. Chinese CCS need targeted and patient-centered information on the change in sexual life caused by treatment, anticipatory guidance, and support in communication with providers and partners, and strategies to cope with the physical and psychosexual sequelae of treatment, all of which must be congruent with their cultural norms.


BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jumara Martins ◽  
Ana Francisca Vaz ◽  
Regina Celia Grion ◽  
Lúcia Costa-Paiva ◽  
Luiz Francisco Baccaro

Abstract Background We aimed to evaluate the effects of different therapeutic options to prevent the evolution of vaginal stenosis after pelvic radiotherapy in women with cervical cancer. Methods open-label randomized clinical trial of 195 women, stage I-IIIB, aged 18–75 years, using topical estrogen (66), topical testosterone (34), water-based intimate lubricant gel (66), and vaginal dilators (29) to assess the incidence and severity of vaginal stenosis after radiotherapy at UNICAMP-Brazil, from January/2013 to May/2018. The main outcome measure was vaginal stenosis assessed using the Common Terminology Criteria for Adverse Events (CTCAE) scale and percental changes in vaginal volume. The women were evaluated at four different times: shortly after the end of radiotherapy, and four, eight, and 12 months after the beginning of the intervention. Statistical analysis was carried out using Symmetry test, Kruskal-Wallis test and multiple regression. Results the mean age of women was 46.78 (±13.01) years, 61,03% were premenopausal and 73,84% had stage IIB-IIIB tumors. The mean reduction in vaginal volume in the total group was 25.47%, with similar worsening in the four treatment groups with no statistical difference throughout the intervention period. There was worsening of vaginal stenosis evaluated by CTCAE scale after 1 year in all groups (p < 0.01), except for the users of vaginal dilator (p = 0.37). Conclusions there was a reduction in vaginal volume in all treatment groups analyzed, with no significant difference between them. However, women who used vaginal dilators had a lower frequency and severity of vaginal stenosis assessed by the CTCAE scale after one year of treatment. Trial registration Brazilian Registry of Clinical Trials, RBR-23w5fv. Registered 10 January 2017 - Retrospectively registered.


2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15518-e15518
Author(s):  
Kameshwarachari Pushpalatha ◽  
Dayanand Sharma ◽  
Pramod Kumar Julka ◽  
Sunesh Kumar ◽  
G K Rath

e15518 Background: With ever-increasing number of cancer survivors nearing 12 million, a majority of women will face vaginal health issues related to their disease and/or treatment. Hypothesis is that there is direct damage to ovarian follicles as a result of ionizing radiation leading to follicular atrophy and decrease in ovarian follicular reserve. Cancer treatment with radiotherapy induces menopause-causing estrogen-deprivation symptoms. Hence this study was conducted to investigate the frequency of radiation-induced menopausal and sexual symptoms in cervical cancer survivors Methods: A cross-sectional study was conducted between Feb-June 2011 on cohort of 55 advanced cervical cancer patients treated with pelvic radiation of 50.4 Gy in 28 fractions over 5.5 weeks and concurrent Cisplatin, followed by intracavitary boost of 15 Grays. Women aged 55 or older and/or postmenopausal at the time of the survey were excluded. By using a questionnaire, frequency of menopause was tried to elicit along with associated sexual symptoms like hot flushes, vaginal dryness, mood swings, dyspareunia, loss of libido, botheration. Results: The average age and parity were 38.8 years and 3.6 respectively. Amenorrhoea was found in all patients. 27 (49%) patients were asymptomatic. Among 28 (50.9%) symptomatic patients, we found hot flushes in 21 (38.2%), vaginal dryness in 38 (69%), mood swings in 12 (21.8%), dyspareunia in 27 (49%), loss of libido in 26 (47.2%), bothersome in 28 (50.9%). Conclusions: Menopausal symptoms were associated with other health-related issues known to compromise the quality of life. These results highlight the need to better acknowledge and define the utility of hormonal therapy in this population. Recommendations need to be provided to treating gynaecologists and Oncologists to identify, treat and promote vaginal health. Vaginal health issues can be reduced by dedicating a small duration of time to educate the cancer survivors on hormonal/non-hormonal vaginal health strategies.


2020 ◽  
Vol 75 (3) ◽  
pp. 216-223
Author(s):  
M. Miccò ◽  
M. Campitelli ◽  
M. Sbarra ◽  
N. Carra ◽  
R. Barone ◽  
...  

2021 ◽  
Vol 20 ◽  
pp. 153303382110421
Author(s):  
Wonguen Jung ◽  
Yun H. Kim ◽  
Kyung S. Kim

To examine the factors associated with ovarian failure (OF) and assess the effectiveness of ovarian transposition (OT) before pelvic irradiation for preserving ovarian function in patients with cervical cancer (CC) undergoing hysterectomy. During 2003 to 2017, patients who underwent hysterectomy with preservation of one or both ovaries were retrospectively enrolled. Patients were divided into 4 groups, depending on whether radiotherapy (RT) and OT were performed: group 1, RT(+) and OT(+); group 2, RT(+) and OT(−); group 3, RT(−) and OT(+); group 4, RT(−) and OT(−). OF was defined as serum follicle-stimulating hormone levels of ≥30 mIU/mL. Sixty-six patients (59 [89.4%] invasive CC and 7 [10.6%] cervical intraepithelial neoplasia) were included. The 2-year OF-free survival rate was 61.4% (95% confidence interval [CI] 37.8-86.0), 0%, 91.7% (95% CI 76.0-100), and 75.8% (95% CI 58.2-93.4) for groups 1, 2, 3, and 4, respectively. In groups 1 and 2 receiving RT, OT, and combination of external beam radiotherapy and vaginal brachytherapy were associated with OF on multivariate analysis (MVA) ( P-value  =  .002 and .046, respectively). In groups 3 and 4 without RT, older age (40 years old) and OT did not affect OF; however, the number of remaining ovaries was independently associated with OF in MVA ( P  =  .035). OT could effectively preserve ovarian function in patients treated with adjuvant RT, while OT procedure itself did not affect ovarian failure. OT should be considered in the management of premenopausal cervical cancer patients.


Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 317
Author(s):  
Mihai Stanca ◽  
Dan Mihai Căpîlna ◽  
Cristian Trâmbițaș ◽  
Mihai Emil Căpîlna

(1) Background: Cervical cancer patients have been found to have worse quality of life (QoL) scores due to cancer treatment, not only when compared to the general population, but also when compared to other gynecological cancer survivors. In Eastern European developing countries, the health care system often cannot afford the uppermost standardized treatment for these patients. In the absence of a comparable study in our country, the authors’ aim for this retrospective cross-sectional observational study was to evaluate the overall survival (OS) and the QoL o cervical cancer survivors; (2) Methods: 430 patients were analyzed. The first objective is to evaluate the OS rates of patients with cervical cancer stages IA2 to IIB undergoing radical hysterectomy (RH) +/− neoadjuvant or adjuvant radiotherapy +/− chemoradiotherapy treatment combinations. The second objective is to assess their QoL, using two standardized questionnaires issued by the European Organisation for Research and Treatment of Cancer (EORTC), namely QLQ-C30 and QLQ-CX24. (3) Results: The mean age of the participants was 51 years (22–76) and the average follow-up time was 65 months (2–128). At the time of the analysis, 308 out of 430 patients were alive, with a mean five-year OS of 72.4%. The multivariate Cox regression analysis identified stage IIB, parametrial invasion, and the lymph node metastases as independent prognostic risk factors negatively impacting the OS. Of the 308 patients still alive at the time of the analysis, 208 (68%) answered the QoL questionnaires. The QLQ-C30 shows a good long-term Global QoL of 64.6 (median), good functioning scores, and a decent symptom scale value. However, the EORTC QLQ-CX24 showed high values of cervical cancer-specific symptoms, namely: lymphedema, peripheral neuropathy, severe menopausal symptoms, and distorted body-image perception. The results also indicate a significant decline in the quality of sexual life with a low sexual enjoyment and decreased level of sexual activities. (4) Conclusion: Despite a good OS, in this setting of patients, cervical cancer survivors have a modest QoL and sexual function. Our study may provide a comparison for future randomized, controlled trials in Eastern European countries needing to confirm these results.


2020 ◽  
Author(s):  
Wonguen Jung ◽  
Yun Hwan Kim ◽  
Kyung Su Kim

Abstract Background: To examine the factors associated with ovarian failure (OF) and assess the effectiveness of ovarian transposition (OT) before pelvic irradiation for preserving ovarian function in patients with cervical cancer (CC) undergoing hysterectomy.Methods: During 2003-2017, patients who underwent hysterectomy with preservation of one or both ovaries were retrospectively enrolled. Patients were divided into 4 groups, depending on whether radiotherapy (RT) and OT were performed: group 1, RT(+) and OT(+); group 2, RT(+) and OT(-); group 3, RT(-) and OT(+); group 4, RT(-) and OT(-). OF was defined as serum follicle-stimulating hormone levels of ≥30 mIU/mL.Results: Sixty-six patients (59 [89.4%] invasive CC and 7 [10.6%] cervical intraepithelial neoplasia) were included. The 2-year ovarian failure-free survival (OFFS) rate was 61.4% (95% confidence interval (CI) 37.8–86.0), 0%, 91.7% (95% CI 76.0–100), and 75.8% (95% CI 58.2–93.4) for groups 1, 2, 3, and 4, respectively. In groups 1 and 2 receiving RT, OT and combination of external beam radiotherapy and vaginal brachytherapy (VB) were associated with OF on multivariate analysis (MVA) (p-value=0.002 and 0.046, respectively). In groups 3 and 4 without RT, older age (40 years) and OT did not affect OF; however, the number of remaining ovaries was independently associated with OF in MVA (p=0.035).Conclusions: OT could effectively preserve ovarian function in adjuvant RT-treated patients. Lower location of transposed ovary with VB boost was significantly associated with early OF.


2021 ◽  
Author(s):  
Jumara Martins ◽  
Ana Francisca Vaz ◽  
Regina Celia Grion ◽  
Lúcia Costa-Paiva ◽  
Luiz Baccaro

Abstract Background: we aimed to evaluate the effects of different therapeutic options to prevent the evolution of vaginal stenosis after pelvic radiotherapy in women with cervical cancer. Methods: open-label randomized clinical trial of 195 women, stage I-IIIB, aged 18-75 years, using topical estrogen (66), topical testosterone (34), water-based intimate lubricant gel (66), and vaginal dilators (29) to assess the incidence and severity of vaginal stenosis after radiotherapy at UNICAMP-Brazil, from January/2013 to May/2018. The main outcome measure was vaginal stenosis assessed using the Common Terminology Criteria for Adverse Events (CTCAE) scale and percental changes in vaginal volume. The women were evaluated at four different times: shortly after the end of radiotherapy, and four, eight, and 12 months after the beginning of the intervention. Statistical analysis was carried out using Symmetry test, Kruskal-Wallis test and multiple regression. Results: the mean age of women was 46.78 (±13.01) years, 61,03% were premenopausal and 73,84% had stage IIB-IIIB tumors. The mean reduction in vaginal volume in the total group was 25.47%, with similar worsening in the four treatment groups with no statistical difference throughout the intervention period. There was worsening of vaginal stenosis evaluated by CTCAE scale after 1 year in all groups (p<0.01), except for the users of vaginal dilator (p=0.37). Conclusions: there was a reduction in vaginal volume in all treatment groups analyzed, with no significant difference between them. However, women who used vaginal dilators had a lower frequency and severity of vaginal stenosis assessed by the CTCAE scale after one year of treatment.Trial registration: Brazilian Registry of Clinical Trials, RBR-23w5fv. Registered 10 January 2017 - Retrospectively registered, https://ensaiosclinicos.gov.br/rg/RBR-23w5fv


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