Interventions Preventing Vaginitis, Vaginal Atrophy after Brachytherapy or Radiotherapy Due to Malignant Tumors of the Female Reproductive Organs—A Systematic Review

Abstract

Background: Radiotherapy, as a method of treatment of cervical and uterine cancers, may induce severe late-onset vaginal side effects. Unfortunately, little evidence on the management of adverse effects has been presented. This study aimed to evaluate the available interventions which reduce symptoms of vaginitis and vaginal atrophy by improving dyspareunia, mucosal inflammation, vaginal pH and vaginal dryness in women who have undergone brachytherapy or radiotherapy due to uterine or cervical malignancies. Materials and methods: A comprehensive literature search was performed following PRISMA guidelines. The systematic search was conducted using electronic databases, namely Scopus, Web of Science and PubMed, between October and November 2020 to identify randomized controlled trials (RCT) and, prospective randomized studies (PRS). Results: The analyzed population consists of 376 patients with uterine or cervical cancer, treated with hyaluronic acid, vitamin A, vitamin E, alpha-tocopherol acetate and dienestrol. Intervention with HA along with vitamin A and vitamin E revealed advantage in endpoints such as reduced dyspareunia, vaginal mucosal inflammation, vaginal dryness, bleeding, fibrosis and cellular atypia. Administration of alpha-tocopherol acetate reduced vaginal mucosal inflammation and improved vaginal acanthosis, whereas dienestrol resulted in reduced dyspareunia, vaginal caliber and bleeding. Conclusions: Vaginal suppositories were found to be clinically effective at the management of late-onset vulvovaginal side effects after radiotherapy.

Vaginal Toxicity Management in Patients with Locally Advanced Cervical Cancer following Exclusive Chemoradiation—A Nationwide Survey on Knowledge and Attitudes by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Gynecology Study Group

“…Dyspareunia occurs in up to 80% of patients with a relevant negative impact on sexuality, mainly due to pain during vaginal intercourse, while sexual satisfaction seems not to be significantly impaired [ 20 , 21 , 26 ]. Despite the relevant impairment in quality of life, only 10–28% of cervical cancer patients received information about the onset of this kind of acute and, above all, late vaginal toxicity [ 26 ].…”

“…For the vagina, these toxicities historically included necrosis, vescico/rectovaginal fistula, while, in the past decade, vaginal stenosis and, above all, dyspareunia were the most frequently experienced symptoms in LACC patients who had undergone exclusive (chemo)radiotherapy and IRT. In fact, vaginal stenosis was recorded for from 21% to 38% of LACC patients, while dyspareunia ranged from 50–60% to 80% of the patients [ 18 , 20 , 21 , 22 ].…”

“…Prevention strategies may include vaginal dilatation, topical therapies, and laser therapy, but consensus is not reached due to the paucity of high-level evidence regarding the prevention and management of vaginal stenosis/dyspareunia [ 20 , 21 , 27 ].…”

The clinician’s guide to radiotherapy complications

“…62 Those complications can be prevented with vaginal douching (benzydamine hydrochloride) and hyaluronic acid suppositories containing vitamin A, vitamin E, alpha -tocopherol acetate, and dienestrol. 63 The role of vaginal dilators is not only to prevent from vaginal stenosis, but also to improve mucosal flexibility and its proper nutrition. Benefits include improvement in physiological vaginal fluid and reduction in discomfort during sexual intercourse and gynecological examination.…”

Hyaluronic Acid: Prospective Use in Gynaecology

“…(2021) показали уменьшение диспареунии, сухости влагалища и фиброза у пациенток, перенесших брахитерапию или лучевую терапию по поводу злокачественных новообразований шейки и тела матки, после использования вагинальных суппозиториев с ГК в комбинации с витаминами А и Е. Похожие данные получены в исследовании S. Dinicola и соавт. (2015) [15,16].…”