The impact of vaginal dilator use on vaginal stenosis and sexual quality of life in women treated with adjuvant radiotherapy for endometrial cancer

Akbaba, Sati; Oelmann-Avendano, Jan Tobias; Krug, David; Arians, Nathalie; Bostel, Tilman; Hoerner-Rieber, Juliane; Nicolay, Nils H.; Debus, Jürgen; Lindel, Katja; Forster, R. E.

doi:10.1007/s00066-019-01466-1

Cited by 20 publications

(19 citation statements)

References 39 publications

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“…Regarding the effect of VDs on VS, similar results were found by several studies [9,20,[30][31][32]. Velaskar et al observed that there was a significant increase in vaginal canal length after 4 months of vaginal dilation therapy [33].…”

Section: Discussionsupporting

confidence: 79%

“…In accordance, Gondi et al observed that high compliance with VD therapy was associated with less severe VS after RT in patients with locally advanced cervical cancer [30]. On the contrary, other authors did not find any impact of VD use on VS after RT [3,23,32,35,36]. Despite mixed evidence regarding the possible benefit of VD use on VS after RT, American Cancer Society recommendations include VD therapy or sexual intercourse three times per week against VS [11,28].…”

Section: Discussionmentioning

confidence: 92%

“…However, the study of van Leeuwen et al did not find any influence of VD use in patients' quality of life; that study showed that over time there was an improvement in quality of life with decreased vaginal symptoms 1 year after RT [3,38]. Although Akbaba et al demonstrated that sexual QoL considerably deteriorated after surgery and radiotherapy due to vaginal toxicity, they found no association between vaginal dilator use and improvement of sexual functioning [32]. In accordance, Jeffries et al and Robinson et al showed no benefit in sexual function scores of both patients using vaginal dilators with guidance and patients with no psychoeducational intervention [18,20,39].…”

Section: Discussionmentioning

confidence: 99%

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

Charatsi¹,

Vanakara²,

Nikolaou³

et al. 2021

IJCST

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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.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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

Charatsi¹,

Vanakara²,

Nikolaou³

et al. 2021

IJCST

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“…With the aim of analyzing the effects of a vaginal dilator on vaginal stenosis, one study included 56 consecutive patients instructed to use a vaginal dilator after completion of radiotherapy. The authors reported that vaginal dilator use had no influence on vaginal dilator diameter ( p = 0.81), indicating that the use of vaginal dilators does not prevent vaginal stenosis or sexual impairment [ 22 ]. In the present series, only 20% of patients showed compliance with vaginal dilator use for more than 2 years, which may help to reduce the rate of G2 toxicity.…”

Section: Discussionmentioning

confidence: 99%

EQD2 Analyses of Vaginal Complications in Exclusive Brachytherapy for Postoperative Endometrial Carcinoma

Zhang

Fornes

Gomez

et al. 2020

Cancers

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Background: To evaluate whether EQD2(α/β = 3Gy) at 2 cm3 of the most exposed area of the vagina is related to late vaginal toxicity in postoperative endometrial cancer (PEC) patients (p) treated with exclusive brachytherapy (BT). Methods: From 2014 to 2017, 43p were included in this study. BT was administered: 3-fractions of 6Gy in 37p and 2-fractions of 7.5Gy in 6p. The dose was prescribed at a depth of 5 mm from the applicator surface with dose-point optimization based on distance. The active treatment length was 2.5 cm. CTV-D90 and the dose to the most exposed 2 cm3 of the vagina was calculated for each patient. Late toxicity of the bladder and rectum was assessed using Radiation Therapy Oncology Group (RTOG) criteria, and vaginal toxicity by objective Late Effects Normal Tissue Task Force (LENT)-Subjective, Objective, Management, Analytic (SOMA) (LENT-SOMA) criteria. Statistics: frequency tables, mean, median, range, standard deviation, and box plot. Results: The median follow-up was 51 months (12–68). 20 p (46.5%) and 2 p (4.7%) developed G1 and G2 vaginal complications, respectively. Only 1/2 p-G2 receiving EQD2(α/β = 3Gy) at 2 cm3 >68Gy presented vaginal shortening and 18/20 p-G1 received doses < 68Gy. Conclusions: PECp receiving exclusive brachytherapy with doses < 68Gy EQD2(α/β = 3Gy) at 2 cm2 of the vagina presented only G0–G1 vaginal toxicity, except for one with bleeding telangiectasias. Larger prospective studies are necessary to confirm the present results.

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“…Several studies have reported similar results regarding the effect of VD on VS. [ 9 , 20 , 30 – 32 ] Velaskar et al [ 33 ] observed a significant increase in vaginal canal length after 4 months of VD therapy. In a prospective cohort study by Law et al, [ 8 ] VD minimized VS in rectal and gynecological cancer survivors.…”

Section: Discussionmentioning

confidence: 99%

Vaginal dilator use to promote sexual wellbeing after radiotherapy in gynecological cancer survivors

et al. 2022

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This study investigated the efficacy of a vaginal dilator (VD) for the treatment of radiation-induced vaginal stenosis (VS) and the effect of a VD on sexual quality of life. Fifty three patients with endometrial or cervical cancers participated in this prospective observational study. All participants were treated with radical or adjuvant external beam radiotherapy and/or brachytherapy. They were routinely examined 4 times after radiotherapy (RT) and were also asked to complete a validated sexual function-vaginal changes questionnaire. SPSS version 20 and Minitab version 16 were used for the statistical analysis. The statistical significance was set at P < .05. The VS grading score decreased and the comfortably insertable VD size gradually increased throughout a year of VD use; all patients with initial grade 3 showed a VS of grade 2 after 12 months of VD use and 65.8% of the patients with initial grade 2 demonstrated a final VS of grade 1, while 77.8% of the participants who started with the first size of VD reached the third size after 12 months. Starting VD therapy ≤3 months after the end of RT was associated with a significant decrease in VS. A total of 60.9% of participants reported that they did not feel their vaginas were too small during intercourse after 12 months of dilation, whereas only 11.5% gave the same answer before starting dilation. Furthermore, 47.17% rated their satisfaction with their sexual life 5 out of 7 and only 3.77% gave a score of 3 after 12 months of dilation. Endometrial and cervical cancer survivors are encouraged to use VD to treat VS and for sexual rehabilitation after RT. This study recommends starting vaginal dilation no more than 3 months after treatment at least 2 to 3 times a week for 10 to 15 minutes over 12 months. However, larger, well-designed randomized clinical trials should be conducted to develop specific guidelines for VD use and efficacy in VS and sexual sexual quality of life after RT.

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The impact of vaginal dilator use on vaginal stenosis and sexual quality of life in women treated with adjuvant radiotherapy for endometrial cancer

Cited by 20 publications

References 39 publications

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

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

EQD2 Analyses of Vaginal Complications in Exclusive Brachytherapy for Postoperative Endometrial Carcinoma

Vaginal dilator use to promote sexual wellbeing after radiotherapy in gynecological cancer survivors

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