Vaginal stenosis in women with cervical or endometrial cancer after pelvic radiotherapy: a cross-sectional study of vaginal measurements, risk for sexual dysfunction and quality of life.

INTRODUCTION AND HYPOTHESIS: Radiotherapy (RT) for cervical (CC) and endometrial cancer (EC) is known to lead to vaginal stenosis (VS), but the comparison between vaginal anatomical measurements and the risk of sexual dysfunction presents a wide variety of results among the literature. Thus, we sought to assess the prevalence of VS, vaginal measurements, sexual dysfunction and QOL in women with CC and EC submitted to pelvic RT with or without previous surgery. METHODS: Cross-sectional study that included 61 women with CC and 69 with EC. VS was classified by the Common Terminology Criteria for Adverse Effects version 5.0 (CTCAE v5.0), sexual function by the validated Female Sexual Function Index (FSFI) and QOL by the validated World Health Organization questionnaire (WHOQOL-BREF). Acrylic cylinders were used for vaginal measurements. Uni-/multivariate analyses to address factors associated with VC in both groups were performed. RESULTS: The prevalence of VS was 79% and 67% within patients with CC and EC, respectively. Vagina length was decreased in both groups without statistical difference (7.2 ± 1.7 vs. 6.6 ± 1.8;p = 0.072). Vaginal diameter was significantly higher (p = 0.047) in women with EC (25.4 ± 6.3) than in those with CC (23.1 ± 5.7). Sexual dysfunction was highly prevalent for both CC and EC (88% vs. 91%; p = 0.598). There was no difference in all WHOQOL-BREF domains between women with CC and EC. CONCLUSIONS: VS is highly prevalent in CC and EC patients, with vaginal length decreased in both groups but with a higher vaginal diameter in those with EC. Nevertheless, sexual dysfunction is highly prevalent in both groups.

Comparação da disfunção do assoalho pélvico com função sexual e qualidade de vida em sobreviventes ao câncer ginecológico / Comparison of pelvic floor dysfunction with sexual function and quality of life in gynecological cancer survivors

Resumo Objetivo Comparar a contração objetiva do assoalho pélvico, estenose vaginal e dispareunia com a função sexual e a qualidade de vida relacionada à saúde de sobreviventes ao câncer ginecológico. Método Estudo transversal com mulheres com diagnóstico de câncer ginecológico e com no mínimo seis meses de término do tratamento oncológico. A avaliação consistiu na aplicação da ficha de identificação, questionários (QS-F e FACT-G) e exame físico ginecológico. Resultados Foram avaliadas 64 pacientes com média de idade de 50 anos, das quais 56,3% eram ativas sexualmente. O tipo de câncer mais frequente foi o de colo uterino (62,5%), sendo o principal tratamento realizado a histerectomia (54,7%). Observou-se a presença de dispareunia em 32,8% das mulheres ativas sexualmente, a estenose vaginal foi identificada em 45,3% dos casos, e 45,3% apresentaram contração objetiva ausente do assoalho pélvico. A comparação das médias dos escores do questionário QS-F evidenciou diferença significante considerando a presença ou não de estenose vaginal e dispareunia, enquanto que a presença ou ausência da contração objetiva do assoalho pélvico não apresentou diferença significante na função sexual. Verificou-se associação entre estenose vaginal e dispareunia, porém a atividade sexual e a contração do assoalho pélvico não estiveram associadas à estenose vaginal. Além disso, a estenose vaginal, dispareunia e a contração do assoalho pélvico não apresentaram associação significante com a qualidade de vida. Conclusão A presença de disfunção do assoalho pélvico nas sobreviventes ao câncer ginecológico indicou prejuízo na função sexual, sem impactar negativamente na qualidade de vida relacionada à saúde.

Abstract Objective To compare objective contraction of the pelvic floor, vaginal stenosis and dyspareunia with sexual function and health related quality of life in gynecological cancer survivors. Method Cross-sectional study with women referred to oncological treatment for gynecological cancer with at least six months of the treatment. Study participants completed an initial evaluation form regarding demographic characteristics, and medical history, QS-F and FACT-G questionnaires, and gynecological physical examination. Results Sixty-four patients with a mean age of 50 years, of which 56.3% were sexually active, were evaluated. The most frequent type of cancer was cervical cancer (62.5%) and the main treatment was hysterectomy (54.7%). The presence of dyspareunia was observed in 32.8% of sexually active women, vaginal stenosis was identified in 45.3% of the cases, and 45.3% presented no objective contraction of the pelvic floor. The comparison of QS-F questionnaire scores showed a significant difference considering the presence or absence of vaginal stenosis and dyspareunia, while the presence or absence of objective contraction of the pelvic floor did not show a significant difference in sexual function. There was an association between vaginal stenosis and dyspareunia, but sexual activity and contraction of the pelvic floor were not related to vaginal stenosis. In addition, vaginal stenosis, dyspareunia and contraction of the pelvic floor were not significantly associated with health-related quality of life. Conclusion The presence of pelvic floor dysfunction in gynecological cancer survivors indicated impairment in sexual function with no negative impact on health-related quality of life.