Longitudinal
study of sexual function and vaginal changes after radiotherapy for cervical cancer
Pernille T. Jensen, IJROBP 2003; 46:937-949
Purpose
Patients treated for cervical cancer by irradiation (RT) are likely to experience
radiation-induced injuries to the genitals and surrounding organs. Additionally,
these patients may be physically and psychologically affected by the general side effects
and emotional distress after diagnosis and RT and are hence highly exposed to disruptions
in their sexual function. Sexual dysfunction in cervical cancer patients has been
described in several studies. The results are difficult to compare because of the
different methods used to assess, analyze, and report sexual function. Most studies have
focused on sexual outcomes after treatment of early-stage cervical cancer and
detailed knowledge concerning patients with locally advanced or recurrent cervical cancer
is still very limited. As a group, patients with locally advanced cervical cancer have a
median 5-year survival of about 50%.. Thus, many cervical cancer patients will live for
years with the sequelae of their disease and need specific information about the
consequences of the treatment they are offered.
In the few studies that have included advanced cervical cancer patients the data were
often pooled with those of early-stage cervical cancer patients who were treated with
surgery alone . Because of the larger tumor burden, more extensive treatment, and less
favorable prognosis, the patient with locally advanced cervical cancer may be exposed to
more sexual and vaginal problems than the early-stage cervical cancer patient cured after
surgery alone. Therefore, when data from locally advanced and early-stage cervical cancer
patients (treated by surgery alone) are pooled, the impact of disease and treatment on the
sexual function is likely to be underestimated in patients with advanced disease. From an
interventional perspective, it is of interest to map the consequences of treatment to
develop relevant disease- and treatment-specific interventions that may alleviate side
effects. In the case of unavoidable side effects, interventions directed toward
information and sexual counseling may provide the patient with the knowledge enabling her
to cope with the anticipated problems.
This paper is the third in a series describing the health-related quality of life in a
sample of patients who were disease free after RT for locally advanced, recurrent, or
persistent (after radical hysterectomy) cervical cancer (20, 21).To investigate the
longitudinal course of self-reported sexual function and vaginal changes in patients
disease free after radiotherapy (RT) for locally advanced, recurrent, or persistent
cervical cancer.
Persistent sexual dysfunction and adverse vaginal changes were
reported throughout the 2 years after RT, with small changes over time: approximately 85%
had low or no sexual interest, 35% had moderate to severe lack of lubrication, 55% had
mild to severe dyspareunia, and 30% were dissatisfied with their sexual life. A reduced
vaginal dimension was reported by 50% of the patients, and 45% were never, or only
occasionally, able to complete sexual intercourse. Despite sexual dysfunction and vaginal
adverse effects, 63% of those sexually active before having cancer remained sexually
active after treatment, although with a considerably decreased frequency.
Conclusion
Patients who are disease free after RT for locally advanced, recurrent, or persistent
cervical cancer are at high risk of experiencing persistent sexual and vaginal problems
compromising their sexual activity and satisfaction. The results of our study emphasize
that patients treated by RT for cervical cancer should be informed about the potential
risk of sexual and vaginal problems. We believe that this patient group has a seriously
underestimated and neglected problem. Not only are the patients at high risk of
experiencing sexual problems, they are also exposed to the taboo on communication about
sexual problems among gynecologic oncologists. Vincent found that 80% of the
patients treated for cervical cancer wished for information on sexual issues from their
physician and 56% of these did not feel sufficiently informed about sex. However, most of
the patients would never themselves pose the question of sexual problems.
Different intervention strategies could be proposed. In a randomized study, Robinson
found increased compliance with the use of vaginal dilators and greater confidence
in having sex in the intervention group given careful counseling about potential sexual
difficulties and suggestions on alternative sexual practices in addition to careful
instruction in the use of a vaginal dilator. After this study, verbal and written
information on the use of a vaginal dilator was elaborated and given to all cervical
cancer patients after intracavitary RT at both departments contributing patients to the
present study. However, as pointed out in the study of Robinson and confirmed by
others, the practical instructions on the use of a vaginal dilator should be accompanied
by specific counseling on sexual problems and vaginal changes anticipated or experienced .
The essential point of the is that all health-care providers can provide
counseling at the level at which they are confident. The most important issue is that
questions regarding sexuality are encouraged and taken up by those who have the knowledge
of potential consequences of the therapy given. The staff should be taught the basic
knowledge of potential sexual problems and the management of the most pertinent ones. The
clinician should be able to identify the couples who should be referred for professional
sexual counseling. The present study provides detailed results useful for basic clinical
information on sexual and vaginal problems after RT for cervical cancer. |