A Retrospective Study of Vaginal Stenosis Following Treatment of Cervical Cancers and the Effectiveness of Rehabilitation Interventions
Vaginal stenosis is a common side effect associated with pelvic radiotherapy in cervical cancer patients which contributes negatively to woman’s health and prevents adequate vaginal/cervical examination. Vaginal dilation with a dilator is routine practice and is internationally advocated as a prophylactic measure to preserve vaginal patency. This retrospective study was carried out with the aim to know the usefulness of vaginal dilation following pelvic radiation therapy in cervical cancer patients in India. Data from medical records of 183 cervical cancer patients, which met the study criteria, were collected related to the stage of the disease, treatment received, commencement period of dilation post radiation therapy, sexual status and side effects associated to dilation practice. Data related to vaginal dimensions as per the length of insertion of a small, medium and large dilator were collected on regular follow-ups until 36 months and/or more. Vaginal dimensions as measured with the length of medium dilator insertion were used for analysis of dilation therapy results using paired t-test. Patients who underwent vaginal dilation with dilator maintained vaginal patency, also the mean vaginal length significantly increased, from 8.02 cm ± 2.69 to 9.96 ± 2.89 cm with a p value <0.001. There was no significant difference found on vaginal patency with different intervals of initiation of dilation therapy. At the third year and more following dilation therapy, significant increase in vaginal length observed with a p value of 0.0001 in both sexually active and inactive patients. Compilation of vaginal dosage during brachytherapy was inadequate, and hence, the secondary objective of the study to determine the effect of radiotherapy on the outcome of rehabilitation intervention was not studied in detail. This retrospective study has found that dilation therapy with vaginal dilators post pelvic radiotherapy is effective in preventing vaginal stenosis and improving vaginal patency and cannot be substituted with vaginal intercourse. Sexual quality of life assessment in the Indian population needs much attention.
 H. M. Keys, B. N. Bundy, F. B. Stehman, L. I. Muderspach, W. E. Chafe, C. L. Suggs III, et al. Cisplatin, radiation, and adjuvant hysterectomy compared with radiation and adjuvant hysterectomy for bulky stage IB cervical carcinoma, New England Journal of Medicine 1999;340: 1154-1161.
 H. Lind, A-C. Waldenstrom, G. Dunberger, M. al-Abany, E. Alevronta, K-A. Johansson, et al., Late symptoms in long- term gynecological cancer survivors after radiation therapy; a population- based cohort study. Bristish Journal of cancer. 2011, 105737-745.
 W. Judith, Prevention and treatment of vaginal stenosis resulting from pelvic radiation therapy. Community Oncology. October 2006; Vol3/Number 10.
 M. M. Abitbol, J. H. Davenport, Sexual dysfunction after therapy for cervical carcinoma. American Journal Obstetrics Gynecology. 1974; 119 (2):181-9.
 K. Bertelsen, Sexual dysfunction after treatment of cervical cancer. Danish Medical Bulletin. 1983 Dec; Val. 30: 31-4.
 G. H. Eltabbakh, M. S. Piver, R. E. Hempling, K. H. Shin, Excellent long-term survival and absence of vaginal recurrences in 332 patients with low-risk stage I endometrial adenocarcinoma treated with hysterectomy and vaginal brachytherapy without formal staging lymph node sampling: report of a prospective trial. International Journal of Radiation Oncology, Biology, Physics. 1997; 38(2):373-80.
 T. Miles, N. Johnson, Vaginal dilator therapy for women receiving pelvic radiotherapy, Cochrane Database Syst. Rev.; (9): CD007291. doi:10.1002/14651858.CD007291. pub2.
 International Guidelines on vaginal dilation after pelvic radiotherapy. National Forum of Gynecological Oncology Nurses 2012.
 I. White, S. Faithfull, Vaginal dilation associated with pelvic radiotherapy: a UK survey of current practice. International Journal Gynaecology Practice 2006; 16:1146–9.
 L. Lancaster, Preventing vaginal stenosis after brachytherapy for gynecological cancer: an overview of Australian practices. European Journal of Oncology Nursing 2004; 8(1): 30-39.
 B. G. Sorbe, A. C. Smeds, Post-operative vaginal irradiation with high dose rate after loading technique in endometrial carcinoma stage I. International Journal of Radiation Oncology Biology and Physics;1990.18(2):305-314.
 P. T. Jensen, M. Groenvold, M. C. Klee, I. Thranov, M. Petersen, D. Machin, Longitudinal study of sexual function and vaginal changes after radiotherapy for cervical cancer. International Journal of Radiation Oncology, Biology, Physics; 2003. 56:937–49.
 K. Bergmark, E. Avall-Lundqvist, P. W. Dickman, L. Henningsohn, G. Steineck, Vaginal changes and sexuality in women with a history of cervical cancer. New England Journal of Medicine; 1999. 340:1383-9.
 M. S. Hoffman, K. E. Wakeley, R. J. Cardosi. Risks of rigid dilation for a radiated vaginal cuff: Two related rectovaginal fistulas. Obstetrics and Gynecology 2003; 101 (5 (suppl)): 1125-6.
 I. White, H. Allan, S. Faithfull, Assessment of treatment-induced female sexual morbidity in oncology: is this a part of routine medical follow-up after radical pelvic radiotherapy? British Journal of Cancer; 2011; 105, 903 – 910.
 D. W. Bruner , R. Lanciano, M. Keegan, B. Corn, E. Martin, G. E. Hanks, Vaginal stenosis and sexual function following intracavitary radiation for the treatment of cervical and endometrial carcinoma. International Journal of Radiation Oncology, Biology, Physics; 1993. 15: 27(4):82530.
 P. A. Poma, Postirradiation vaginal occlusion: nonoperative management. International Jurnal of Gynaecology and Obsetetrics 1980; 18(2): 90-2.
 S. B. Decruze, D. Guthrie, R. Magnani. Prevention of vaginal stenosis in patients following vaginal brachytherapy. Clinical Oncology; 1999. 11(1):46-8.
 L. Rutten, N. Arora, A. Bakos, N. Aziz, J. Rowland, Information needs and sources of information among cancer patients: a systematic review of research (1980-2003). Patient Education Counseling. 2005; 57:250–261.
 P. Cardy, J. Corner, J. Evans, N. Jackson, K. Shearn, L. Sparham, Worried sick: the emotional impact of cancer. Macmillan Cancer Support, London; 2006 (p. 1–24).
 A. Cox, V. Jenkins, S. Catt, C. Langbridge, L. Fallowfield, Information needs and experiences: An audit of UK cancer patients. European Journal Oncology Nursing. 2006; 10: 263–272.
 E. Voogt, A. van Leewen, A. Visser, A. van der heide, P. van der Maas, Information needs of patients with incurable cancer. Support Care Cancer. 2005; 13: 943–948.