Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Instituto Nacional de Câncer José Alencar Gomes da Silva. Estimate/2020 – Cancer Incidence in Brazil: INCA; 2019.

  2. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A, et al. 2018 GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.

    PubMed  Google Scholar 

  3. Annede P, Gouy S, Haie-Meder C, Morice P, Chargari C. Place of radiotherapy and surgery in the treatment of cervical cancer patients. Cancer Radiotherapie: Journal de la Societe Francaise de Radiotherapie Oncologique. 2019;23(6-7):737–44.

    Article  CAS  Google Scholar 

  4. Lee YC, Lheureux S, Oza AM. Treatment strategies for endometrial cancer: current practice and perspective. Curr Opin Obstetr Gynecol. 2017;29(1):47–58.

    Article  Google Scholar 

  5. Park HS, Ratner ES, Lucarelli L, Polizzi S, Higgins SA, Damast S. Predictors of vaginal stenosis after intravaginal high-dose-rate brachytherapy for endometrial carcinoma. Brachytherapy. 2015;14(4):464–70.

    Article  PubMed  Google Scholar 

  6. Rosa LM, Hammerschmidt KSA, Radünz V, Ilha P, Tomasi AVR, Valcarenghi RV. Evaluation and classification of vaginal stenosis after brachytherapy. Texto Contexto Enferm 1-8. 2016.

  7. Bruner DW, Nolte SA, Shahin MS, Huang HQ, Sobel E, Gallup D, et al. Measurement of vaginal length: reliability of the vaginal sound--a gynecologic oncology group study. Int J Gynecol Cancer. 2006;16(5):1749–55.

    Article  CAS  PubMed  Google Scholar 

  8. Morris L, Do V, Chard J, Brand AH. Radiation-induced vaginal stenosis: current perspectives. Int J Women's Health. 2017;9:273–9.

    Article  Google Scholar 

  9. Silva MPP, Gannuny CS, Aiello NA, Higinio MAR, Ferreira NO, Oliveira MMF. Assessment methods for post radiotherapy vaginal stenosis. Brasileira de Cancerologia. 2010;56(1):71–83.

    Article  Google Scholar 

  10. U.S. Department of Health and Human Services. Common Terminology Criteria for Adverse Events Version 5.0 (CTCAE v5.0) – November 27, 2017.

  11. Silva RDN, Rosa LM, Radünz V, Cesconetto D. Evaluation and classification of vaginal stenosis in brachytherapy: instrument content validation for nurses. Texto Contexto - Enferm. 2018;27(2):e5700016.

    Google Scholar 

  12. Thiel Rdo R, Dambros M, Palma PC, Thiel M, Riccetto CL, de Ramos MF. Translation into Portuguese, cross-national adaptation and validation of the female sexual function index. Rev Bras Ginecol Obstet. 2008;30(10):504–10.

    Article  PubMed  Google Scholar 

  13. Fleck MP, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L, et al. Application of the Portuguese version of the abbreviated instrument of quality life WHOQOL-bref. Rev Saude Publica. 2000;34(2):178–83.

    Article  CAS  PubMed  Google Scholar 

  14. Martins J, Vaz AF, Grion RC, Esteves SCB, Costa-Paiva L, Baccaro LF. Factors associated with changes in vaginal length and diameter during pelvic radiotherapy for cervical cancer. Arch Gynecol Obstet. 2017;296(6):1125–33.

    Article  PubMed  Google Scholar 

  15. Dias M, Custódio LL, Bragante K, Patrício JJS, Roussenq SC, Zomkowski K, et al. Prevalence of vaginal stenosis in the physical therapy evaluation after high dose rate brachytherapy at a referral center in southern Brazil. J Sex Med. 2018;15:S383.

    Article  Google Scholar 

  16. Dias M, Custódio LL, Patrício JJS, Bragante KC, Zomkovski K, Sperandio FF, et al. Sexual dysfunctions after high dose rate brachytherapy for gynaecological cancer treatment. J Sex Med. 2018;15:S232.

    Article  Google Scholar 

  17. Vaz AF, Conde DM, Costa-Paiva L, Morais SS, Esteves SB, Pinto-Neto AM. Quality of life and adverse events after radiotherapy in gynecologic cancer survivors: a cohort study. Arch Gynecol Obstet. 2011;284(6):1523–31.

    Article  PubMed  Google Scholar 

  18. Correa CS, Leite IC, Andrade AP, de Souza Sergio Ferreira A, Carvalho SM, Guerra MR. Sexual function of women surviving cervical cancer. Arch Gynecol Obstet. 2016;293(5):1053–63.

    Article  PubMed  Google Scholar 

  19. Damast S, Jeffery DD, Son CH, Hasan Y, Carter J, Lindau ST, et al. Literature review of vaginal stenosis and dilator use in radiation oncology. Pract Radiat Oncol. 2019;9(6):479–91.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Santos F, Pacheco MA, Morera JLE, Lagoa AA. Cervical adenocarcinoma: a clinical challenge. Acta Obstet Ginecol Port. 2018;12(1):8–13.

    Google Scholar 

  21. Pessi MR, Feuerchutte KK, Rosa LM, Hammerschmidt KSA, Radünz V, Alvarez AM. Prevention of vaginal stenosis after brachytherapy: nursing intervention. J Nurs UFPE Online Recife. 2016;10(9):3495–502.

    Google Scholar 

  22. Kirchheiner K, Nout RA, Lindegaard JC, Haie-Meder C, Mahantshetty U, Segedin B, et al. Dose-effect relationship and risk factors for vaginal stenosis after definitive radio(chemo)therapy with image-guided brachytherapy for locally advanced cervical cancer in the EMBRACE study. Radiother Oncol. 2016;118(1):160–6.

    Article  PubMed  Google Scholar 

  23. Stahl JM, Qian JM, Tien CJ, Carlson DJ, Chen Z, Ratner ES, et al. Extended duration of dilator use beyond 1 year may reduce vaginal stenosis after intravaginal high-dose-rate brachytherapy. Support Care Cancer. 2019;27(4):1425–33.

    Article  PubMed  Google Scholar 

  24. Akbaba S, Oelmann-Avendano JT, Krug D, Arians N, Bostel T, Hoerner-Rieber J, et al. The impact of vaginal dilator use on vaginal stenosis and sexual quality of life in women treated with adjuvant radiotherapy for endometrial cancer. Strahlenther Onkol. 2019;195(10):902–12.

    Article  PubMed  Google Scholar 

Download references

Funding

First author (T.M.S.) was the recipient of a scholarship sponsored by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brasil (CAPES), Code 001.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas – UNICAMP, Rua Alexander Fleming 101, Cidade Universitária, Campinas, SP, 13083-881, Brazil

    Thaís de Morais Siqueira, Sophie Derchain, Cassia Raquel Teatin Juliato, Marcela Ponzio Pinto e Silva, Helymar Costa Machado & Luiz Gustavo Oliveira Brito

Authors
  1. Thaís de Morais Siqueira
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sophie Derchain
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cassia Raquel Teatin Juliato
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marcela Ponzio Pinto e Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Helymar Costa Machado
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luiz Gustavo Oliveira Brito
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luiz Gustavo Oliveira Brito.

Ethics declarations

Conflicts of interest

None.

Ethical approval

The Institutional Review Board has approved this study: Women’s Hospital, Campinas, Brazil, number CAAE 98061018.3.0000.5404.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

de Morais Siqueira, T., Derchain, S., Juliato, C.R.T. et al. 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. Int Urogynecol J 33, 637–649 (2022). https://doi.org/10.1007/s00192-021-04798-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-021-04798-8

Keywords

Search

Navigation