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Chore or priority? Barriers and facilitators affecting dilator use after pelvic radiotherapy for gynaecological cancer

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Abstract

Purpose

Pelvic radiotherapy for gynaecological cancer often leads to damage of the vaginal mucosa, resulting in stenosis (obstruction by scar tissue). Stenosis has been associated with sexual dysfunction and can hinder medical examinations to detect recurrence. The use of vaginal dilators is frequently recommended to prevent or minimise stenosis, but women are reluctant to use these devices. The aim of this study was to explore the patient experience of dilator use and identify the barriers and facilitators affecting compliance with clinician recommendations.

Methods

Women were eligible for the study if they had undergone pelvic radiotherapy for gynaecological cancer up to 2 years ago and received a vaginal dilator as part of their post-treatment rehabilitation. Fifteen participants completed a semi-structured interview.

Results

Barriers to dilator use included: uncertainty about how/when to use dilators, viewing it as a negative experience, lack of time or forgetting and the need for discretion due to an association with sex aids. Facilitators included: concern about stenosis, belief that dilators work, reminders of stenosis, acceptance of dilator use as part of their normal routine or an extension of medical treatment and focusing on positive aspects. These factors were incorporated into a model of dilator use based on the Health Belief Model.

Conclusions

This is the first qualitative study to specifically investigate the patient experience of dilator use. The barriers and facilitators identified in this study and the proposed theory-based model provide new insights to inform future research and clinical management of dilator use.

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Conflict of interest

The authors have no conflict of interest to declare.

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Authors and Affiliations

  1. Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, NSW, Australia

    Carissa Bonner, Caroline Anderson & Ilona Juraskova

  2. Sydney Gynaecologic Oncology Group, Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney South West Area Health Service, Sydney, NSW, Australia

    Kathryn Nattress, Jonathan Carter, Chris Milross & Shannon Philp

Authors
  1. Carissa Bonner
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  2. Kathryn Nattress
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  3. Caroline Anderson
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  4. Jonathan Carter
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  5. Chris Milross
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  6. Shannon Philp
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  7. Ilona Juraskova
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Corresponding author

Correspondence to Ilona Juraskova.

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Bonner, C., Nattress, K., Anderson, C. et al. Chore or priority? Barriers and facilitators affecting dilator use after pelvic radiotherapy for gynaecological cancer. Support Care Cancer 20, 2305–2313 (2012). https://doi.org/10.1007/s00520-011-1337-z

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  • DOI: https://doi.org/10.1007/s00520-011-1337-z

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