Perceptions and Practices regarding Women's Vaginal Health following Radiation Therapy: A Survey of Radiation Oncologists Practicing in the USA

Publication date: Available online 14 February 2017
Source:Practical Radiation Oncology
Author(s): L.A. Kachnic, D.W. Bruner, M.M. Qureshi, G.A. Russo
Purpose/ObjectivesVaginal stenosis (VS) is a recognized complication of pelvic and vaginal radiation therapy (RT).Materials/MethodsA 26-item survey assessing the signs/symptoms, risk factors, diagnosis, prevention, treatment and impact of VS on women's sexual health was distributed. Descriptive statistics were calculated. Chi-square tests examined differences in categorical responses.Results233 (10.5%) completed the entire survey. Twelve%, 21%, and 68% report treating only gynecologic (GYN) tumors, only non-GYN pelvic tumors, or both, respectively. Regarding risk factors, 78% feel that VS can be caused by pelvic RT alone, 91% by vaginal brachytherapy (VB) alone, and 98% by combined pelvic RT and VB. Approximately half of respondents felt that being post-menopausal and having a hysterectomy prior to radiation therapy were risk factors for VS, while the other half felt that these were not risk factors. All respondents agree that VS is a clinical diagnosis. Reported VS symptoms include dyspareunia, vaginal pain, dryness, and/or bleeding (100%, 90%, 85% and 72%, respectively); 65% indicate all four. The most commonly recommended treatment for VS is vaginal dilator (VD) use Radiation oncologists who treat only GYN vs. non-GYN cancers are more likely to perform a vaginal exam, to distribute written instructions regarding VD use (p=0.002), to have vaginal bleeding reported after RT (p=0.001), and to refer patients to a sexual counselor (p=0.007). Most providers (73%) expressed willingness to participate in prospective research on the diagnosis and treatment of VS.ConclusionsThis is the first large-scale survey of radiation oncologists' perceptions and practices regarding VS. There is agreement among providers regarding the signs/symptoms of VS, and strategies for the prevention/treatment using vaginal dilators. Further prospective and observational research is needed. This survey shows a willingness on the part of providers to take part in prospective research regarding the diagnosis, impact, and treatment of VS on women's sexual health.



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