Vaginal dilation after pelvic radiotherapy

Abstract

This quality improvement project addressed the inequity between assessment of female versus male sexual health in patients undergoing pelvic radiotherapy. Women undergoing pelvic radiotherapy suffer from the long-term side effect of vaginal stenosis which has been cited to decrease sexual satisfaction, result in pain with penetration, and decrease overall quality of life. Vaginal dilation has shown to decrease the degree of vaginal stenosis, and increase overall sexual satisfaction in this population. While national guidelines exist for the assessment of sexual health in men undergoing pelvic radiotherapy, no such guidelines exist for women. The setting of interest was a radiation oncology clinic in Montana, and the following procedures took place: phone calls to women who underwent pelvic radiotherapy between January 1, 2020 and September 9, 2020 to assess sexual health utilizing a validated screening form, the FSFI-6. At the initial phone call, adherence to twice per week vaginal dilation was asked, the woman was re-educated on vaginal dilation to prevent stenosis, and offered a vibrating dilator utilized at other radiation sites with increased adherence rates. Eight weeks later a follow-up call was placed, the FSFI-6 was reviewed and adherence to twice per week vaginal dilation was asked. Initial FSFI-6 and adherence scores were then compared to follow-up scores. The project sample consisted of 55 women meeting inclusion criteria, 13 women were lost to death or recurrence (23%); thus, phone calls took place to 42 women. Seven of these 42 (17%) women answered their phones and provided consent, five consented to the mailing of a vibrating dilator (one of these women was lost to recurrence). A mere two of the seven women (29%) were adherent to twice per week vaginal dilation at initial phone call. At eight-week follow-up phone call to those consenting to vibrating dilator, three of four women (75%) were adherent to at least twice per week dilation, and pain with penetration score on the FSFI-6 decreased by an average of three points, illustrating that issuing a vibrating dilator at completion of pelvic radiotherapy has the potential to increase adherence and decrease pain when a validated screening tool is utilized.