A nurse-led sexual rehabilitation intervention after radiotherapy for gynecological cancer

R M Bakker, J W M Mens, H E de Groot, C C Tuijnman-Raasveld, C Braat, W C P Hompus, J G M Poelman, M S Laman, L A Velema, C D de Kroon, H C van Doorn, C L Creutzberg, M M Ter Kuile, R M Bakker, J W M Mens, H E de Groot, C C Tuijnman-Raasveld, C Braat, W C P Hompus, J G M Poelman, M S Laman, L A Velema, C D de Kroon, H C van Doorn, C L Creutzberg, M M Ter Kuile

Abstract

Purpose: Although vaginal dilator use after combined pelvic radiation therapy and brachytherapy (RT/BT) is recommended to prevent vaginal shortening and stenosis, women fail to use them and experience sexual problems. A nurse-led sexual rehabilitation intervention targeting sexual recovery and vaginal dilatation was developed. Its feasibility was investigated during a prospective, longitudinal, observational pilot study.

Methods: Four oncology nurses were specifically trained to conduct the intervention. Gynecologic cancer patients treated with RT/BT were assessed using (i) questionnaires on frequency of dilator use (monthly), sexual functioning, and sexual distress (at baseline and 1, 6, and 12 months) and psychological and relational distress (at 1, 6, and 12 months); (ii) semi-structured interviews (between 6 and 12 months); and (iii) consultation recordings (a random selection of 21 % of all consults).

Results: Twenty participants were 26-71 years old (mean = 40). Eight participants discontinued participation after 3 to 9 months. At 6 months after RT, 14 out of 16 (88 %), and at 12 months 9 out of 12 (75 %), participants dilated regularly, either by having sexual intercourse or by using dilators. Sexual functioning improved between 1 and 6 months after RT, with further improvement at 12 months. Most participants reported that the intervention was helpful and the nurses reported having sufficient expertise and counseling skills.

Conclusions: According to the pilot results, the intervention was feasible and promising for sexual rehabilitation and regular dilator use after RT. Its (cost-)effectiveness will be investigated in a randomized controlled trial.

Keywords: Dilator use compliance; Gynecological cancer; Nurse-led intervention; Pelvic radiation therapy and brachytherapy; Sexual rehabilitation.

Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of the participant selection. EMC Erasmus MC Cancer Institute, LUMC Leiden University Medical Center
Fig. 2
Fig. 2
Sexual functioning assessed retrospectively about pre-diagnosis and during the intervention at 1, 6, and 12 months after treatment
Fig. 3
Fig. 3
Average dilation frequency per week (n = 20)

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