Sexual Health Dysfunction After Radiotherapy for Gynecological Cancer: Role of Physical Rehabilitation Including Pelvic Floor Muscle Training.

Amelia Barcellini,Kari Bø,Ester Orlandi,Helena Biancuzzi,Mattia Dominoni,Barbara Gardella,Francesca Dal Mas,Sara Carla Venturini

doi:10.3389/fmed.2021.813352

Abstract

IntroductionThe present study aims to describe: 1. How the side effects of radiotherapy (RT) could impact sexual health in women; 2. The effectiveness of physical rehabilitation including pelvic floor muscle training (PFMT) in the management of sexual dysfunction after RT.Materials and MethodsSearch keys on PubMed, Web of Science, Scopus, PEDro, and Cochrane were used to identify studies on women treated with radical or adjuvant RT and/or brachytherapy for gynecological cancers with an emphasis on vulvo-vaginal toxicities and PFMT studies on sexual dysfunction for this group of women.ResultsRegarding the first key question, we analyzed 19 studies including a total of 2,739 women who reported vaginal dryness, stenosis, and pain as the most common side effects. Reports of dosimetric risk factors and dose-effect data for vaginal and vulvar post-RT toxicities are scant. Only five studies, including three randomized controlled trials (RCTs), were found to report the effect of PFMT alone or in combination with other treatments. The results showed some evidence for the effect of training modalities including PFMT, but to date, there is insufficient evidence from high-quality studies to draw any conclusion of a possible effect.ConclusionsGynecological toxicities after RT are common, and their management is challenging. The few data available for a rehabilitative approach on post-actinic vulvo-vaginal side effects are encouraging. Large and well-designed RCTs with the long-term follow-up that investigate the effect of PFMT on vulvo-vaginal tissues and pelvic floor muscle function are needed to provide further guidance for clinical management.

Highlights

The present study aims to describe: 1. How the side effects of radiotherapy (RT) could impact sexual health in women; 2
For studies on sexual health morbidity after RT in gynecological cancers (GyC) survivors, the database search was done with a combination of the following keywords: “pelvic radiotherapy,” “toxicity,” “vaginal toxicity,” “vaginal brachytherapy,” “hadrontherapy,” “radiotherapy,” “rehabilitation,” “gynecological cancer,” “sexual health,” “quality of life”, “sexual dysfunction,” “pelvic floor,” including pluralization and US English/UK English spelling variations and suffixes/prefixes
We reported a descriptive analysis for the rehabilitation approach, and for randomized controlled trials (RCTs), the methodological quality of the studies was evaluated using the PEDro scale (Table 3)

Summary

Introduction

The present study aims to describe: 1. How the side effects of radiotherapy (RT) could impact sexual health in women; 2. Women who underwent RT and patients with ovarian cancers [17] experienced a reduction of sexual function after diagnosis and oncological treatment. Several of these side effects appear as underreported and undertreated [18, 19] even though more than 40% of cancer survivors expressed interest in receiving sexual healthcare [20]. Despite the impact on QoL of long-survivors and sexually active patients, the vagina has so far only slightly been included in the panel of organs at risk (OARs) in the RT planning treatment for GyC. The psychological stress of sexually related toxicities negatively impacts the QoL of GyC survivors who often report feelings of shame, inadequacy, emotional distancing from the partner, and alteration in body image [21–23]

Methods

Results

Discussion

Conclusion