Dilation, Sexual Activity Improves Vaginal Stenosis in Cervical Cancer Survivors

Recent data from a subset of the EMBRACE trial suggests that regular vaginal dilation or sexual activity among patients with cervical cancer may reduce the risk of experiencing significant vaginal shortening after chemoradiation. These results, presented at the 2023 ASTRO Annual Meeting, align with clinical guidelines for postradiotherapy care in cancer survivors.¹

The standard-of-care therapy for patients with locally advanced cervical cancer not eligible for surgery includes external beam radiotherapy, chemotherapy, and internal brachytherapy. Advances in brachytherapy have improved disease control and remission rates, but high doses of radiation increase the risk of developing vaginal stenosis.

The multi-institutional, prospective, observational EMBRACE study (ClinicalTrials.gov Identifier: NCT00920920) assessed data from 1416 patients with cervical cancer between 2008 and 2015 using both physician-reported and patient-reported outcomes with a median follow-up of 5 years.

Patients underwent regular gynecologic examinations to evaluate vaginal adverse events and completed questionnaires about quality of life, sexual activity, and use of a vaginal dilator at baseline, every 3 months for the first year, every 6 months for the second and third years, and annually thereafter.

In this cohort of 882 patients, 64% reported actively engaging in sexual activity or vaginal dilation at 50% of their follow-up appointments, and the incidence of moderate (grade 2 or higher) vaginal shortening in these patients was 23% after 5 years of treatment.

In contrast, the rate of moderate vaginal stenosis among patients with infrequent (<50% of visits) and no reports of penetration was significantly higher (37% and 36%, respectively; P <.001).

Among these patients, the lowest incidence of grade 2 or worse vaginal stenosis (18%) was observed in patients who actively engaged in both vaginal dilation and sexual intercourse. The second lowest rate (23%) occurred in patients who engaged in sexual activity without the use of dilators. Patients who used dilators but were not engaging in sexual intercourse experienced a rate of 28%. In contrast, patients who did not engage in either were the most likely to experience moderate stenosis, with an incidence rate of 37%.²

However, grade 1 vaginal dryness and grade 1 bleeding were higher in patients reporting regular penetration compared with those reporting infrequent and no penetration (72%, 69%, 62%, respectively; P =.038; and 61%, 40%, 25%, respectively; P =.001).¹

Since EMBRACE is an observational study, it can only assess correlations, and further research is needed to better understand whether and how sexual activity and use of a dilator may prevent irreversible vaginal stenosis. The management and prevention of vaginal side effects could support improved quality of life.² Top of FormBottom of Form

Reference

1. Kirchheiner K, Zaharie AT, Smet S, et al. Association between regular vaginal dilation and/or vaginal sexual activity and long-term vaginal morbidity in cervical cancer survivors. Presented at 2023 ASTRO. September 30-October 4, 2023. Abstract 4.

2. Sexual activity and vaginal dilation associated with fewer side effects after cervical cancer treatment [news release]. American Society for Radiation Oncology. Published October 1, 2023. Accessed October 12, 2023. https://www.eurekalert.org/news-releases/1003210