Vaginal dilators and intercourse are useful for alleviating post-radiotherapy vaginal problems, but more evidence is required to assess oestrogens and benzydamine

Denton AS, Maher J

Published Online:

January 21, 2009

The physical side effects of radiotherapy to the female pelvis may lead to difficulty and/or pain during intercourse. Studies of treatments (vaginal oestrogens, benzydamine douches, dilators, and intercourse) were neither recent nor good quality. This review endorses the current recommendation of using dilators and/or intercourse to prevent vaginal narrowing, however although some studies recommend the use of vaginal oestrogen or benzydamine douches, they are not statistically significant and large randomized trials are required to assess their effectiveness.

Abstract (click to read)

Background:

Following pelvic radiotherapy (RT), a proportion of women experience problems related to sexual function, which are multifactorial in origin. The physical components relate to distortion of the perineum and vagina, which may occur as a result of surgery and/or radiotherapy and compromise sexual activity resulting in considerable distress.

Objectives:

The aim of this review was to evaluate the evidence for treatment options addressing the physical components of sexual dysfunction arising from pelvic radiotherapy as prevention or treatment of acute or late complications.

Search strategy:

The concepts used included synonyms for radiation therapy and brachytherapy and synonyms for the spectrum of physical aspects of sexual dysfunction in women. randomized. We searched the Cochrane Controlled Trials Register (CENTRAL), Issue 1, 2002, MEDLINE 1966 to 2002, EMBASE 1980 to 2002, CANCERCD 1980 to 2002, Science Citation Index 1991 to 2002, CINAHL 1982 to 2002, as well as sources of grey literature. We also hand searched relevant textbooks and contacted experts in the field.

Selection criteria:

Any study describing the therapeutic trial of a treatment to relieve the physical aspects of female sexual dysfunction which had developed following pelvic radiotherapy was considered. The quality of each study was then assessed by two reviewers independently to determine its suitability for inclusion in statistical analysis.

Data collection and analysis:

Thirty-two references met the inclusion criteria for the search but of these only four were suitable to be included for statistical analysis.

Main results:

The strongest evidence for benefit is the grade IC data in the topical oestrogens and benzydamine sections which describes the treatment of acute radiation vaginal changes. The use of vaginal dilators to prevent the development of vaginal stenosis is supported by grade IIC evidence. The value of hyperbaric oxygen therapy and surgical reconstruction is supported by the much weaker grade IIIC evidence in the form of case series.

Authors' conclusions:

These findings reflect the quality of published data regarding interventions for this aspect of the management of radiation induced complications. Although there is grade IC evidence, these studies are not recent, the allocation concealment is unclear in the text, and overall there is a variable level of assessment of the response, emphasising the need for more studies to be conducted with improved designs to clarify the investigative process and support the final result.

This record should be cited as:

Denton AS, Maher J. Interventions for the physical aspects of sexual dysfunction in women following pelvic radiotherapy. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD003750. DOI: 10.1002/14651858.CD003750

Assessed as up to date:

September 7, 2002

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Primary Review Group:

Gynaecological Cancer Group

Health topics:

Cancer > Generic cancer care > Psychosocial interventions

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Vaginal dilators and intercourse are useful for alleviating post-radiotherapy vaginal problems, but more evidence is required to assess oestrogens and benzydamine

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