Reduced vaginal elasticity, reduced lubrication, and deep and superficial dyspareunia in irradiated gynecological cancer survivors

Figures & data

Table I. Demographic characteristics of gynecological cancer survivors (n = 616).

	Intercourse during the previous 6 months (n = 243)	No intercourse during the previous 6 months (n = 373)
	Patients (%)	Patients (%)
Age at diagnosis
18-29	6 (2)	2 (< 1)
30-39	29 (12)	14 (4)
40-49	44 (18)	33 (9)
50-59	97 (40)	113 (30)
60-69	57 (23)	145 (39)
70-75	10 (4)	66 (18)
Diagnosis
Cervical cancer	67 (28)	76 (20)
Endometrial cancer	129 (53)	237 (64)
Ovarian cancer	19 (8)	26 (7)
Sarcoma uteri	14 (6)	16 (4)
Tubal cancer	4 (2)	8 (2)
Vaginal cancer	8 (3)	6 (2)
Vulvar cancer	2 (1)	4 (1)
Time from treatment to data collection	Months (years)
Median	78 (7)	95 (8)
Min - max	30 -180 (3-15)	30-183 (3-15)
Estrogen treatment at data collection	Patients (%)
Systemic	51 (21)	38 (10)
Local	66 (27)	75 (20)
Marital Status
Married or living with partner	187 (77)	157 (42)
Widow	8 (3)	76 (20)
In a relationship but lives alone	31 (13)	6 (2)
No relationship and lives alone	15 (6)	133 (36)
Not stated	1 (< 1)	1 (< 1)
Parity
Nulli para	49 (20)	111 (30)
1 or 2 para	128 (53)	162 (43)
≥ 3 para	66 (27)	99 (27)
Not stated	0 (0)	1 (< 1)
Smoking
Current smoker	50 (21)	92 (25)
Former smoker	77 (32)	105 (28)
Never smoked	109 (46)	168 (46)
Not stated	2 (1)	4 (1)
Body Mass Index (BMI)
< 18.5 (lean)	2 (1)	14 (4)
18.6-24.9 (normal weight)	112 (48)	149 (44)
25.0-29.9 (overweight)	81 (35)	120 (35)
≥ 30 (obese)	38 (16)	59 (17)
Not stated	10 (4)	31 (9)
Hypertension	74 (30)	153 (41)
Diabetes Mellitus	14 (6)	48 (13)
Total irradiation
< 35 Gy^a without BT^b	1 (2)	3 (5)
35-40 Gy without BT	5 (10)	5 (8)
40-45 Gy without BT	26 (54)	34 (52)
45-50 Gy without BT	6 (13)	6 (9)
≥ 50 Gy without BT	10 (21)	18 (27)
≤ 35 Gy and BT	0 (0)	3 (1)
35-40 Gy and BT	61 (31)	93 (30)
40-45 Gy and BT	29 (15)	71 (23)
45-50 Gy and BT	89 (46)	112 (37)
≥ 50 Gy and BT	16 (8)	27 (9)
Surgery
Hysterectomy, SOE^c, lymph ovh oment^d +/− oophrectomy	216 (89)	327 (88)
Vulvar surgery	3 (1)	4 (1)
Other surgery	4 (2)	1 (< 1)
No surgery	20 (8)	41 (11)
Distribution of dyspareunia among women sexually active (n = 243)^e	Patients (%)
Superficial dyspareunia^f	134 (55)
Deep dyspareunia^g	97 (40)
Superficial dyspareunia only	47 (19)
Deep dyspareunia only	10 (4)
Both superficial and deep dyspareunia	87 (36)
No dyspareunia	82 (34)
Missing	17 (7)

^aGy = Grey

^bBT = Brachytherapy

^cSOE = Salpingo-oophorectomy

^dLymph ovh oment = lymph oophorectomy

^eNumbers do not add to 243 because reported types of dyspareunia overlap.

^fIncludes women reporting superficial dyspareunia only and both types of dyspareunia

^gIncludes women reporting deep dyspareunia only and both types of dyspareunia

Table II. Late symptoms with intercourse during the past six months among gynecological cancer survivors treated with pelvic radiation therapy with or without surgery (n = 243).

	Women reporting superficial dyspareunia (n = 135)*		Women reporting deep dyspareunia (n = 97)*
	No./Total (%)	RR (95% CI)	No./Total (%)	RR (95% CI)
Vaginal elasticity
Moderate/good	77/155 (50)	1.0	52/155 (34)	1.0
No/little	55/70 (79)	1.58 (1.29-1.93)	44/70 (63)	1.87 (1.41-2.49)
Adjusted for vaginal lubrication when aroused		1.24 (0.98-1.57)		1.80 (1.33-2.44)
Adjusted for age < 60**		Not done		1.92 (1.49-2.47)
Adjusted for age and lubrication**		Not done		1.89 (1.41-2.51)
Adjusted for vaginal lubrication and swollen lower abdomen**		1.24 (0.98-1.56)		Not done
Vaginal lubrication when sexually aroused
Moderate/good	53/119 (45)	1.0	42/119 (35)	1.0
No/little	78/101 (77)	1.73 (1.38-2.18)	51/100 (51)	1.45 (1.06-1.97)
Adjusted for elasticity		1.51 (1.15-1.98)		1.11 (0.83-1.47)
Adjusted for swollen lower abdomen**		1.67 (1.32-2.11)		Not done
Adjusted for swollen lower abdomen and elasticity**		1.51 (1.15-1.98)		Not done
Genital engorgement when sexually aroused
More than half the time/Every time	67/112 (60)	1.0	49/113 (43)	1.0
Never/Less than half the time	60/100 (60)	1.00 (0.80-1.25)	42/98 (43)	0.99 (0.72-1.35)
Adjusted for lubrication**		0.87 (0.73-1.04)		Not done
Adjusted for elasticity**		Not done		0.88 (0.66-1.16)
Age at follow-up
>/ = 60			44/138 (32)	1.0
< 60			53/90 (59)	1.85 (1.37-2.49)
Adjusted for elasticity**		Not done		1.85 (1.41-2.42)
Adjusted for lubrication and elasticity**		Not done		1.75 (1.33-2.30)
Swollen lower abdomen
No	93/176 (53)
Yes	40/51 (78)	1.48 (1.21-1.81)

*Women reporting having pain to the questions regarding superficial and deep pain, respectively.

**Statistical adjustment limited to known confounders.

Figure 1. Flow chart for study population.

Figure 2. Distribution of superficial and deep dyspareunia among gynecological cancer survivors treated with pelvic radiation therapy (n = 243).