Patients’ perception and adherence to vaginal dilator therapy: a systematic review and synthesis employing symbolic interactionism

Figures & data

Figure 1 PRISMA 2009 flow diagram for selection of the studies.

Abbreviation: PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Table 1 Characteristics of the 21 reviewed studies

Authors (year)	Aim of study	Study design	Population explored on the VD therapy
Adeyemi-Fowode and Dietrich^Citation14 (2017)	To explore the experience of dilator use for neovagina creation in women with MRKH syndrome	Qualitative study with structure questionnaire	13 participants diagnosed with MRKH syndrome – Mean age: 26 (±11.4) years – Mostly Caucasian
Bakker et al^Citation27 (2017)	To test the feasibility of a nurse-led sexual rehabilitation intervention targeting sexual recovery and vaginal dilatation	Quantitative longitudinal intervention study	34 participants who received pelvic EBRT/BT for gynecologic cancer – Mean age: 40 (±11) years – Using Dutch language
Ketheeswaran et al^Citation24 (2017)	To examine the effect of intensive VD therapy for neovagina creation	Retrospective cohort study	68 women diagnosed with MRKH syndrome – Median age: 18 years – Women treated in Australia
Bakker et al^Citation13 (2015)	To explore the determinants of women’s adherence to dilator use	Qualitative study with semistructured interviews	30 participants who received pelvic EBRT/BT for gynecologic cancer – Mean age: 45 years – Women treated in the Netherlands
Law et al^Citation7 (2015)	To assess the adherence and efficacy of VD use in women after pelvic RT	Prospective intervention study	109 patients with rectal or anal or endometrial cancers self-reported use – Median age: 58 years – 75% White, 8% Asian, 6% each African American and Hispanic
Iavazzo et al^Citation31 (2015)	To assess patients’ experience on gynecological cancer management	Retrospective cross-sectional study	194 women with gynecological cancer – Mean age: 59 years – Women treated in the UK
Son et al^Citation15 (2015)	To examine the compliance with VD use and factors related to the development of vaginal stenosis	Prospective observational correlational study	54 women who received pelvic RT for rectal or anal cancer – Median age: 55 years – Women treated in the USA
Antosh et al^Citation11 (2013)	To compare rates of de novo dyspareunia in women with/ without VD use after posterior colporrhaphy	Randomized controlled trail	Women who received posterior colporrhaphy for pelvic organ prolapse (30 in dilator group and 30 in control group) – Mean age: 53.9 years – Women treated in the USA
Bonner et al^Citation8 (2012)	To examine the patient experience and facilitators/ barriers related to VD use	Qualitative study with semistructured interview	15 women who received pelvic RT for gynecological cancer in the last 2 years and were prescribed VD use – Mean age: 53 years – Women treated in Australia
Brand et al^Citation3 (2012)	To determine whether an educational intervention would facilitate compliance with VD	Prospective intervention study	60 women who received RT for gynecological malignancy – Median age: 60 years – Women treated in Australia
Edmonds et al^Citation22 (2012)	To explore the efficacy of VD in MRKH syndrome management	Retrospective sequential intervention study	245 women with MRKH – Mean age: 18.6 years – Women treated in the UK
Cullen et al^Citation2 (2012)	To assess women’s experience with VD and influencing psychosocial factors	Exploratory qualitative study with semistructured interviews	10 women with gynecological cancer and prescribed VD use after RT – Mean age: 52 years – Primarily White (60%), one each Black, East-Indian, Asian-Canadian, and Eastern European
Bach et al^Citation1 (2011)	To assess VD therapy in women with MRKH syndrome	Retrospective correlational study	80 women diagnosed with MRKH – Mean age: 19.5 years – Women treated in the UK
Friedman et al^Citation28 (2011)	To determine demographic, clinical, and psychosocial factors associated with adherence to VD	Retrospective correlational study	78 women with endometrial cancer treated with high dose rate brachytherapy – Mean age: 64.3 years – 82.1% White, 16.7% Black, and 1.3% others
Punt^Citation6 (2011)	To assess the compliance of VD use in women after receiving RT for cervical or endometrial cancer	Prospective correlational study	75 women who received RT for either cervix or endometrial cancer – Mean age: 63.24 years – Women treated in the UK
McVearry and Warner^Citation30 (2011)	To evaluate how certain physical therapy can augment VD therapy	Case study	One case of a 36 years old Asian women with MRKH syndrome
Stratton et al^Citation26 (2007)	To describe the management of GVH disease	Retrospective correlational study	29 women with GVH disease – Median age: 43 years – Women treated in the USA
Jeffries et al^Citation12 (2006)	To explore the effect of group psychoeducational intervention for compliance with VD	Randomized controlled trial	Women with gynecological cancer (26 in intervention and 21 in control group) – Mean age: 42.98 (±10.26) years – Women treated in Canada
White and Faithfull^Citation41 (2006)	To get the overview of current practice related to VD in the UK	Cross-sectional study	52 gynecological oncology nurse specialists and 40 RT centers – Experience with women treated in the UK
Nadarajah et al^Citation23 (2005)	To explore the sexual satisfaction among women with vaginal agenesis who received VD	Retrospective correlational study	60 women with vaginal agenesis – Mean age: 20.5 years – Women treated in the UK
Idama and Pring^Citation25 (2000)	To review the management of women with dyspareunia	Case study	18 women with superficial dyspareunia – Mean age: 26 years – Women treated in the UK

Note: Data are shown as mean (±SD).

Abbreviations: EBRT/BT, external beam radiation and intrauterine/brachytherapy; GVH, graft-versus-host; MRKH, Mayer–Rokitansky–Küster–Hauser; RT, radiation therapy; VD, vaginal dilator.

Adeyemi-FowodeOADietrichJEAssessing the experience of vaginal dilator use and potential barriers to ongoing use among a focus group of women with Mayer-Rokitansky-Küster-Hauser syndromeJ Pediatr Adolesc Gynecol201730449149428216131

 PubMed Web of Science ®Google Scholar

BakkerRMMensJWMde GrootHEA nurse-led sexual rehabilitation intervention after radiotherapy for gynecological cancerSupport Care Cancer201725372973727787681

 PubMed Web of Science ®Google Scholar

KetheeswaranAMorriseyJAbbottJBennettMDudleyJDeansRIntensive vaginal dilation using adjuvant treatments in women with Mayer-Rokitansky-Kuster-Hauser syndrome: retrospective cohort studyAust N Z J Obstet Gynaecol201758110811328960241

 PubMed Web of Science ®Google Scholar

BakkerRMVermeerWMCreutzbergCLMensJWMNoutRAter KuileMMQualitative accounts of patients’ determinants of vaginal dilator use after pelvic radiotherapyJ Sex Med201512376477325424559

 PubMed Web of Science ®Google Scholar

LawEKelvinJFThomBProspective study of vaginal dilator use adherence and efficacy following radiotherapyRadiother Oncol2015116114915526164775

 PubMed Web of Science ®Google Scholar

IavazzoCJohnsonKSavageHGallagherSDattaMWinter-RoachBASexuality issues in gynaecological oncology patients: post treatment symptoms and therapeutic optionsArch Gynecol Obstet2015291365365625260989

 PubMed Web of Science ®Google Scholar

SonCHLawEOhJHDosimetric predictors of radiation-induced vaginal stenosis after pelvic radiation therapy for rectal and anal cancerInt J Radiat Oncol Biol Phys201592354855425936810

 PubMed Web of Science ®Google Scholar

AntoshDDGutmanREParkAJVaginal dilators for prevention of dyspareunia after prolapse surgery: a randomized controlled trialObstet Gynecol201312161273128023812462

 PubMed Web of Science ®Google Scholar

BonnerCNattressKAndersonCChore or priority? Barriers and facilitators affecting dilator use after pelvic radiotherapy for gynaecological cancerSupport Care Cancer201220102305231322160621

 PubMed Web of Science ®Google Scholar

BrandAHDoVStenlakeACan an educational intervention improve compliance with vaginal dilator use in patients treated with radiation for a gynecological malignancy?Int J Gynecol Cancer201222589790422552831

 PubMed Web of Science ®Google Scholar

EdmondsDKRoseGLLiptonMGQuekJMayer-Rokitansky-Küster-Hauser syndrome: a review of 245 consecutive cases managed by a multidisciplinary approach with vaginal dilatorsFertil Steril201297368669022265001

 PubMed Web of Science ®Google Scholar

CullenKFergusKDasguptaTFitchMDoyleCAdamsLFrom “sex toy” to intrusive imposition: a qualitative examination of women’s experiences with vaginal dilator use following treatment for gynecological cancerJ Sex Med2012941162117322304701

 PubMed Web of Science ®Google Scholar

BachFGlanvilleJMBalenAHAn observational study of women with Müllerian agenesis and their need for vaginal dilator therapyFertil Steril201196248348621683350

 PubMed Web of Science ®Google Scholar

FriedmanLCAbdallahRSchluchterMPanneerselvamAKunosCAAdherence to vaginal dilation following high dose rate brachytherapy for endometrial cancerInt J Radiat Oncol Biol Phys201180375175720619551

 PubMed Web of Science ®Google Scholar

PuntLPatient compliance with the use of vaginal dilators following pelvic radiotherapy for a gynaecological cancerJ Radiother Pract20111011325

 Google Scholar

McVearryMEWarnerWBUse of physical therapy to augment dilator treatment for vaginal agenesisFemale Pelvic Med Reconstr Surg201117315315622453790

 PubMed Web of Science ®Google Scholar

StrattonPTurnerMLChildsRVulvovaginal chronic graft-versus-host disease with allogeneic hematopoietic stem cell transplantationObstet Gynecol200711051041104917978118

 PubMed Web of Science ®Google Scholar

JeffriesSARobinsonJWCraigheadPSKeatsMRAn effective group psychoeducational intervention for improving compliance with vaginal dilation: a randomized controlled trialInt J Radiat Oncol Biol Phys200665240441116542794

 PubMed Web of Science ®Google Scholar

WhiteIDFaithfullSVaginal dilation associated with pelvic radiotherapy: a UK survey of current practiceInternational Journal of Gynecological Cancer20061631140114616803497

 PubMed Web of Science ®Google Scholar

NadarajahSQuekJRoseGLEdmondsDKSexual function in women treated with dilators for vaginal agenesisJ Pediatr Adolesc Gynecol2005181394215749583

 PubMedGoogle Scholar

IdamaTOPringDWVaginal dilator therapy – an outpatient gynaecological option in the management of dyspareuniaJ Obstet Gynaecol200020330330515512559

 PubMedGoogle Scholar