Changes of the Vagina After Concurrent Radiochemotherapy and Brachytherapy in Cervical Cancer Anatomical and Physiological Changes

Abstract

The objective of the study: The aim of our study was to highlight the anatomical and physiological changes of the vagina after external radiotherapy and brachytherapy in cervical cancer. Materials and Methods: This was a prospective descriptive study conducted over a period of 6 months, from March to August 2022. A total of 123 women with cervical cancer, treated with concurrent radiochemotherapy and uterovaginal brachytherapy, who reported having had sexual intercourse in the six months prior, were included in the study. Patients were interviewed and examined during post-therapeutic follow-up consultations. Results and Statistical Analysis: The age of the patients (n=123) ranged from 33 to 67 years, with a mean of 49.35 ± 9.84 years. The post-therapeutic follow-up duration ranged from 6 months to 7 years. The most common histological type was squamous cell carcinoma, and the most common FIGO stage was stage II. Treatment consisted of concurrent radiochemotherapy and uterovaginal brachytherapy. Interviews revealed several changes related to the vagina after treatment. More than 65% of patients (n=81) reported the onset or worsening of vaginal dryness, over 50% (n=63) reported the onset or worsening of dyspareunia. Nearly 70% (n=83) reported a decrease in sexual desire frequency or dissatisfaction, and over 60% (n=78) became indifferent to sexual life. Gynecological examination revealed a vaginal length ranging from 2 to 10 cm with a mean of 5.66 ± 2.09 cm, the presence of synechiae and/or stenosis in nearly 43% (n=53), and bleeding in nearly 40% (n=47). In univariate analysis, vaginal dryness and dyspareunia significantly increased with age. Resumption of sexual activity was slower in younger and older women. Among patients followed for two years or less, there was a significant increase in synechiae or stenosis, as well as bleeding. Conversely, the prevalence of vaginal dryness and dyspareunia increased with follow-up duration, especially in those exceeding two years. In groups with vaginal dryness or dyspareunia, a large proportion of patients reported a decrease in sexual desire and indifference to their sexual life. Conclusion: This study revealed that patients with cervical cancer experienced significant anatomical and physiological changes in the vagina after treatment with concurrent radiochemotherapy and uterovaginal brachytherapy, leading to chronic sequelae and sexual disorders. It is therefore essential to implement measures to prevent or limit certain side effects associated with these treatments.