Sexual Activity Lowers Risk of Side Effects After Cervical Cancer Treatment

SAN DIEGO — Patients who engage in sexual activity and/or vaginal dilation after undergoing chemoradiation for cervical cancer had a lower risk of sexual health-related side effects, according to results from the EMBRACE study.

In a subcohort of 882 women with at least three follow-up assessments, those reporting regular vaginal dilation and/or sexual intercourse had a lower estimated 5-year risk of moderate vaginal stenosis — shortening or narrowing of the vagina — compared with women who had no or infrequent dilation or intercourse (23% vs 37%, P≤0.001), reported Kathrin Kirchheiner, MSc, PhD, of the Medical University of Vienna.

“These long-term data support clinical recommendations worldwide for vaginal dilation or sexual intercourse after radiotherapy,” Kirchheiner said during a press briefing at the American Society for Radiation Oncology annual meeting.

These results were confirmed in a multivariable model adjusting for risk factors such as tumor infiltration, patient age, and use of hormonal replacement therapy.

Women who engaged in both regular dilation and intercourse — defined as report of the practices during at least half of their follow-ups — had the lowest risk of grade ≥2 vaginal stenosis (18%), followed by those who were sexually active but did not use vaginal dilators (23%), and those who used dilators but were not sexually active (28%).

However, regular compared with no or infrequent dilation or sexual activity was associated with a higher risk for mild vaginal dryness (72% vs 67%, respectively, P=0.028) and mild vaginal bleeding (61% vs 34%, P≤0.001), though Kirchheiner emphasized that these mild side effects can be managed with lubricants, moisturizer, and/or hormone replacement therapy.

“On the other hand, moderate vaginal shortening and narrowing represents an irreversible side effect that can cause painful intercourse in many cervical cancer survivors,” she pointed out.

No associations were seen for grade ≥1 vaginal stenosis, grade ≥2 dryness, grade ≥2 bleeding, and grade≥1/grade≥2 mucositis.

Commenting on the study, Akila Viswanathan, MD, MPH, MSc, of Johns Hopkins Medicine in Baltimore, said that issues related to quality of life among cervical cancer patients are understudied, “and vaginal side effects, in particular, are heavily underreported.”

“We currently do not have any specific treatments that are given, other than these very low-cost interventions such as providing medical dilators and encouraging sexual activity,” she added, suggesting that future trials should look at whether starting these therapies earlier in the treatment course may be preventive.

In explaining the background of this study, Kirchheiner noted that standard non-surgical treatment for cervical cancer that has spread to the surrounding tissue involves radiation therapy, chemotherapy, and brachytherapy.

She added while brachytherapy — which involves inserting radioactive implants directly into the tumor — has substantially improved tumor control and cure rates, delivering high doses of radiation to tumors near the vagina leads to vaginal stenosis.

These long-term changes in vaginal tissue can both complicate gynecological examinations and/or cause pain during intercourse. According to Kirchheiner, while physicians often recommend regular dilation to mitigate the side effects and prevent the formation of scar tissue, there has been little in the way of research quantifying the impacts of the therapy.

The EMBRACE study began in 2008 and included 1,416 patients, 882 of whom were evaluated in this analysis.

At a median follow-up of 60 months, regular vaginal dilation and/or sexual activity was reported by 64% of patients, while 23% reported infrequent vaginal dilation and/or sexual activity, and 13% reported none at all.

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