Improvements following multimodal pelvic floor physical therapy in gynecological cancer survivors suffering from pain during sexual intercourse: Results from a one-year follow-up mixed-method study

Abstract

Background A large proportion of gynecological cancer survivors suffer from pain during sexual intercourse, also known as dyspareunia. Following a multimodal pelvic floor physical therapy (PFPT) treatment, a reduction in pain and improvement in psychosexual outcomes were found in the short term, but no study thus far has examined whether these changes are sustained over time. Purpose To examine the improvements in pain, sexual functioning, sexual distress, body image concerns, pain anxiety, pain catastrophizing, painful intercourse self-efficacy, depressive symptoms and pelvic floor disorder symptoms in gynecological cancer survivors with dyspareunia after PFPT, and to explore women’s perceptions of treatment effects at one-year follow-up. Methods This mixed-method study included 31 gynecological cancer survivors affected by dyspareunia. The women completed a 12-week PFPT treatment comprising education, manual therapy and pelvic floor muscle exercises. Quantitative data were collected using validated questionnaires at baseline, post-treatment and one-year follow-up. As for qualitative data, semi-structured interviews were conducted at one-year follow-up to better understand women’s perception and experience of treatment effects. Results Significant improvements were found from baseline to one-year follow-up on all quantitative outcomes (P ≤ 0.028). Moreover, no changes were found from post-treatment to one-year follow-up, supporting that the improvements were sustained at follow-up. Qualitative data highlighted that reduction in pain, improvement in sexual functioning and reduction in urinary symptoms were the most meaningful effects perceived by participants. Women expressed that these effects resulted from positive biological, psychological and social changes attributable to multimodal PFPT. Adherence was also perceived to influence treatment outcomes. Conclusions Findings suggest that the short-term improvements following multimodal PFPT are sustained and meaningful for gynecological cancer survivors with dyspareunia one year after treatment.

Acceptability of multimodal pelvic floor physical therapy to treat dyspareunia after gynecological malignancies: a qualitative study of women’s views and experiences

“…As women were also able to observe their progress (e.g., increase in muscle control with biofeedback or upgrading the size of dilator) during the treatment (quotes 19 and 20), they explained that they were encouraged to pursue their efforts which, in turn, increased the treatment effectiveness (quote 18). It should be pointed out that the majority of our cohort reported that the treatment effects were maintained during the follow-up period while a few admitted that these were attenuated over time [ 14 ].…”

“…This qualitative study was conducted in the Province of Quebec, Canada, and it followed a multicenter prospective interventional study investigating a multimodal PFPT treatment for gynecological cancer survivors with dyspareunia [11][12][13][14]. Individual semi-structured telephone interviews were carried out at 12-month follow-up, allowing participants to take a step back from the treatment.…”

“…Results suggested a reduction in pain as well as an improvement in sexual function [ 11 ], pelvic floor muscle function [ 12 ], and psychosexual outcomes [ 13 ] immediately at post-treatment. Data collected at 12-month follow-up suggested that these improvements were maintained over time [ 14 ]. Overall, findings indicate that women with dyspareunia could benefit from multimodal PFPT.…”

Genitourinary Syndrome of Menopause in Cancer Survivors

“…8 One-year follow-up data demonstrated that improvements were maintained, suggesting that this approach could be useful for cancer survivors with GSM-associated sexual pain. 8 Psychosocial Support GSM can have a significant impact on a patient's quality of life and may lead to psychological distress in patients with and without cancer. Counseling, psychotherapy, or support groups may be helpful in managing the emotional and psychological aspects of GSM in cancer survivors.…”

Sexuality After Cancer as an Unmet Need: Addressing Disparities, Achieving Equality

“…If progress is limited or if compliance becomes an issue, evaluation with pelvic floor physical therapy can be helpful, including education, manual therapy, and biofeedback, which have been shown to result in sustained improvement in gynecologic cancer survivors. 25 Vaginal stenosis is the narrowing or shortening of the vaginal tissue resulting from scar tissue and can occur after pelvic radiation or as a consequence of vulvovaginal atrophy. Vaginal stenosis (any grade) at 3 years postradiation has been reported in 50% of patients with endometrial cancer, 60% with cervical cancer, and 80% with anal cancer.…”