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

Abstract

BackgroundVaginal dilator (VD) therapy is often recommended for women receiving pelvic radiation therapy or experiencing pain and discomfort during intercourse, as well as for women with a congenital malformation of the vagina. VD use has both physical and psychological benefits; however, it often causes pain, discomfort, and adverse emotions, including embarrassment and loss of modesty, which often result in low adherence to therapy.ObjectivesThe aims of this study were to explore the use and adherence of VD therapy in women, identify barriers and facilitators of therapy adherence, and suggest improvement strategies from the theoretical perspective of symbolic interactionism.MethodsA systematic review of the literature was conducted using PubMed, CINAHL, and Scopus databases, with no year restrictions. Articles addressing the experience of women using VD therapy, as well as barriers and facilitators of therapy adherence were selected and analyzed. Then, the theoretical perspective of symbolic interactionism was introduced and applied to synthesize the results.ResultsA total of 21 articles were selected for the review. Most of the reviewed studies explored VD therapy in women who had undergone pelvic radiation therapy for gynecological cancer. Women’s adherence to the therapy ranged between 25% and 89.2%, with great variance in definitions and methods for assessing therapy adherence. Among the five categories of identified barriers to therapy adherence, “unhelpful circumstances” and “negative perceptions toward the VD” were the two most frequently mentioned. The two most frequently reported facilitators of adherence among the six identified categories were “supportive interactions with health care providers” and “risk perception and positive outcome expectancies”. On the basis of the perspective of symbolic interactionism, strategies for strengthening interactions with others (eg, health care providers, significant others, and support groups) are discussed in detail.ConclusionStrategic intervention regarding the decisive factors identified in the review can benefit women by enhancing their experience and adherence to VD therapy.

Developing personal sense of risk: a grounded theory in men with hypertension

“…The important roles of nurses (Himmelfarb & Commodore-Mensah 2016) are recognized in the promoting of blood pressure control and long-term treatment adherence. Previous evidence has identified sociocultural factors that influence treatment adherence in men such as access to healthcare, beliefs, perception, culture and income level (Bennett 2015;Elbur 2015;Khayyal et al 2016;Lee 2018;Long et al 2017). Men were less likely to adhere to treatments and did not pay attention to knowledge about negative outcomes than women (Amuta et al 2016;Mohd Azahar et al 2017;Reniers et al 2016).…”

“…Previous evidence has identified sociocultural factors that influence treatment adherence in men such as access to healthcare, beliefs, perception, culture and income level (Bennett ; Elbur ; Khayyal et al. ; Lee ; Long et al. ).…”

Clinical and Psychological Outcomes of the Use of Vaginal Dilators After Gynaecological Brachytherapy: a Randomized Clinical Trial

“…Acute effects are all clinical manifestations that occur within the first 3 months after treatment [12, 13], the most frequent of which are gastrointestinal and genitourinary [13]. In addition, the radiation causes damage to the vaginal epithelium, which may reduce tissue vascularization leading to pallor of the vaginal mucosa, loss of lubrication and inflammation [9, 14–16].…”

“…Aiming to minimize the effects that the radiotherapy treatment promotes on the vaginal dimensions, vaginal dilators [22–25] have been widely used [2, 24]. However, their use is limited by psychological resistance [16] and the reasons why women are reluctant to engage in rehabilitative dilator use have not been fully investigated. This resistance may be related to several factors such as embarrassment, anxiety, modesty, pain, fear of damaging the vagina, feeling unskilled at putting an object inside one’s own vagina and insufficient information about dilator use [26].…”

“…This resistance may be related to several factors such as embarrassment, anxiety, modesty, pain, fear of damaging the vagina, feeling unskilled at putting an object inside one’s own vagina and insufficient information about dilator use [26]. In addition, there is still a lack of evidence demonstrating the benefits of using this technique on vaginal dimensions, pelvic floor (PF) functionality, clinical signs and symptoms, and QoL [16, 27]. Therefore, the objective of this study was to evaluate the effect of the use of vaginal dilators (VD) on the vaginal canal dimensions of patients undergoing gynaecological brachytherapy.…”