Vaginal development and sexual functioning in young women after stem cell transplantation, chemotherapy, and/or radiotherapy for childhood hematological diseases

Abstract

To study vaginal development and sexual functioning in young women after childhood hemopoietic stem cell transplantation (HSCT) and radio/chemotherapy. Observational case-control study on 30 young sexually active women survived after HSCT and/or radio/chemotherapy for childhood malignancies or hematologic diseases and 48 controls matched for age. Female Sexual Function Index was lower (median 24.05, IQR = 17.30-28.30 vs. 29.00, IQR = 25.30-31.40, p = 0.001), Female Sexual Distress Scale higher (median 16.00, IQR = 8.00-23.00 vs. 2.00, IQR = 0.00-4.00, p < 0.001), vaginal length shorter (mean difference = 21.1 mm; 95% CI = 19.3-23, p < .001) and vaginal maturation index worst in cases than in controls. Subjects treated by irradiation before HSCT had lower FSFI (median 21.85, IQR = 9.60-31.10 vs. 24.90, IQR = 17.30-28.30) and shorter vaginal length (median 45.55, IQR = 42.60-45.80 vs. 50.10, IQR = 45.30-52.90) compared to those who had not received conditioning treatment (p-values = 0.004 and p = 0.05, respectively). Compared to untreated subjects, women receiving hormonal replacement therapy had higher overall FSFI (p = 0.02), lower FSDS (0.04), and better VMI. Gonadotoxic therapies have adverse effects on vaginal development, sexual functioning, and distress in young females. Hormonal replacement therapy should be shortly considered after main gonodatoxic treatments to improve vaginal and sex health.

Review – Late toxicity of abdominal and pelvic radiotherapy for childhood cancer

“…[7] The literature review resulted in one category C article meeting inclusion criteria for the present review (Table 1). [91] In the aforementioned study, young adult female CCS who had received TBI (dose not reported) before hematopoietic stem cell transplantation during childhood, reported lower Female Sexual Function Index score, indicating issues in sexual functioning, and showed a trend towards shorter vaginal length compared to survivors in the chemotherapy and RT (chest or abdominopelvic, dose not reported) group. [91] The aforementioned study provides insufficient information to recommend specific dose constraints for the vaginal wall.…”

Is Gonadal Therapy a Promoter of Breast Cancer? Incidence of Breast Cancer in a Cohort of Survivors of Oncological Diseases Treated with Gonadal Steroids

“…Subsequent treatment included no suppressible gonadotropins, with sequential estradiol and progestin (estradiol hemihydrate 2 mg during 12 days; norethisterone acetate 1 mg during 10 days plus estradiol hemihydrate 2 mg and finally only estradiol hemihydrate 1 mg during 6 days). The median age at disease onset was 10.5 years (0-18), the median age at treatment onset was 16 years (11)(12)(13)(14)(15)(16)(17)(18), and the median duration of treatment in group A patients was 12 years (4-36) ( Tables 1 and 2). Group B included 69 patients.…”

“…The median age at diagnosis was 44 years (41-51) and the median age at treatment onset was 46 years (42-59). They underwent treatment during a median period of 10 years (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). All data concerning this cohort is explained in Tables 1 and 2.…”

“…Furthermore, protection against vascular dementia in those receiving HRT was demonstrated by Mikkola et al [19]. Bearing in mind the aforementioned beneficial effects, in 2018, Angioli et al [12] published an article supporting replacement therapy in cancer survivors and Beneventi et al [11] published one regarding BMT. Considering our 2 cases, we identified several risk factors for breast cancer development.…”

“…Beneventi et al [11] stressed the importance of keeping in mind the negative long-time effects of female hormone absence, namely regarding vaginal dryness, urinary tract infections and dyspareunia. Concerning cancer survival, Angioli et al [12] and Beneventi et al [11] advocate the utilization of HRT.…”