Cervical Cancer
Pat Price, Karol Sikora in Treatment of Cancer, 2020
Radical hysterectomy should not alter sexual function markedly, although patients do report altered sensation. However, radiotherapy can lead to shortening and drying of the vagina with loss of lubrication and pliability. Shortening due to the formation of adhesions in the vagina can be avoided by using a vaginal dilator starting a few weeks after treatment. This will maintain patency of the vagina, enabling resumption of sexual activity at a later date and also examination in the follow-up clinic. Dryness of the vagina may be helped by a lubricant gel and also by HRT, which in addition, can help increase libido, which is often low in this group of patients.
Cervical cancer
Pat Price, Karol Sikora in Treatment of Cancer, 2014
Radical hysterectomy should not alter sexual function markedly, although patients do report altered sensation. However, radiotherapy can lead to shortening and drying of the vagina with loss of lubrication and pliability. Shortening due to the formation of adhesions in the vagina can be avoided by using a vaginal dilator starting a few weeks after treatment. This will maintain patency of the vagina, enabling resumption of sexual activity at a later date and also examination in the follow-up clinic. Dryness of the vagina may be helped by a lubricant gel and also by HRT which, in addition, can help increase libido which is often low in this group of patients.
Importance of collaboration in pelvic reconstruction: How to avoid complications and extra interventions
Alejandra Vilanova-Sánchez, Marc A. Levitt in Pediatric Colorectal and Pelvic Reconstructive Surgery, 2020
When caring for patients with multiorgan system concerns, it is important to systematically assess for any concerns at each visit. Collaborative care across specialties may allow for combination cases, which in the end reduce the patient's total number of trips to the operating room and exposure to anesthesia. In this case, the vaginal stenosis may have been addressed at the time of her urologic procedure. In women who have had a cloacal malformation repair, the assessment of the vaginal introitus diameter (and patency) should be performed at puberty. This ensures distal patency for menstrual egress, ability to use tampons, and the ability to have vaginal intercourse. Of note, an assessment of the patient's pubertal status/stage, with attention to thelarche (breast development) and menarche (first menses), is crucial. Providers should inquire about the patient's menses (menarche, frequency, length and volume of flow, and presence of any dysmenorrhea). Adolescents with anorectal malformations may have associated Müllerian anomalies—some of which may be obstructive. A pelvic ultrasound, and in some cases, a pelvic MRI, is helpful to delineate Müllerian anatomy and evaluate for menstrual outflow obstruction. If introital stenosis is noted, the patient may benefit from an introitoplasty to enlarge the diameter of the introitus. It may be reasonable to attempt dilation of the introitus via patient-directed vaginal dilator use; however, if the tissue is not supple, this may not be adequate and the patient may benefit from an introitoplasty. If there is a narrowing of the introitus, but not complete obstruction, this is not emergent and therefore could be combined with other procedures for the patient's convenience.
Non-hormonal approaches for the treatment of vulvovaginal atrophy: the choice between hyaluronic acid and glycerin
Published in Gynecological Endocrinology, 2020
A recently published randomized pilot study of 57 postmenopausal women with early stage breast cancer who started treatment with aromatase inhibitors randomly assigned patients to three treatment groups. The two active treatment groups received for 6 months, vaginal hyaluronic acid or a vaginal prebiotic, as well as a lubricant with a vaginal dilator. The active treatments groups displayed less dyspareunia (p = 0.07) and sexual distress (p = 0.02) at 6 months as compared to control group. At 6 months, the hyaluronic acid group had improved sexual function (total FSFI score) significantly more than the prebiotic group (p = 0.04) [8]. In another study, Serati et al. [9] compared the efficacy of topical vaginal estrogens with that of hyaluronic acid for treatment of dyspareunia in sexually active women who took oral contraceptives. The authors concluded that vaginal supplementation with estriol 50 μg/g or hyaluronic acid could reduce dyspareunia associated with hormonal oral contraceptive use and that both treatments improved sexual relations.
Patient’s characteristics and outcome of therapy in vaginismus: a single-center report of nine-year experience
Published in Sexual and Relationship Therapy, 2023
Furthermore, the patients were shown the genital anatomy on a pelvic model and described the functions of the genital organs (especially the clitoris, vagina, hymen). Then, systematic desensitization and dilatation techniques with behavioral approaches like mirror exercises, external genital massage, Kegel exercises, and firstly finger and then mechanic vaginal dilator insertions were implemented. Finger dilatation was avoided except for discovering the vaginal structure, and for these exercises were not found attractive or hygienic by the patients.
An alternative approach to vaginal dilation in patients with Meyer-Rokitanski-Küster-Hauser syndrome: two case reports
Published in Gynecological Endocrinology, 2020
Kátia Crys Moura Ogliari, Salete da Silva Rios, Ana Carolina Rios Chen, Juliana Rios Chen, Ceres Nunes Resende, Edward Araujo Júnior
The acrylic vaginal dilator is currently used to perform daily exercises to form a tunnel that enables sexual activity [5]. Although Frank’s technique is a good alternative, discomfort due to the use of rigid molding is possible; according to Marin et al., monitoring is required at the start of treatment to avoid urethral dilation [5]. The use of acrylic dilators may cause complications such as urethritis, cystitis, vesical or rectovaginal fistula, secondary genital prolapse [2], and even vaginal necrosis [10].
Related Knowledge Centers
- Agenesis
- Brachytherapy
- Cancer Treatment
- Mullerian Agenesis
- Vaginismus
- Vagina
- Vaginal Stenosis
- Dyspareunia
- Müllerian Agenesis
- Vaginoplasty
- Rectal Dilator