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Self-Reported Sexual, Bowel and Bladder Function in Cervical Cancer Patients Following Different Treatment Modalities: Longitudinal Prospective Cohort Study
  1. Quirine D. Pieterse, MD, PhD*,
  2. Gemma G. Kenter, MD, PhD*,
  3. Cornelis P. Maas, MD, PhD*,
  4. Cor D. de Kroon, MD, PhD*,
  5. Carien L. Creutzberg, MD, PhD,
  6. J. Baptist M. Z. Trimbos, MD, PhD* and
  7. Moniek M. Ter Kuile, PhD*
  1. *Departments of Gynaecology
  2. Oncology, Leiden University Medical Centre, Leiden, the Netherlands.
  1. Address correspondence and reprint requests to Moniek M. Ter Kuile, PhD, Poortgebouw-zuid (VRSP), Department of Gynaecology, Leiden University Medical Centre (LUMC), PO Box 9600, 2300 RC Leiden, the Netherlands. E-mail: M.M.ter_kuile{at}


Objective Conventional radical hysterectomy with pelvic lymphadenectomy (RHL) for early-stage cervical cancer is associated with significant bladder, anorectal, and sexual dysfunction. Nerve-sparing modification of RHL (NS-RHL) has been developed with the aim to reduce surgical treatment-related morbidity. Postoperative radiation therapy (RT) is offered to patients with unfavorable prognostic features to improve local control. The aim of the study was to assess self-reported morbidity of various types of treatment in cervical cancer patients.

Methods Self-reported symptoms were prospectively assessed before and 1 and 2 years after treatment by the Dutch Gynaecologic Leiden Questionnaire.

Results Included were 229 women (123 NS-RHL and 106 conventional RHL). Ninety-four (41%) received RT. Up to 2 years (response rate, 81%), women reported significantly more bowel, bladder, and sexual symptoms compared with the pretreatment situation. No significant difference was found between the conventional RHL and NS-RHL with the exception of the unexpected finding that a smaller percentage in the NS-RHL group (34% vs 68%) complained about numbness of the labia and/ or thigh. Radiation therapy had a negative impact on diarrhea, urine incontinence, lymphedema, and sexual symptoms (especially a narrow/short vagina).

Conclusions In the current longitudinal cohort study, treatment for early-stage cervical cancer was associated with worse subjective bladder, anorectal, and sexual functioning, irrespective of the surgical procedure used. Postoperative RT resulted in a significant deterioration of these functions. The results have to be interpreted with caution in view of the study design and method used.

  • Cervical cancer
  • Morbidity
  • Radical hysterectomy
  • Nerve-sparing

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  • The authors declare no conflicts of interest.