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Sexual Rehabilitation After Pelvic Radiotherapy and Vaginal Dilator Use: Consensus Using the Delphi Method
  1. Rinske Maria Bakker, MSc*,
  2. Moniek M. ter Kuile, PhD*,
  3. Willemijn M. Vermeer, PhD*,
  4. Remi A. Nout, MD, PhD,
  5. Jan Willem M. Mens, MD,
  6. Lena C. van Doorn, MD, PhD§,
  7. Cor D. de Kroon, MD, PhD*,
  8. Willemien C.P. Hompus, BSc§,
  9. Cora Braat, MANP and
  10. Carien L. Creutzberg, MD, PhD
  1. *Departments of Gynecology, and
  2. Clinical Oncology, Leiden University Medical Center, Leiden; and Departments of
  3. Radiotherapy, and
  4. §Gynecology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands.
  1. Address correspondence and reprint requests to Rinske Maria Bakker, MSc, Department of Gynecology, Leiden University Medical Center, Zone VRSP, PO Box 9600, 2300 RC Leiden, the Netherlands. E-mail: R.M.Bakker{at}


Objective This study aimed to reach consensus among professional experts on patient information provision and support regarding sexual rehabilitation and vaginal dilator use after radiotherapy (RT) for gynecological cancers.

Methods A 3-round online Delphi study was conducted among 10 radiation oncologists, 10 gynecologic oncologists, and 10 oncology nurses from 12 gynecological cancer centers providing RT for gynecological tumors. We assessed the desired content and provider of instructions and patient support regarding sexuality and vaginal dilator use. Responses were measured on a 7-point scale varying from “totally disagree” to “totally agree.” Consensus was reached when 70% of participants’ answers fell within 2 scale categories with an interquartile range less than or equal to 1.

Results The panel agreed that information about sexual rehabilitation using vaginal dilators should be provided by radiation oncologists before treatment. Information should always be provided to sexually active cervical and vaginal cancer patients younger than 70 years. Tailored information was recommended for vulvar and endometrial cancer patients, patients older than 70 years, and sexually inactive patients. Preferably, specifically trained oncology nurses should give psychological and practical support. Participants recommended vaginal dilation to prevent vaginal adhesions, tightening, and shortening. The panel advised to start dilation around 4 weeks after treatment to perform dilation 2 to 3 times a week for 1 to 3 minutes and to continue dilation for 9 to 12 months. Plastic dilator sets were considered the most suitable type of dilator.

Conclusions Consensus was reached on patient information provision and support during sexual rehabilitation after RT for gynecological cancers. Results were used to develop a sexual rehabilitation intervention.

  • Gynecological cancer
  • Pelvic radiotherapy
  • Sexual rehabilitation
  • Vaginal dilator use
  • Delphi method

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  • This study was funded by the Dutch Cancer Society and Alpe d’HuZes foundation (UL2011-5245).

  • Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (

  • The authors declare no conflicts of interest.