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A Controlled Study on Vaginal Blood Flow During Sexual Arousal Among Early-Stage Cervical Cancer Survivors Treated With Conventional Radical or Nerve-Sparing Surgery With or Without Radiotherapy
  1. Rinske Maria Bakker, MSc*,
  2. Quirine D. Pieterse, MD, PhD*,
  3. Luc R.C.W. van Lonkhuijzen, MD, PhD,
  4. Baptist J.B.M.Z. Trimbos, MD, PhD*,
  5. Carien L. Creutzberg, MD, PhD,
  6. Gemma G. Kenter, MD, PhD,
  7. Cor D. de Kroon, MD, PhD* and
  8. Moniek M. ter Kuile, PhD*
  1. *Department of Gynecology, Leiden University Medical Center, Leiden;
  2. Department of Gynecology, Amsterdam Medical Center, Amsterdam; and
  3. Department of Radiation Oncology, Leiden University Medical Center, Leiden, 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:


Objective Sexual problems among cervical cancer survivors may in part be caused by reduced vaginal blood flow due to damaged hypogastric nerves during radical hysterectomy with pelvic lymphadenectomy and/or by radiation-induced vaginal changes after pelvic radiotherapy. A nerve-sparing modification of radical hysterectomy (NSRH) may preserve vaginal blood flow. Vaginal blood flow during sexual arousal was compared between different treatment modalities.

Methods We investigated premenopausal women treated for early-stage cervical cancer with radical hysterectomy (n = 29), NSRH (n = 28), NSRH with radiotherapy (n = 14), and controls (n = 31). Genital arousal and subjective sexual arousal in response to sexual stimuli were measured using vaginal photoplethysmography and a questionnaire. Results were compared by using a between-study (treatment groups) by within-study (stimulus) design.

Results Participants were aged 29 to 51 years (mean, 42 years) and at 1 to 14 years (mean, 5 years) after treatment. Measured vaginal blood flow in women treated with NSRH was similar to controls. Women treated with radical hysterectomy had a significantly lower vaginal blood flow compared with controls overall and lower compared with the NSRH group during sexual stimulation. Women treated with radiotherapy had a vaginal blood flow intermediate between the other groups without significant differences. The erotic films were equally effective in enhancing subjective sexual arousal among treatment groups.

Conclusions Cervical cancer treatment with radical hysterectomy disrupts the vaginal blood flow response, and this may be prevented by conducting an NSRH. Treatment with radiotherapy did not significantly impact vaginal blood flow, but further investigation is needed with a larger sample.

  • Cervical cancer
  • Radical hysterectomy
  • Sexual functioning
  • Vaginal blood flow
  • Vaginal plethysmography

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  • The authors declare no conflicts of interest.

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