Article Text

Download PDFPDF

SO006/#55  Regular dilation and/or sexual activity show less risk for vaginal stenosis in cervical cancer patients
  1. Kathrin Kirchheiner1,
  2. Alexandru Zaharie1,
  3. Stéphanie Smet Smet2,
  4. Sofia Spampinato3,
  5. Cyrus Chargari4,
  6. Umesh Mahantshetty5,
  7. Barbara Šegedin6,
  8. Kjersti Bruheim7,
  9. Bhavana Rai8,
  10. Rachel Cooper9,
  11. Elzbieta Van Der Steen-Banasik10,
  12. Ericka Wiebe11,
  13. Richard Pötter1,
  14. Christian Kirisits1,
  15. Maximilian Schmid1,
  16. Christine Haie-Meder4,
  17. Kari Tanderup3,
  18. Astrid De Leeuw12,
  19. Ina Jürgenliemk-Schulz12 and
  20. Remi Nout13
  1. 1Medical University Vienna, Radiation Oncology, Vienna, Austria
  2. 2AZ Turnhout, Radiation Oncology, Turnhout, Belgium
  3. 3Aarhus University Hospital, Oncology, Aarhus N, Denmark
  4. 4Gustave-Roussy, Radiotherapy, Villejuif, France
  5. 5Tata Memorial Center, Homi Bhabha Cancer Hospital and Research Center, Punjab, India
  6. 6Institute of Oncology Ljubljana, University of Ljubljana, Radiotherapy, Faculty of Medicine, Ljubljana, Slovenia
  7. 7The Radium Hospital, Oslo University Hospital, Oncology, Oslo, Norway
  8. 8Postgraduate Institute of Medical Education and Research, Radiotherapy and Oncology, Chandigarh, India
  9. 9St James’s University Hospital, Leeds Cancer Centre, Leeds, UK
  10. 10Radiotherapiegroep Arnhem, Radiotherapy, Arnhem, Netherlands
  11. 11Cross Cancer Institute and University of Alberta, Oncology, Edmonton, Canada
  12. 12University Medical Center Utrecht, Radiation Oncology, Utrecht, Netherlands
  13. 13Erasmus MC Cancer Institute, University Medical Center, Radiotherapy, Rotterdam, Netherlands


Introduction Purpose/Objective: To evaluate the association between regular vaginal dilation and/or sexual activity on vaginal stenosis in locally advanced cervical cancer patients after definitive radiochemotherapy and image-guided adaptive brachytherapy from the EMBRACE-I study.

Methods Material/Methods Physician-assessed vaginal stenosis (CTCAEv.3), vaginal dilation and patient-reported sexual activity (EORTC-QLQ-CX24) were prospectively assessed at baseline and during regular follow-up. For this longitudinal analysis, a subgroup of patients was selected with at least 3 follow-ups with information on vaginal dilation and/or sexual activity. Vaginal penetration summarized either the use of vaginal dilators or sexual activity or both. Regular vaginal penetration was defined, if reported in ≥50%; no/infrequent penetration, if reported in <50% of follow-ups.

Results Of 1416 patients overall, the subgroup for this longitudinal evaluation included 882 patients, with a median follow-up of 60 months. Regular penetration was associated with a significantly lower 5-year actuarial risk estimate for vaginal stenosis G≥2, compared to reporting no/infrequent penetration (23% vs. 37%, p≤0.001, figure 1). A multivariable Cox regression model confirmed this association (HR=0.630), adjusting for other known risk factors (table 1).

Conclusion/Implications Conclusion: Regular dilation and/or sexual activity is associated with significantly lower risk for vaginal stenosis in cervical cancer patients. As a correlation does not justify any cause-effect relation, it cannot finally be concluded that regular penetration prevents vaginal stenosis or if the development of vaginal stenosis interferes with these activities. However, as a randomized trial design is not appropriate in this context, the multivariable model supports the clinical observations and recommendations for prevention of vaginal stenosis.

Abstract SO006/#55 Figure 1

Actuarial estimates of vaginal stenosis G ≥ 2 were calculated with Kaplan-Meier method and subgroup comparison between patients with regular penetration ( ≥ 50% of follow-ups) and no/infrequent penetration (<50% of follow-ups) evaluated with the log-rank test. Penetration is defined as either vaginal dilation and/or sexual activity

Abstract SO006/#55 Table 1

Univariate and multivariable analyses of patient-, disease and treatment-related risk factors for vaginal stenosis G≥2 (Cox proportional hazards regression model); p-values and hazard ratios with 95% confidence intervals (Cl) shown

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.