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M. Cyr, C. Dumoulin, P. Bessette, A. Pina, W.H. Gotlieb, K. Lapointe-Milot, M. Mayrand, M. Morin, 046 Feasibility, Acceptability and Effects of Physical Therapy Treatment for Gynecological Cancer Survivors with Dyspareunia, The Journal of Sexual Medicine, Volume 17, Issue Supplement_3, July 2020, Pages S240–S241, https://doi.org/10.1016/j.jsxm.2020.04.282
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Introduction
Dyspareunia affects more than half of gynecological cancer survivors. These women are confronted with this serious health issue as well as relationship difficulties and psychological distress. Despite the impact on their quality of life, the available treatments remain limited and poorly studied. Physical therapy (PT) has been shown to be highly effective to treat dyspareunia in younger populations with no history of cancer. However, no study has investigated PT in gynecological cancer survivors with dyspareunia.
Objectives
The main goal of this single-arm pilot study was to evaluate the feasibility and acceptability of a 12-week PT treatment in gynecological cancer survivors with dyspareunia. Secondary goals included examining the effects of PT in terms of frequency of sexual activities, pain quality and intensity, sexual function, sexual distress as well as patient’s satisfaction and global impression of change.
Methods
Women who had completed treatment for a gynecological malignancy for at least 3 months, and were considered cured, were eligible to participate if they reported vulvovaginal pain at an intensity of ≥5 on a numerical rating scale (NRS: 0-10), for at least 80% of sexual intercourse attempts, for more than 3 months. The treating gynecologic oncologist performed a standardized pelvic and rectal examination to confirm eligibility. PT treatment consisted of 12 weekly 60-minute individual sessions including education, pelvic floor muscle exercises with biofeedback, manual therapy and home exercises. Attendance rate (proportion of sessions attended) and adherence rate (proportion of completed home exercises according to a diary) were calculated to describe feasibility and acceptability, as primary outcomes. Secondary outcomes concerning treatment effects were collected at baseline and post-treatment by a physical therapist not involved in patient’s care. They included frequency of sexual activities with vaginal penetration (number per month), pain quality (McGill Pain Questionnaire; minimal clinically important difference (MCID) -30%) and intensity (NRS; MCID -2), sexual function (Female Sexual Function Index; MCID +2.1) and sexual distress (Female Sexual Distress Scale-Revised; MCID -7). Level of satisfaction with treatment (NRS: 0-10) and Patient Global Impression of Change (PGIC 7-point scale: very much improved to very much worse) were also used. Paired t-tests or Wilcoxon signed-rank tests were conducted in conformity to data distribution to investigate the changes from baseline to post-treatment.
