Photo Credit: Mohammed Haneefa Nizamudeen

The following is a summary of “Association between the regular use of vaginal dilators and/or sexual activity and vaginal morbidity in locally advanced cervical cancer survivors – an EMBRACE-I study report,” published in the September 2024 issue of Oncology by Kirchheiner et al.

This study provides critical risk estimations for vaginal morbidity, focusing on the role of vaginal dilation, including the use of dilators and sexual activity, in patients with locally advanced cervical cancer (LACC) treated with definitive radiochemotherapy and image-guided adaptive brachytherapy (IGABT). Conducted within the framework of the prospective, multi-institutional EMBRACE-I study, this research aims to elucidate the relationship between vaginal dilation practices and long-term vaginal health outcomes. Vaginal morbidity, as assessed by physicians using the CTCAEv3.0 system, and patient-reported sexual activity through the EORTC-CX24 questionnaire were tracked from baseline throughout regular follow-up visits. A subset of 882 patients with a median follow-up of 60 months from the original cohort of 1,416 participants (2008-2015) was analyzed for this report. Frequency analysis was performed on patients with three or more follow-ups, categorizing dilation frequency as regular (reported in ≥50% of follow-ups) or no/infrequent (reported in <50%). The actuarial estimates for vaginal stenosis grade ≥2 were calculated using the Kaplan-Meier method, with risk factors evaluated through both univariate and multivariable Cox proportional hazard regression models.

The results revealed that 64% (565) of the evaluated patients reported regular vaginal dilation, which was associated with a significantly lower 5-year risk of vaginal stenosis grade ≥2 (23% compared to 37% in the no/infrequent dilation group, p≤0.001). This finding remained consistent in multivariable analysis after adjusting for other potential risk factors (HR=0.630, p=0.001). However, regular dilation was also linked to a higher incidence of grade ≥1 vaginal dryness (72% vs. 67%, p=0.028) and bleeding (61% vs. 34%, p≤0.001), though these were limited to mild cases (grade ≥1) and manageable with clinical interventions. Importantly, there was no observed increase in the risk for more severe grade ≥2 dryness or bleeding. 

The findings emphasize that while regular vaginal dilation significantly reduces the risk of severe vaginal stenosis, it also increases the likelihood of mild dryness and bleeding, both of which can be clinically managed. Vaginal stenosis, characterized by irreversible fibrotic changes, can cause significant discomfort during gynecological exams and dyspareunia. Therefore, regular dilation appears to be an essential strategy for maintaining vaginal patency and reducing stenosis in LACC survivors.

Source: sciencedirect.com/science/article/pii/S0360301624033704