Clinical study of using constant temperature vaginal mould to prevent radiation vaginal stenosis in patients with cervical cancer treated with radiotherapy / 中国辐射卫生

Objective to investigate the clinical effect of constant temperature vaginal mould in preventing vaginal stricture in patients with cervical cancer treated with radiotherapy. Methods from January 2017 to December 2018, 80 patients with cervical cancer were selected and divided into vaginal irrigation control group (n = 40) and observation group (n = 40). The incidence of vaginal stricture was compared between the two groups. Results the incidence of vaginal stenosis was 32.50% in the observation group and 70.00% in the control group (P < 0.05). Conclusion vaginal mould is helpful to reduce the incidence of vaginal stenosis caused by external irradiation and close irradiation, which is worth popularizing in the future.

Comparação da disfunção do assoalho pélvico com função sexual e qualidade de vida em sobreviventes ao câncer ginecológico / Comparison of pelvic floor dysfunction with sexual function and quality of life in gynecological cancer survivors

Resumo Objetivo Comparar a contração objetiva do assoalho pélvico, estenose vaginal e dispareunia com a função sexual e a qualidade de vida relacionada à saúde de sobreviventes ao câncer ginecológico. Método Estudo transversal com mulheres com diagnóstico de câncer ginecológico e com no mínimo seis meses de término do tratamento oncológico. A avaliação consistiu na aplicação da ficha de identificação, questionários (QS-F e FACT-G) e exame físico ginecológico. Resultados Foram avaliadas 64 pacientes com média de idade de 50 anos, das quais 56,3% eram ativas sexualmente. O tipo de câncer mais frequente foi o de colo uterino (62,5%), sendo o principal tratamento realizado a histerectomia (54,7%). Observou-se a presença de dispareunia em 32,8% das mulheres ativas sexualmente, a estenose vaginal foi identificada em 45,3% dos casos, e 45,3% apresentaram contração objetiva ausente do assoalho pélvico. A comparação das médias dos escores do questionário QS-F evidenciou diferença significante considerando a presença ou não de estenose vaginal e dispareunia, enquanto que a presença ou ausência da contração objetiva do assoalho pélvico não apresentou diferença significante na função sexual. Verificou-se associação entre estenose vaginal e dispareunia, porém a atividade sexual e a contração do assoalho pélvico não estiveram associadas à estenose vaginal. Além disso, a estenose vaginal, dispareunia e a contração do assoalho pélvico não apresentaram associação significante com a qualidade de vida. Conclusão A presença de disfunção do assoalho pélvico nas sobreviventes ao câncer ginecológico indicou prejuízo na função sexual, sem impactar negativamente na qualidade de vida relacionada à saúde.

Abstract Objective To compare objective contraction of the pelvic floor, vaginal stenosis and dyspareunia with sexual function and health related quality of life in gynecological cancer survivors. Method Cross-sectional study with women referred to oncological treatment for gynecological cancer with at least six months of the treatment. Study participants completed an initial evaluation form regarding demographic characteristics, and medical history, QS-F and FACT-G questionnaires, and gynecological physical examination. Results Sixty-four patients with a mean age of 50 years, of which 56.3% were sexually active, were evaluated. The most frequent type of cancer was cervical cancer (62.5%) and the main treatment was hysterectomy (54.7%). The presence of dyspareunia was observed in 32.8% of sexually active women, vaginal stenosis was identified in 45.3% of the cases, and 45.3% presented no objective contraction of the pelvic floor. The comparison of QS-F questionnaire scores showed a significant difference considering the presence or absence of vaginal stenosis and dyspareunia, while the presence or absence of objective contraction of the pelvic floor did not show a significant difference in sexual function. There was an association between vaginal stenosis and dyspareunia, but sexual activity and contraction of the pelvic floor were not related to vaginal stenosis. In addition, vaginal stenosis, dyspareunia and contraction of the pelvic floor were not significantly associated with health-related quality of life. Conclusion The presence of pelvic floor dysfunction in gynecological cancer survivors indicated impairment in sexual function with no negative impact on health-related quality of life.

Impact of vaginal cylinder diameter on outcomes following brachytherapy for early stage endometrial cancer / 부인종양

OBJECTIVE: To examine the outcomes (tolerability, toxicity, and recurrence) of vaginal brachytherapy (VBT) among endometrial cancer (EC) patients treated with small cylinder size. METHODS: Patients with EC who received adjuvant VBT between September 2011 and December 2015 were reviewed. Patients were fitted with the largest vaginal cylinder they could comfortably accommodate, from 2.0–3.0 cm diameter. Small cylinders were defined as size 2.3 cm or less. Patient, tumor, or treatment characteristics were correlated with need for small cylinders. Treatment tolerability, measures of gastrointestinal (GI), genitourinary (GU), and vaginal toxicity, and rates of recurrence were analyzed. RESULTS: Three hundred four patients were included. Small cylinders were used in 51 patients (17%). Normal body mass index (BMI; p<0.001), nulligravidity (p<0.001), and shorter vaginal length (p<0.001) were associated with small cylinder size. There was no acute or late grade 3 toxicity. Rates of acute (grade 1–2) GI, GU, or vaginal symptoms were low (10%, 11%, and 19%, respectively). Small cylinder size was associated with increased likelihood of reporting acute GI (p<0.05) but not GU or vaginal symptoms. Small cylinder size was associated with higher risk of grade 1–2 vaginal stenosis (odds ratio [OR]=4.7; 95% confidence interval [CI]=1.5–14.7; p=0.007). There was no association between cylinder size and recurrence rate (p=0.55). CONCLUSION: VBT is generally very well tolerated, however, patients fitted with smaller cylinders (commonly nulligravid and low BMI) may have increased side effects. Further study to improve the dosimetry of VBT for patients requiring small cylinders may be worthwhile.

Complete vaginal outlet stenosis in a patient with Sheehan’s syndrome

We present a case of complete vaginal stenosis in a woman diagnosed with Sheehan’s syndrome. The patient delivered at full-term 5 months prior, and experienced massive postpartum bleeding at that time. During evaluation of persistent amenorrhea, we found that her vaginal orifice was completely adhesive and obstructed. Prior to corrective surgery, we managed the patient with an oral contraceptive to induce uterine bleeding into the vaginal outflow tract. After three cycles of an oral contraceptive, we could confirm that there was no stenotic lesion in the vaginal cavity as a hematocolpos was created. Adhesiolysis with scar revision for the vaginal stenosis was successfully performed; it was found that the lesion was limited to only the distal part of the vaginal outlet. Complete vaginal stenosis in reproductive age women with hypopituitarism has not been reported. The artificial induction of hematometrocolpos before surgery was useful in determining the extent of the stenotic lesion, and assured safety.

A case of transverse vaginal septum with modified Garcia technique / 대한산부인과학회지

The incidence of all transverse vaginal septum is 1:2,100 - 1:72,000. The transverse vaginal septum is a developmental defect of vagina which may be fused incompletely between the Mullerian duct component and the urogenital sinus component of vagina. Serious complications may be hematocolpos, hematometra and hematosalpinx. Simple surgical excision or simple incision have been developed to treat congenital transverse vaginal septa, but also caused common complications such as secondary tissue contracture. Garcia technique using eight vaginal mucosa flaps was developed to avoid common complication of secondary vaginal stenosis. Here, we present a case of contracted transverse vaginal septum who has been performed a simple incision 13 years ago, successfully performed the modified Garcia technique without serious postoperative complication.