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. 2003;2003(1):CD003750.
doi: 10.1002/14651858.CD003750.

Interventions for the physical aspects of sexual dysfunction in women following pelvic radiotherapy

A S Denton  1 , E J Maher
Affiliations

Interventions for the physical aspects of sexual dysfunction in women following pelvic radiotherapy

A S Denton et al. Cochrane Database Syst Rev. 2003.

Abstract

Background: Following pelvic radiotherapy (RT), a proportion of women experience problems related to sexual function, which are multifactorial in origin. The physical components relate to distortion of the perineum and vagina, which may occur as a result of surgery and/or radiotherapy and compromise sexual activity resulting in considerable distress.

Objectives: The aim of this review was to evaluate the evidence for treatment options addressing the physical components of sexual dysfunction arising from pelvic radiotherapy as prevention or treatment of acute or late complications.

Search strategy: The concepts used included synonyms for radiation therapy and brachytherapy and synonyms for the spectrum of physical aspects of sexual dysfunction in women. randomized. We searched the Cochrane Controlled Trials Register (CENTRAL), issue 1, 2002, MEDLINE 1966 to 2002, EMBASE 1980 to 2002, CANCERCD 1980 to 2002, Science Citation Index 1991 to 2002, CINAHL 1982 to 2002, as well as sources of grey literature. We also hand searched relevant textbooks and contacted experts in the field.

Selection criteria: Any study describing the therapeutic trial of a treatment to relieve the physical aspects of female sexual dysfunction which had developed following pelvic radiotherapy was considered. The quality of each study was then assessed by two reviewers independently to determine its suitability for inclusion in statistical analysis.

Data collection and analysis: Thirty-two references met the inclusion criteria for the search but of these only four were suitable to be included for statistical analysis.

Main results: The strongest evidence for benefit is the grade IC data in the topical oestrogens and benzydamine sections which describes the treatment of acute radiation vaginal changes. The use of vaginal dilators to prevent the development of vaginal stenosis is supported by grade IIC evidence. The value of hyperbaric oxygen therapy and surgical reconstruction is supported by the much weaker grade IIIC evidence in the form of case series.

Reviewer's conclusions: These findings reflect the quality of published data regarding interventions for this aspect of the management of radiation induced complications. Although there is grade IC evidence, these studies are not recent, the allocation concealment is unclear in the text, and overall there is a variable level of assessment of the response, emphasising the need for more studies to be conducted with improved designs to clarify the investigative process and support the final result.

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Conflict of interest statement

None known

Figures

1.1
1.1. Analysis
Comparison 1 Resolution of acute vaginal mucositis, Outcome 1 Resolution of acute vaginal mucositis using BDZ and placebo.
2.1
2.1. Analysis
Comparison 2 Prevention of vaginal stenosis, Outcome 1 Prevention of VS using intercourse or a vaginal stent.
3.1
3.1. Analysis
Comparison 3 Reduction of vaginal radiation symptoms that prevent intercourse, Outcome 1 Reduction of vaginal bleeding.
3.2
3.2. Analysis
Comparison 3 Reduction of vaginal radiation symptoms that prevent intercourse, Outcome 2 Improvement in dyspareunia.
3.3
3.3. Analysis
Comparison 3 Reduction of vaginal radiation symptoms that prevent intercourse, Outcome 3 Improved vaginal mucosa.
See this image and copyright information in PMC

References

References to studies included in this review

Bentivoglio 1981 {published data only}
    1. Bentivoglio G, Diani F. Use of topical benzydamine in gynaecology. Clinical and Experimental Obstetrics & Gynecology 1981;8(3):103‐10. - PubMed
Decruze 1999 {published data only}
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Pitkin 1971 {published data only}
    1. Pitkin RM, VanVoorhis LW. Post irradiation vaginitis. An evaluation of prophylaxis with topical oestrogen. Radiology 1971;99(2):417‐21. - PubMed
Volteranni 1987 {published data only}
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References to studies excluded from this review

Achauer 1983 {published data only}
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Adrien 1983 {published data only}
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Glassburn 1997 {published data only}
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Gleeson 1994 {published data only}
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Poma 1980 {published data only}
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Robinson 1999 {published data only}
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