title: Adherence to vaginal dilation following high dose rate brachytherapy for endometrial cancer.
abstract: OBJECTIVE
  We report demographic, clinical, and psychosocial factors associated with adherence to vaginal dilation and describe the sexual and marital or nonmarital dyadic functioning of women following high dose rate (HDR) brachytherapy for endometrial cancer.
  
  
  METHODS
  We retrospectively evaluated women aged 18 years or older in whom early-stage endometrial (IAgr3-IIB) cancers were treated by HDR intravaginal brachytherapy within the past 3.5 years. Women with or without a sexual partner were eligible. Patients completed questionnaires by mail or by telephone assessing demographic and clinical variables, adherence to vaginal dilation, dyadic satisfaction, sexual functioning, and health beliefs.
  
  
  RESULTS
  Seventy-eight of 89 (88%) eligible women with early-stage endometrial cancer treated with HDR brachytherapy completed questionnaires. Only 33% of patients were adherers, based on reporting having used a dilator more than two times per week in the first month following radiation. Nonadherers who reported a perceived change in vaginal dimension following radiation reported that their vaginas were subjectively smaller after brachytherapy (p = 0.013). Adherers reported more worry about their sex lives or lack thereof than nonadherers (p = 0.047). Patients reported considerable sexual dysfunction following completion of HDR brachytherapy.
  
  
  CONCLUSIONS
  Adherence to recommendations for vaginal dilator use following HDR brachytherapy for endometrial cancer is poor. Interventions designed to educate women about dilator use benefit may increase adherence. Although sexual functioning was compromised, it is likely that this existed before having cancer for many women in our study.
authors.affiliation: Department of Psychiatry, CASE Comprehensive Cancer Center and University Hospitals of Cleveland, Cleveland, OH 44106, USA. Lois.Friedman@UHhospitals.org
authors.forename: Lois C
authors.initials: LC
authors.lastname: Friedman
authors.forename: Rita
authors.initials: R
authors.lastname: Abdallah
authors.forename: Mark
authors.initials: M
authors.lastname: Schluchter
authors.forename: Ashok
authors.initials: A
authors.lastname: Panneerselvam
authors.forename: Charles A
authors.initials: CA
authors.lastname: Kunos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000379:methods; D003075:Coitus / Q000523:psychology; D004106:Dilatation / Q000295:instrumentation / Q000706:statistics & numerical data*; D016889:Endometrial Neoplasms / Q000473:pathology / Q000523:psychology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008875:Middle Aged; D009367:Neoplasm Staging; D009929:Organ Size / Q000528:radiation effects; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012747:Sexual Partners; D011795:Surveys and Questionnaires; D014621:Vagina / Q000473:pathology / Q000528:radiation effects*