title: Sexual rehabilitation after pelvic radiotherapy and vaginal dilator use: consensus using the Delphi method.
abstract: OBJECTIVE
  This study aimed to reach consensus among professional experts on patient information provision and support regarding sexual rehabilitation and vaginal dilator use after radiotherapy (RT) for gynecological cancers.
  
  
  METHODS
  A 3-round online Delphi study was conducted among 10 radiation oncologists, 10 gynecologic oncologists, and 10 oncology nurses from 12 gynecological cancer centers providing RT for gynecological tumors. We assessed the desired content and provider of instructions and patient support regarding sexuality and vaginal dilator use. Responses were measured on a 7-point scale varying from "totally disagree" to "totally agree." Consensus was reached when 70% of participants' answers fell within 2 scale categories with an interquartile range less than or equal to 1.
  
  
  RESULTS
  The panel agreed that information about sexual rehabilitation using vaginal dilators should be provided by radiation oncologists before treatment. Information should always be provided to sexually active cervical and vaginal cancer patients younger than 70 years. Tailored information was recommended for vulvar and endometrial cancer patients, patients older than 70 years, and sexually inactive patients. Preferably, specifically trained oncology nurses should give psychological and practical support. Participants recommended vaginal dilation to prevent vaginal adhesions, tightening, and shortening. The panel advised to start dilation around 4 weeks after treatment to perform dilation 2 to 3 times a week for 1 to 3 minutes and to continue dilation for 9 to 12 months. Plastic dilator sets were considered the most suitable type of dilator.
  
  
  CONCLUSIONS
  Consensus was reached on patient information provision and support during sexual rehabilitation after RT for gynecological cancers. Results were used to develop a sexual rehabilitation intervention.
authors.affiliation: Departments of *Gynecology, and †Clinical Oncology, Leiden University Medical Center, Leiden; and Departments of ‡Radiotherapy, and §Gynecology, Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands.
authors.forename: Rinske Maria
authors.initials: RM
authors.lastname: Bakker
authors.forename: Moniek M
authors.initials: MM
authors.lastname: ter Kuile
authors.forename: Willemijn M
authors.initials: WM
authors.lastname: Vermeer
authors.forename: Remi A
authors.initials: RA
authors.lastname: Nout
authors.forename: Jan Willem M
authors.initials: JW
authors.lastname: Mens
authors.forename: Lena C
authors.initials: LC
authors.lastname: van Doorn
authors.forename: Cor D
authors.initials: CD
authors.lastname: de Kroon
authors.forename: Willemien C P
authors.initials: WC
authors.lastname: Hompus
authors.forename: Cora
authors.initials: C
authors.lastname: Braat
authors.forename: Carien L
authors.initials: CL
authors.lastname: Creutzberg
mesh_terms: D003697:Delphi Technique; D004106:Dilatation / Q000295:instrumentation / Q000379:methods; D037001:Directive Counseling / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005833:Genital Neoplasms, Female / Q000453:epidemiology / Q000532:radiotherapy* / Q000534:rehabilitation*; D006801:Humans; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D010388:Pelvis / Q000528:radiation effects; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D020127:Recovery of Function; D012725:Sexual Behavior / Q000502:physiology*; D014621:Vagina / Q000473:pathology* / Q000528:radiation effects