title: Qualitative accounts of patients' determinants of vaginal dilator use after pelvic radiotherapy.
abstract: BACKGROUND
  Treatment with pelvic external beam radiotherapy with brachytherapy (EBRT/BT) for gynecological cancers may cause sexual dysfunction because of vaginal shortening and tightening. Regular vaginal dilator use is thought to reduce vaginal shortening and/or tightening, but compliance is poor.
  
  
  OBJECTIVE
  This study identified determinants of patients' adherence with dilator use after EBRT/BT.
  
  
  METHODS
  Semi-structured interviews were conducted with 30 women, aged 32-67 years, treated with EBRT/BT for gynecological cancers at two university medical centers in the past 36 months. Transcriptions were coded and analyzed with N-Vivo software.
  
  
  METHODS
  Determinants of dilator use were clustered based on the Health Action Process Approach, which describes (i) motivation processes that lead to a behavioral intention and (ii) volition processes that lead to the initiation or maintenance of actual behavior.
  
  
  RESULTS
  Almost all women attempted to perform long-term regular vaginal dilator use. Intended dilator use was determined by the expectation that it would prevent the development of vaginal adhesions and stenosis. Planning dilator use and making it part of a routine, using it under the shower, using lubricants, a smaller dilator size, or vibrators helped women. Others reported a lack of time or privacy, forgetting, or feeling tired. Women self-regulated dilator use by rotating the dilator and timing dilator use. Influencing factors were negative emotions regarding dilator use or its hard plastic design, (being anxious for) pain or blood loss, and an association with EBRT/BT. Some women mentioned a lack of instrumental support, for example, lubricants. Others received reassurance through informational support or were supported socially.
  
  
  CONCLUSIONS
  Motivation and volition processes that determined dilator use were identified and used in the development of a sexual rehabilitation intervention. It is important to provide sufficient patient information and support, and enlarge patients' perceived self-efficacy.
authors.affiliation: Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Rinske M
authors.initials: RM
authors.lastname: Bakker
authors.forename: Willemijn M
authors.initials: WM
authors.lastname: Vermeer
authors.forename: Carien L
authors.initials: CL
authors.lastname: Creutzberg
authors.forename: Jan Willem M
authors.initials: JW
authors.lastname: Mens
authors.forename: Remi A
authors.initials: RA
authors.lastname: Nout
authors.forename: Moniek M
authors.initials: MM
authors.lastname: Ter Kuile
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000517:prevention & control*; D003674:Defense Mechanisms; D004106:Dilatation / Q000295:instrumentation* / Q000379:methods / Q000523:psychology; D005260:Female; D005833:Genital Neoplasms, Female / Q000532:radiotherapy* / Q000534:rehabilitation; D006801:Humans; D054327:Lubricants; D008875:Middle Aged; D009426:Netherlands; D010349:Patient Compliance / Q000523:psychology; D010353:Patient Education as Topic; D011832:Radiation Injuries / Q000523:psychology / Q000534:rehabilitation*; D020127:Recovery of Function; D012725:Sexual Behavior / Q000523:psychology; D012944:Social Support; D014621:Vagina / Q000473:pathology / Q000528:radiation effects*
chemical_list: D054327:Lubricants
keywords: Gynecological Cancer; Pelvic Radiotherapy; Qualitative Research; Sexual Rehabilitation; Vaginal Dilator Use