title: Reduced vaginal elasticity, reduced lubrication, and deep and superficial dyspareunia in irradiated gynecological cancer survivors.
abstract: OBJECTIVE
  The purpose of this study was to examine whether or not vaginal elasticity or lack of lubrication is associated with deep or superficial dyspareunia. We investigated gynecological cancer survivors treated with radiation therapy.
  
  
  METHODS
  In a population-based study with 616 women answering a questionnaire (participation rate 78%) and who were treated with radiotherapy for gynecological cancer, we analyzed information from 243 women (39%) who reported that they had had intercourse during the previous six months. Analyses included log-binomial regression (relative risks) and multiple imputations by chained equations in combination with Bayesian Model Averaging, yielding a posterior probability value. Age range of this cancer recurrent-free group of women was 29-80.
  
  
  RESULTS
  Dyspareunia affected 164 of 243 of the women (67%). One hundred thirty-four women (55%) reported superficial pain, 97 women (40%) reported deep pain, and 87 women (36%) reported both types of dyspareunia. The relative risk (RR) of deep dyspareunia was 1.87 (CI 1.41-2.49) with impaired vaginal elasticity compared to normal vaginal elasticity. Age and lower abdominal swelling were separate risk factors for deep dyspareunia. However, effects remain after adjusting for these factors.
  
  
  CONCLUSIONS
  The relative risk of deep dyspareunia was almost twice as high with impaired vaginal elasticity compared to normal vaginal elasticity. If we wish to treat or even prevent deep dyspareunia in women with gynecological cancer, we may use our knowledge of the pathophysiology of deep dyspareunia and increasingly provide dilators together with instructions on how to use them for stretching exercises in order to retain vaginal elasticity. Results highlight the need for studies with more precise questions distinguishing superficial from deep dyspareunia so that in the future we may be able to primarily try to avoid reduced vaginal elasticity and secondarily reduce the symptoms.
authors.affiliation: Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Stinesen Kollberg
authors.forename: Ann-Charlotte
authors.initials: AC
authors.lastname: Waldenström
authors.forename: Karin
authors.initials: K
authors.lastname: Bergmark
authors.forename: Gail
authors.initials: G
authors.lastname: Dunberger
authors.forename: Anna
authors.initials: A
authors.lastname: Rossander
authors.forename: Ulrica
authors.initials: U
authors.lastname: Wilderäng
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Åvall-Lundqvist
authors.forename: Gunnar
authors.initials: G
authors.lastname: Steineck
mesh_terms: D000328:Adult; D000368:Aged; D001499:Bayes Theorem; D003075:Coitus; D004414:Dyspareunia / Q000453:epidemiology* / Q000209:etiology; D004548:Elasticity / Q000502:physiology / Q000528:radiation effects*; D005260:Female; D005833:Genital Neoplasms, Female / Q000532:radiotherapy*; D006801:Humans; D008875:Middle Aged; D011832:Radiation Injuries / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D012044:Regression Analysis; D012306:Risk; D011795:Surveys and Questionnaires; D017741:Survivors; D013997:Time Factors; D014621:Vagina / Q000378:metabolism / Q000503:physiopathology / Q000528:radiation effects*