title: A nurse-led sexual rehabilitation intervention after radiotherapy for gynecological cancer.
abstract: Although vaginal dilator use after combined pelvic radiation therapy and brachytherapy (RT/BT) is recommended to prevent vaginal shortening and stenosis, women fail to use them and experience sexual problems. A nurse-led sexual rehabilitation intervention targeting sexual recovery and vaginal dilatation was developed. Its feasibility was investigated during a prospective, longitudinal, observational pilot study.
  
  
  
  Four oncology nurses were specifically trained to conduct the intervention. Gynecologic cancer patients treated with RT/BT were assessed using (i) questionnaires on frequency of dilator use (monthly), sexual functioning, and sexual distress (at baseline and 1, 6, and 12 months) and psychological and relational distress (at 1, 6, and 12 months); (ii) semi-structured interviews (between 6 and 12 months); and (iii) consultation recordings (a random selection of 21 % of all consults).
  
  
  
  Twenty participants were 26-71 years old (mean = 40). Eight participants discontinued participation after 3 to 9 months. At 6 months after RT, 14 out of 16 (88 %), and at 12 months 9 out of 12 (75 %), participants dilated regularly, either by having sexual intercourse or by using dilators. Sexual functioning improved between 1 and 6 months after RT, with further improvement at 12 months. Most participants reported that the intervention was helpful and the nurses reported having sufficient expertise and counseling skills.
  
  
  
  According to the pilot results, the intervention was feasible and promising for sexual rehabilitation and regular dilator use after RT. Its (cost-)effectiveness will be investigated in a randomized controlled trial.
authors: Department of Gynecology, Leiden University Medical Center, Zone VRSP, PO Box 9600, 2300 RC, Leiden, the Netherlands. R.M.Bakker@lumc.nl.
authors: R M
authors: RM
authors: Bakker
authors: Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
authors: J W M
authors: JW
authors: Mens
authors: Department of Gynecology, Leiden University Medical Center, Zone VRSP, PO Box 9600, 2300 RC, Leiden, the Netherlands.
authors: H E
authors: HE
authors: de Groot
authors: Department of Gynecology, Leiden University Medical Center, Zone VRSP, PO Box 9600, 2300 RC, Leiden, the Netherlands.
authors: C C
authors: CC
authors: Tuijnman-Raasveld
authors: Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
authors: C
authors: C
authors: Braat
authors: Department of Gynecology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
authors: W C P
authors: WC
authors: Hompus
authors: Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands.
authors: J G M
authors: JG
authors: Poelman
authors: Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands.
authors: M S
authors: MS
authors: Laman
authors: Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands.
authors: L A
authors: LA
authors: Velema
authors: Department of Gynecology, Leiden University Medical Center, Zone VRSP, PO Box 9600, 2300 RC, Leiden, the Netherlands.
authors: C D
authors: CD
authors: de Kroon
authors: Department of Gynecology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
authors: H C
authors: HC
authors: van Doorn
authors: Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands.
authors: C L
authors: CL
authors: Creutzberg
authors: Department of Gynecology, Leiden University Medical Center, Zone VRSP, PO Box 9600, 2300 RC, Leiden, the Netherlands.
authors: M M
authors: MM
authors: Ter Kuile
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000209:etiology / Q000451:nursing / Q000534:rehabilitation; D005260:Female; D005833:Genital Neoplasms, Female / Q000451:nursing* / Q000503:physiopathology / Q000532:radiotherapy / Q000534:rehabilitation*; D006801:Humans; D008875:Middle Aged; D024802:Nurse's Role; D010865:Pilot Projects; D011446:Prospective Studies; D011832:Radiation Injuries / Q000209:etiology / Q000451:nursing* / Q000503:physiopathology / Q000534:rehabilitation*; D012725:Sexual Behavior / Q000502:physiology*; D011795:Surveys and Questionnaires; D014621:Vagina / Q000473:pathology / Q000503:physiopathology / Q000528:radiation effects
keywords: Dilator use compliance; Gynecological cancer; Nurse-led intervention; Pelvic radiation therapy and brachytherapy; Sexual rehabilitation