title: Perceptions and practices regarding women's vaginal health following radiation therapy: A survey of radiation oncologists practicing in the United States.
abstract: OBJECTIVE
  Vaginal stenosis (VS) is a recognized complication of pelvic and vaginal radiation therapy (RT).
  
  
  METHODS
  A 26-item survey assessing the signs/symptoms, risk factors, diagnosis, prevention, treatment, and impact of VS on women's sexual health was distributed to radiation oncologists. Descriptive statistics were calculated. Chi-square tests examined differences in categorical responses.
  
  
  RESULTS
  A total of 233 (10.5%) participants completed the entire survey. Twelve percent, 21%, and 68% report treating gynecologic (GYN) tumors only, non-GYN pelvic tumors only, or both, respectively. Regarding risk factors, 78% believed that VS can be caused by pelvic RT alone, 91% by vaginal brachytherapy alone, and 98% by combined pelvic RT and vaginal brachytherapy. Approximately one-half of respondents felt that being postmenopausal and having a hysterectomy before radiation therapy were risk factors for VS, whereas the other half felt that these were not risk factors. All respondents agreed that VS is a clinical diagnosis. Respondents indicated that VS symptoms include dyspareunia, vaginal pain, dryness, and/or bleeding (100%, 90%, 85%, and 72%, respectively); 65% indicated all 4. The most commonly recommended treatment for VS is vaginal dilator use. Radiation oncologists who treat GYN-only versus non-GYN cancers were more likely to perform a vaginal examination, to distribute written instructions regarding vaginal dilator use (P = .002), to have vaginal bleeding reported after RT (P = .001), and to refer patients to a sexual counselor (P = .007). Most providers (73%) expressed willingness to participate in prospective research on the diagnosis and treatment of VS.
  
  
  CONCLUSIONS
  This is the first large-scale survey of radiation oncologists' perceptions and practices regarding VS. There is agreement among providers regarding the signs/symptoms of VS and strategies for its prevention/treatment using vaginal dilators. Further prospective and observational research is needed. This survey shows a willingness on the part of providers to take part in prospective research regarding the diagnosis, impact, and treatment of VS on women's sexual health.
authors.affiliation: Vanderbilt Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee.
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Kachnic
authors.affiliation: Winship Cancer Institute, Emory University, Atlanta, Georgia.
authors.forename: Deborah W
authors.initials: DW
authors.lastname: Bruner
authors.affiliation: Boston Medical Center, Boston University, Boston, Massachusetts.
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Qureshi
authors.affiliation: Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Electronic address: Gregory.russo@hitchcock.org.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Russo
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000209:etiology; D004106:Dilatation / Q000295:instrumentation; D004414:Dyspareunia / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005833:Genital Neoplasms, Female / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D008297:Male; D010386:Pelvic Neoplasms / Q000532:radiotherapy*; D010465:Perception; D017698:Postmenopause; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D000072378:Radiation Oncologists / Q000523:psychology*; D012307:Risk Factors; D012725:Sexual Behavior / Q000528:radiation effects*; D011795:Surveys and Questionnaires; D014481:United States; D014621:Vagina / Q000473:pathology / Q000528:radiation effects*