Rinske M. Bakker

Women's experiences with information provision and deciding about fertility preservation in the Netherlands: ‘satisfaction in general, but unmet needs’

It is not well‐known how women receiving counselling consultation about fertility preservation (FP) in the Netherlands perceive the information provision about and referral for FP in the oncology setting. The aim of this study was to qualitatively explore womens experiences with the (process of) information provision about the gonadotoxic effects of cancer treatment and about FP and the decision‐making process and to obtain their recommendation for improvements.

Sexual rehabilitation after pelvic radiotherapy and vaginal dilator use: Consensus using the Delphi method

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.

Psychosexual support for gynecological cancer survivors: professionals' current practices and need for assistance

PurposeAbout half of the gynecological cancer (GC) survivors suffer from sexual dysfunctions and report a need for professional psychosexual support. The current study assessed (1) health care professionals’ (HCP) current psychosexual support practices, (2) barriers to providing psychosexual support, and (3) HCP needs for training and assistance.MethodsSemistructured interviews were conducted with gynecological oncologists (n = 10), radiation oncologists (n = 10), and oncology nurses involved in the treatment of GC (n = 10).ResultsThe majority of the professionals reported discussing sexuality at least once with each patient. An important reason for addressing sexual functioning was to reassure patients that it is normal to experience sexual concerns and give them an opportunity to discuss sexual issues. About half of the professionals provided specific suggestions. Patients were rarely referred to a sexologist. Barriers encountered by professionals in the provision of psychosexual support were embarrassment and lack of time. HCP suggestions for the facilitation of psychosexual support provision were skills training, an increased availability of patient information, and the standard integration of psychosexual support in total gynecological cancer care.ConclusionThe majority of the professionals reported discussing sexuality at least once with every patient, but discussions of sexual functioning were often limited by time and attention. The development of comprehensive patient information about sexuality after GC is recommended as well as a more standard integration of psychosexual support in GC care and specific training.

Sexual distress and associated factors among cervical cancer survivors: A cross‐sectional multicenter observational study

To assess whether sexual distress among cervical cancer (CC) survivors is associated with frequently reported vaginal sexual symptoms, other proposed biopsychosocial factors and whether worries about painful intercourse mediate the relation between vaginal sexual symptoms and sexual distress.

A Controlled Study on Vaginal Blood Flow During Sexual Arousal Among Early-Stage Cervical Cancer Survivors Treated With Conventional Radical or Nerve-Sparing Surgery With or Without Radiotherapy

Objective Sexual problems among cervical cancer survivors may in part be caused by reduced vaginal blood flow due to damaged hypogastric nerves during radical hysterectomy with pelvic lymphadenectomy and/or by radiation-induced vaginal changes after pelvic radiotherapy. A nerve-sparing modification of radical hysterectomy (NSRH) may preserve vaginal blood flow. Vaginal blood flow during sexual arousal was compared between different treatment modalities. Methods We investigated premenopausal women treated for early-stage cervical cancer with radical hysterectomy (n = 29), NSRH (n = 28), NSRH with radiotherapy (n = 14), and controls (n = 31). Genital arousal and subjective sexual arousal in response to sexual stimuli were measured using vaginal photoplethysmography and a questionnaire. Results were compared by using a between-study (treatment groups) by within-study (stimulus) design. Results Participants were aged 29 to 51 years (mean, 42 years) and at 1 to 14 years (mean, 5 years) after treatment. Measured vaginal blood flow in women treated with NSRH was similar to controls. Women treated with radical hysterectomy had a significantly lower vaginal blood flow compared with controls overall and lower compared with the NSRH group during sexual stimulation. Women treated with radiotherapy had a vaginal blood flow intermediate between the other groups without significant differences. The erotic films were equally effective in enhancing subjective sexual arousal among treatment groups. Conclusions Cervical cancer treatment with radical hysterectomy disrupts the vaginal blood flow response, and this may be prevented by conducting an NSRH. Treatment with radiotherapy did not significantly impact vaginal blood flow, but further investigation is needed with a larger sample.