Sexual Activity May Reduce Long-Term Side Effects After Cervical Cancer

Engaging in sexual activity or vaginal dilation is associated with lower risk of developing long-term side effects for patients with cervical cancer, according to findings from an observational study.

“I hope this research helps to reduce the taboo around sexual health and makes it easier for clinicians to discuss these issues with their patients,” Kathrin Kirchheiner, clinical psychologist from the department of radiation oncology at the Medical University of Vienna in Austria and lead study author, said in a news release based on a presentation at the American Society for Radiation Oncology (ASTRO) Annual Meeting.

According to American Cancer Society, cervical cancer is a type of gynecologic cancer which forms in the cells lining the cervix, or the lower part of the womb. Over time, normal cells in the cervix could develop abnormal changes, which may become cancer.

The news release stated that a study, EMBRACE, evaluated doctor-reported vaginal side effects and patient-reported outcomes. The study included 1,416 patients who were treated with external radiation, chemotherapy and internal radiotherapy (brachytherapy) for locally advanced cervical cancer. The patients’ median age was 49 years old.

In a sub-cohort of 882 patients, Kirchheiner and her co-authors analyzed vaginal side effects for people who were sexually active or used vaginal dilators in the years after treatment for cervical cancer and compared results to people who were not sexually active or used vaginal dilators.

Pelvic radiotherapy can cause long-term changes in the vaginal tissue that lead to shortening and narrowing, Kirchheiner told CURE® during an interview, and this can complicate gynecological examinations or cause pain during intercourse.

“In the weeks after treatment, inflammation can lead to vaginal adhesions that need to be separated by vaginal dilation. If they are not resolved regularly by the patient, little tissue bridges may form over time that become painful during the examination with the vaginal speculum,” Kirchheiner said. “But regular dilation or sexual activity might also be effective regarding the long-term side effect of tissue scarring that leads to the loss of elasticity, shortening and tightening over the years following treatment.

The patients within the EMBRACE study were seen by doctors for 11 follow-up visits to examine any vaginal side effects five years after receiving treatment. During this time, they also completed questionnaires that asked about quality of life, vaginal dilation and sexual activity.

From the questionnaires, 64% of patients reported to engage in regular vaginal dilation, sexual activity or both. This was significantly associated with a lower risk for moderate vaginal stenosis (vaginal shortening and narrowing) of grade 2 or higher, five years after receiving treatment, according to the study.

More specifically, patients who reported both dilation and intercourse had the lowest risk of grade ≥2 vaginal stenosis (18%), followed by those who were sexually active but did not use vaginal dilators (23%) and those who used dilators but were not sexually active (28%). Patients who did not engage in regular dilation or intercourse were most likely to experience moderate stenosis (37%).

However, the researchers also found that regular sexual activity and use of vaginal dilators was associated with an increased risk for other mild vaginal symptoms, such as grade ≥1 vaginal dryness and bleeding.

“We always recommend our patients to use water-based lubricants for dilation and sexual intercourse to counteract vaginal dryness. The products should not contain any irritating ingredients and be adapted to the vaginal pH value,” Kirchheiner noted. “Also, (patients) can use vaginal moisturizers that are applied every few days. They hydrate the vaginal lining and keep it more supple and flexible, so it becomes less prone to tearing. Patients don't need a prescription for these products and can take care of themselves effectively. I call it the vaginal health care plan.”

In the study, vaginal dryness of grade ≥1 occurred in 72% of patients who reported that they regularly engaged in sexual activity and vaginal dilation, compared with 67% of patients who reported no regular engagement in sexual activity or dilation.

Vaginal bleeding of grade ≥1 occurred in 61% of patients who regularly engaged in sexual activity or dilation, versus 34% of patients who reported no regular engagement in sexual activity or dilation.

Kirchheiner emphasized that these mild side effects should not stop patients from dilating or having sexual intercourse, as this might help to prevent a more serious and irreversible condition. She highlights the importance for patients to talk about this topic with their doctor.

“It’s much better to talk about problems than just to suffer alone, because there’s really plenty of help available. There are plenty of things for patients to do and to try out that really work effectively,” she said. “But if we always keep this as a taboo topic and never dare to talk openly about it, then everyone is suffering quietly.”

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