Lee Yaelim
Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea.
Patient Prefer Adherence. 2018 Apr 12;12:551-560. doi: 10.2147/PPA.S163273. eCollection 2018.
Vaginal dilator (VD) therapy is often recommended for women receiving pelvic radiation therapy or experiencing pain and discomfort during intercourse, as well as for women with a congenital malformation of the vagina. VD use has both physical and psychological benefits; however, it often causes pain, discomfort, and adverse emotions, including embarrassment and loss of modesty, which often result in low adherence to therapy.
The aims of this study were to explore the use and adherence of VD therapy in women, identify barriers and facilitators of therapy adherence, and suggest improvement strategies from the theoretical perspective of symbolic interactionism.
A systematic review of the literature was conducted using PubMed, CINAHL, and Scopus databases, with no year restrictions. Articles addressing the experience of women using VD therapy, as well as barriers and facilitators of therapy adherence were selected and analyzed. Then, the theoretical perspective of symbolic interactionism was introduced and applied to synthesize the results.
A total of 21 articles were selected for the review. Most of the reviewed studies explored VD therapy in women who had undergone pelvic radiation therapy for gynecological cancer. Women's adherence to the therapy ranged between 25% and 89.2%, with great variance in definitions and methods for assessing therapy adherence. Among the five categories of identified barriers to therapy adherence, "unhelpful circumstances" and "negative perceptions toward the VD" were the two most frequently mentioned. The two most frequently reported facilitators of adherence among the six identified categories were "supportive interactions with health care providers" and "risk perception and positive outcome expectancies". On the basis of the perspective of symbolic interactionism, strategies for strengthening interactions with others (eg, health care providers, significant others, and support groups) are discussed in detail.
Strategic intervention regarding the decisive factors identified in the review can benefit women by enhancing their experience and adherence to VD therapy.
阴道扩张器（VD）疗法通常推荐给接受盆腔放射治疗的女性、性交时感到疼痛和不适的女性以及患有先天性阴道畸形的女性。使用VD有生理和心理上的益处；然而，它常常会引起疼痛、不适以及不良情绪，包括尴尬和丧失尊严感，这往往导致治疗依从性较低。
本研究的目的是探讨女性对VD疗法的使用和依从性，确定治疗依从性的障碍和促进因素，并从符号互动理论的角度提出改进策略。
使用PubMed、CINAHL和Scopus数据库对文献进行系统综述，无年份限制。选择并分析了涉及女性使用VD疗法的经验以及治疗依从性的障碍和促进因素的文章。然后，引入并应用符号互动理论的观点来综合研究结果。
共选择了21篇文章进行综述。大多数综述研究探讨了接受妇科癌症盆腔放射治疗的女性的VD疗法。女性对该疗法的依从性在25%至89.2%之间，评估治疗依从性的定义和方法差异很大。在确定的五类治疗依从性障碍中，“不利情况”和“对VD的负面看法”是最常被提及的两类。在确定的六类依从性促进因素中，最常报告的两类是“与医疗保健提供者的支持性互动”和“风险认知和积极结果预期”。基于符号互动理论的观点，详细讨论了加强与他人（如医疗保健提供者、重要他人和支持小组）互动的策略。
针对综述中确定的决定性因素进行战略干预，可通过增强女性对VD疗法的体验和依从性而使其受益。
