School of Rehabilitation, Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, Quebec J1H 5N4, Canada; Research Center of the Centre Hospitalier Universitaire de Sherbrooke, 3001 12e Avenue N, Sherbrooke, Quebec J1H 5N4, Canada.
School of Rehabilitation, Faculty of Medicine, University of Montreal, 7077 Park Avenue, Montreal, Quebec H3N 1X7, Canada; Research Center of the Institut Universitaire de Gériatrie de Montréal, 4545 Queen Mary, Montreal, Quebec H3W 1W6, Canada.
Gynecol Oncol. 2020 Dec;159(3):778-784. doi: 10.1016/j.ygyno.2020.09.001. Epub 2020 Oct 1.
Painful sexual intercourse (dyspareunia) is a distressing condition affecting a large proportion of gynecological cancer survivors, yet treatments remain limited and poorly studied. This multicenter prospective interventional study examined the feasibility, acceptability and effects of multimodal pelvic floor physical therapy in gynecological cancer survivors with dyspareunia.
Thirty-one endometrial and cervical cancer survivors with dyspareunia participated in 12 weekly 60-min physical therapy sessions combining education, manual therapy, pelvic floor muscle exercises using biofeedback and home exercises, which included the use of a dilator. The adherence rate to home exercises (≥80%), the attendance rate at physical therapy sessions (≥80% of participants attending ≥10 sessions) and the dropout rate (˂15%) served as feasibility and acceptability outcomes and benchmarks. Pain intensity, pain quality, sexual function, pelvic floor dysfunction symptoms and quality of life were measured at baseline and post-treatment. Treatment satisfaction and participants' perceived improvement were also assessed.
The adherence rate was 88% (SD 10), 29/31 (94%) women attended ≥10 treatment sessions, and the dropout rate was 3%. Moreover, women experienced significant improvements in all outcomes after the intervention (p ≤ 0.044). They also reported being highly satisfied with the treatment (9.3/10 (SD 1.2)), and 90% of them were very much or much improved.
Our findings support the feasibility and acceptability of multimodal pelvic floor physical therapy for gynecological cancer survivors with dyspareunia. The intervention also led to significant improvements in pain, sexual function, pelvic floor dysfunction symptoms and quality of life. A randomized controlled trial is needed to confirm these results.
性交痛（性交困难）是一种困扰大量妇科癌症幸存者的痛苦病症，但治疗方法仍然有限且研究不足。这项多中心前瞻性干预研究检查了多模式盆底物理疗法在患有性交困难的妇科癌症幸存者中的可行性、可接受性和效果。
31 名患有性交困难的子宫内膜癌和宫颈癌幸存者参加了 12 周每周 60 分钟的物理治疗课程，包括教育、手法治疗、使用生物反馈的盆底肌肉锻炼和家庭锻炼，其中包括使用扩张器。家庭锻炼的依从率（≥80%）、物理治疗课程的出勤率（≥80%的参与者参加≥10 次课程）和退出率（＜15%）作为可行性和可接受性的结果和基准。在基线和治疗后测量疼痛强度、疼痛质量、性功能、盆底功能障碍症状和生活质量。还评估了治疗满意度和参与者的感知改善。
依从率为 88%（SD 10），29/31（94%）名女性参加了≥10 次治疗课程，退出率为 3%。此外，女性在干预后所有结局均显著改善（p≤0.044）。她们还报告对治疗非常满意（9.3/10（SD 1.2）），90%的人认为自己有很大或很大程度的改善。
我们的研究结果支持多模式盆底物理疗法治疗患有性交困难的妇科癌症幸存者的可行性和可接受性。干预还导致疼痛、性功能、盆底功能障碍症状和生活质量显著改善。需要进行随机对照试验来证实这些结果。
