Women with gynecologic cancer may benefit from performing pelvic floor exercises and using a vaginal dilator to prevent pelvic floor dysfunction. Structural and personal factors may influence adherence to treatment and affect its success. Objective: To explore the barriers and facilitators of adherence considering the experience of female gynecologic cancer (GC) survivors participating in a protocolized educational program to prevent pelvic floor dysfunction.

Qualitative research with content analysis.  It included 11 of 56 women treated for gynecologic cancer who participated in an educational intervention to perform pelvic floor exercises before, during, and after radiotherapy and to use vaginal dilator post-radiotherapy, at home. The sample was theoretical and included women with different levels of adherence to the program, who were interviewed based on a semi-structured script based on the available evidence, considering the following dimensions: 1) opinion about adherence barriers to practice pelvic floor exercises; 2) opinion about adherence barriers to use of vaginal dilator; 3) opinion about adherence facilitators to practice pelvic floor exercises; 4) opinion about adherence facilitators to use of vaginal dilator; and 5) overall experience in the program. The information was analyzed manually, assisted with Nvivo12® software, and triangulated with open coding.

Most of them were diagnosed with cervical cancer, the mean age was 47.5 years (SD= 14.78),  and they had at least 12 years of formal education (Table 1). 
From the analysis of the five dimensions explored, the following categories emerged: related treatment, related program, personal, social, and physician-patient relationship; identifying 9 barriers and 9 facilitators. In addition, two categories emerged in relation to the overall program experience: shared learning, and recommendations and improvements. (Table 2).

More facilitators than barriers were found in the adherent women, identifying high self-motivation, desire to improve their health good results obtained, and availability of time. The instructional audio, partner support, clarity of the information and instructions given, and close communication with the physical therapist were also valued as facilitators.  Highlighted as barriers: General malaise secondary to oncological treatments, forgetfulness, lack of time (return to work), disinformation, and lack of coordination with the treatment team. Among the barriers perceived by adherent women for the use of the vaginal dilator was discomfort in its use and feeling of shame. Feedback from the attending physician was a facilitator when present or a barrier when absent (Table 2).

Adherent women were more motivated than non-adherent women, understanding of instructions and availability of time were facilitators or barriers, as was the use of technology. General discomfort secondary to cancer treatments must be considered as a limiting factor for adherence. Feedback from the treating physician regarding the program is important for women to adhere or not adhere. These factors should be incorporated when designing and implementing pelvic floor reeducation programs in the gynecologic cancer population.

Araya-Castro, P., Sacomori, C., Diaz-Guerrero, P., Gayán, P., Román, D., & Sperandio, F. F. (2020). Vaginal Dilator and Pelvic Floor Exercises for Vaginal Stenosis, Sexual Health and Quality of Life among Cervical Cancer Patients Treated with Radiation: Clinical Report. Journal of sex & marital therapy, 46(6), 513-527.
Sacomori, C., Araya-Castro, P., Diaz-Guerrero, P., Ferrada, I. A., Martínez-Varas, A. C., & Zomkowski, K. (2020). Pre-rehabilitation of the pelvic floor before radiation therapy for cervical cancer: a pilot study. International urogynecology journal, 31(11), 2411-2418.