The aim of this study was to analyze the risk factors for vaginal stenosis in women after six months of radiotherapy treatment for gynecological pelvic cancer.

This is a cross-sectional study, approved by the Ethics and Research Committee. Women who agreed to participate in the study signed an informed consent form.
The study population consisted of 113 women who underwent radiotherapy for the treatment of gynecological pelvic cancer and who were assessed in the physiotherapy service six months after the end of radiotherapy. Women who had already undergone radiotherapy for other types of neoplasms and who had difficulty understanding the questions or had cognitive impairment were not included.
Data collection personal data, sociodemographic variables (age, city, lifestyle), type of gynecological cancer, use of vaginal dilators, frequency and data related to self-reported sexual activity were collected and considered as a dichotomous variable. The diagnosis of vaginal stenosis was based on the Common Criteria for Adverse Events Version (CTCAE v4.03).
The Chi square test was used to analyse the association between sexual activity and vaginal stenosis. Statistical analysis was performed on a frequency basis for clinical and lifestyle variables. Multiple logistic regression were used to adjust for confounding variables

In total, 113 women with a mean age of 52.4±13.6 years were included in this study. Among them, 72% had a partner, 81% had a job and 88% low-income. Among the lifestyle habits, 7% were smokers and 34% were ex-smokers, 50% were sexually active with frequency of 2.7±2.2 times a week. The most prevalent gynecological pelvic cancer was cervical cancer 73%, and stading I-II 62%. In relation to treatment, 63% did not had surgery, 78% underwent chemo, 90% tele, 100% brachytherapy, and 78% underwent 28GY dose. 
Table 1 shows the variables of clinical treatment, whether the women were sexually active or not, use of vaginal dilators and frequency, and CTCAE.
Women without vaginal stenosis were more likely to be sexually active (OR=5.20, CI95% 12.59; 2.15; p=0.001).
Other factors associated with vaginal stenosis: not being sexually active increases the chance of developing vaginal stenosis (OR=3.97; CI 95% 9.08; 1.73 p=0.001). Not using vaginal dilators increases the chance of developing vaginal stenosis (OR=3.52; CI 95% 8.04; 1.54; p=0.003).

Women who did not use vaginal dilators and were not sexually active were more likely to develop vaginal stenosis, while women without vaginal stenosis were more likely to be sexually active.

The results of this study shows how vaginal stenosis after treatment of gynecologic pelvic cancer can impact women´s sexual activity. High quality randomized controlled trials are urgently needed  to investigate the impact of specific programs focused on the use of vaginal dilators, as well as sexual education to prevent and to reduce the impact of vaginal stenosis post-pelvic cancer treatment.

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