QS109 - Incidence of Vaginal Stenosis and Sexual Dysfunction After Radiation for Anal and Rectal Cancer

Purpose/Background: Vaginal stenosis (VS) is defined as abnormal tightening and shortening of the vagina due to the formation of fibrosis. This is a common outcome for women after radiation therapy (RT) for pelvic cancers. It is well-recognized that RT-induced VS may have negative impacts on patient well-being, in particular sexual dysfunction and dyspareunia. Vaginal stenosis after radiation therapy has been reported in the literature following treatment for cervical cancer. However, there is little research on the incidence of vaginal stenosis after radiation for anal or rectal cancer and how it relates to sexual dysfunction. Our purpose is to determine how many of our own patients have suffered from VS. Secondary goals will be to assess if this has caused sexual dysfunction and to see if patients have been counseled about this outcome or possible treatments.

Methods/Interventions: Female patients included in the study were identified through retrospective analysis of the EMR of a single colorectal practice. All females who received radiation therapy for anal or rectal cancer were included over a 3 year time frame (2019-2022). Patients who did not receive radiation as part of their therapy for anal or rectal cancer were excluded. A letter was sent to each patient explaining the goals of the study. If the patient agreed to participate in the study, then a survey was sent by email. Participation was voluntary.

Results/Outcomes: 60 female patients who had radiation therapy for anal cancer and 83 female patients with radiation therapy for rectal cancer were identified through retrospective chart review from a single colorectal clinic. A total of 41 patients (20 patients with anal cancer and 21 with rectal cancer) participated in the survey. The age range was 35 to 77 years old and the results were anonymous. Only 31% of patients recalled discussion of sexual dysfunction or VS with their physician before RT. 80% of patients did not ask about vaginal pain or sexual dysfunction as risk of RT. 92% of patients felt their sexual function differed after RT. 63% reported dyspareunia after RT. Most patients were not referred to pelvic floor therapy or offered a dilating regimen for VS. Of the patients who participated in pelvic floor therapy and serial dilations, 50% did not feel like treatment was successful. 40% of patients felt their VS was grade 3. 88% of patients suffered from grade 2 or grade 3 dyspareunia.

Conclusion/Discussion: There is little research identifying the incidence of VS after radiation for anal and rectal cancer. We had 41 patients who underwent radiation for anal and rectal cancer respond to our survey. 44% of patients reported moderate discomfort/dyspareunia while another 44% reported severe discomfort/dyspareunia. Only 31% of patients recalled discussion of sexual dysfunction or VS with their physician before RT. Despite VS being a known complication of RT, our results suggest that physicians are not discussing this complication or treatment options with their patients. It can also be implied that females do not seem to be asking about the complications of pelvic RT, including vaginal stenosis and dyspareunia. This study highlights the need for discussions with patients about vaginal stenosis before, during and after RT for anal and rectal cancers. Hopefully if we initiate the conversation about VS with patients then we can mitigate the effects during radiation and develop a standardized treatment plan for patients who develop VS and sexual dysfunction.