595
ORIGINAL RESEARCH—SURGERY Sexual Functioning and Vaginal Changes after Radical Vaginal Trachelectomy in Early Stage Cervical Cancer Patients: A Longitudinal Study Ligita Paskeviciute Froeding, MD,* Christian Ottosen, MD,† Helle Rung-Hansen, MD,‡ Danny Svane, MD,† Berit Jul Mosgaard, MD, PhD,† and Pernille Tine Jensen, MD, PhD§ *Department of Gynecology, Copenhagen University Hospital Herlev, Herlev, Denmark; †Department of Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; ‡Herlev Primary Care Center, Herlev, Denmark; § Department of Gynecology, Odense University Hospital, Odense, Denmark DOI: 10.1111/jsm.12399
ABSTRACT
Introduction. Radical vaginal trachelectomy (RVT) offers low complication rate, good survival, and possibility for future childbearing for young women with early stage cervical cancer. However, the literature on quality of life (QOL) and sexual functioning in patients undergoing RVT is scarce. Aim. The aims of this study were to prospectively assess sexual function after RVT and to compare scores of sexual function in patients operated by RVT and radical abdominal hysterectomy (RAH) with those of age-matched control women from the general population. Methods. Eighteen patients with early stage cervical cancer operated with RVT were prospectively included and assessed preoperatively, and 3, 6, and 12 months postoperatively using validated questionnaires. RAH patients were included consecutively and assessed once at 12 months postsurgery, while an age-matched control group of 30 healthy women was assessed once. Main Outcome Measure. Sexual dysfunction total score as measured by the Female Sexual Function Index (FSFI) was the main outcome measure. Results. During the 12 months posttreatment, RVT patients tended to have persistent sexual dysfunction as measured by FSFI (mean overall score 11). Sexual worry (P < 0.001) and lack of sexual desire (P = 0.038) were more frequently reported among patients in both treatment groups compared with control women. Sexual activity increased significantly during the observation time for the RVT group (P = 0.023) and reached that of healthy women. Global Health Status score improved over time for the RVT group but never reached that of healthy control women (P = 0.029). Conclusions. Our data suggest that patients treated with RVT for early stage cervical cancer experience persistent sexual dysfunction up to one year post surgery influencing negatively on their QOL. Froeding LP, Ottosen C, Rung-Hansen H, Svane D, Mosgaard BJ, and Jensen PT. Sexual functioning and vaginal changes after radical vaginal trachelectomy in early stage cervical cancer patients: A longitudinal study. J Sex Med 2014;11:595–604. Key Words. Cevical Cancer; Radical Trachelectomy; Radical Hysterectomy; Sexual Functioning; Quality of Life
Introduction
A
lthough the incidence of cervical cancer is decreasing in Western countries, it is still one of the most common cancers affecting young © 2013 International Society for Sexual Medicine
women during their childbearing years [1]. Because of screening, 54% of patients are diagnosed while at stage I, with an expected 90% 5-year survival [1]. About 15% of all cervical cancers are diagnosed in women under the age of 40, and about 45% are J Sex Med 2014;11:595–604
596 treated surgically [2,3]. Early stage cervical cancer is usually treated by radical hysterectomy and pelvic lymphadenectomy [4]. The median age of first delivery in Denmark in the period 1995–2008 increased from 27.4 to 30.8. In 2008, 19.8% of women delivered their first child after the age of 35 years [5]. The same tendency regarding age at first delivery is seen in other Scandinavian countries. Radical vaginal trachelectomy (RVT) with preservation of fertility is therefore becoming increasingly relevant for young women with early stage cervical cancer. Based on the existing literature, RVT is a safe alternative to conventional radical hysterectomy, with similar survival and recurrence rates [6]. Patients receiving RVT are expected to be longterm survivors and must therefore deal with the consequences of surgery. Several studies describe quality of life (QOL) and sexual dysfunction after conventional radical hysterectomy [7–10], but only few reports on short- and long-term self-reported sequelae after RVT have been published. Two small prospective studies of women undergoing radical trachelectomy vs. radical hysterectomy did not find group differences of mood, distress, sexual function, and QOL [11,12]. However, RVT and radical abdominal hysterectomy (RAH) for early stage cervical cancer significantly compromised sexual function up to two years postsurgery according to measurements using the Female Sexual Function Index (FSFI) [11,12]. Aim
The aim of this study was to evaluate short- and long-term sexual dysfunction and QOL after RVT, comparing RVT patients to those receiving conventional radical hysterectomy and to healthy women. Methods
Patients Patients with cervical cancer stage IA1-IB1 who were eligible for RVT and stage IA1-IB2 who were eligible for RAH, and who attended the Department of Gynecology, Copenhagen University Hospital–Rigshospitalet and Herlev University Hospital were included from April 1, 2007 to December 1, 2009. The criteria for offering RVT have been almost unchanged for more than 10 years [13]. They are patients with stage IA1-IB1 cervical cancer, with a tumor
ORIGINAL RESEARCH—SURGERY Sexual Functioning and Vaginal Changes after Radical Vaginal Trachelectomy in Early Stage Cervical Cancer Patients: A Longitudinal Study Ligita Paskeviciute Froeding, MD,* Christian Ottosen, MD,† Helle Rung-Hansen, MD,‡ Danny Svane, MD,† Berit Jul Mosgaard, MD, PhD,† and Pernille Tine Jensen, MD, PhD§ *Department of Gynecology, Copenhagen University Hospital Herlev, Herlev, Denmark; †Department of Gynecology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; ‡Herlev Primary Care Center, Herlev, Denmark; § Department of Gynecology, Odense University Hospital, Odense, Denmark DOI: 10.1111/jsm.12399
ABSTRACT
Introduction. Radical vaginal trachelectomy (RVT) offers low complication rate, good survival, and possibility for future childbearing for young women with early stage cervical cancer. However, the literature on quality of life (QOL) and sexual functioning in patients undergoing RVT is scarce. Aim. The aims of this study were to prospectively assess sexual function after RVT and to compare scores of sexual function in patients operated by RVT and radical abdominal hysterectomy (RAH) with those of age-matched control women from the general population. Methods. Eighteen patients with early stage cervical cancer operated with RVT were prospectively included and assessed preoperatively, and 3, 6, and 12 months postoperatively using validated questionnaires. RAH patients were included consecutively and assessed once at 12 months postsurgery, while an age-matched control group of 30 healthy women was assessed once. Main Outcome Measure. Sexual dysfunction total score as measured by the Female Sexual Function Index (FSFI) was the main outcome measure. Results. During the 12 months posttreatment, RVT patients tended to have persistent sexual dysfunction as measured by FSFI (mean overall score 11). Sexual worry (P < 0.001) and lack of sexual desire (P = 0.038) were more frequently reported among patients in both treatment groups compared with control women. Sexual activity increased significantly during the observation time for the RVT group (P = 0.023) and reached that of healthy women. Global Health Status score improved over time for the RVT group but never reached that of healthy control women (P = 0.029). Conclusions. Our data suggest that patients treated with RVT for early stage cervical cancer experience persistent sexual dysfunction up to one year post surgery influencing negatively on their QOL. Froeding LP, Ottosen C, Rung-Hansen H, Svane D, Mosgaard BJ, and Jensen PT. Sexual functioning and vaginal changes after radical vaginal trachelectomy in early stage cervical cancer patients: A longitudinal study. J Sex Med 2014;11:595–604. Key Words. Cevical Cancer; Radical Trachelectomy; Radical Hysterectomy; Sexual Functioning; Quality of Life
Introduction
A
lthough the incidence of cervical cancer is decreasing in Western countries, it is still one of the most common cancers affecting young © 2013 International Society for Sexual Medicine
women during their childbearing years [1]. Because of screening, 54% of patients are diagnosed while at stage I, with an expected 90% 5-year survival [1]. About 15% of all cervical cancers are diagnosed in women under the age of 40, and about 45% are J Sex Med 2014;11:595–604
596 treated surgically [2,3]. Early stage cervical cancer is usually treated by radical hysterectomy and pelvic lymphadenectomy [4]. The median age of first delivery in Denmark in the period 1995–2008 increased from 27.4 to 30.8. In 2008, 19.8% of women delivered their first child after the age of 35 years [5]. The same tendency regarding age at first delivery is seen in other Scandinavian countries. Radical vaginal trachelectomy (RVT) with preservation of fertility is therefore becoming increasingly relevant for young women with early stage cervical cancer. Based on the existing literature, RVT is a safe alternative to conventional radical hysterectomy, with similar survival and recurrence rates [6]. Patients receiving RVT are expected to be longterm survivors and must therefore deal with the consequences of surgery. Several studies describe quality of life (QOL) and sexual dysfunction after conventional radical hysterectomy [7–10], but only few reports on short- and long-term self-reported sequelae after RVT have been published. Two small prospective studies of women undergoing radical trachelectomy vs. radical hysterectomy did not find group differences of mood, distress, sexual function, and QOL [11,12]. However, RVT and radical abdominal hysterectomy (RAH) for early stage cervical cancer significantly compromised sexual function up to two years postsurgery according to measurements using the Female Sexual Function Index (FSFI) [11,12]. Aim
The aim of this study was to evaluate short- and long-term sexual dysfunction and QOL after RVT, comparing RVT patients to those receiving conventional radical hysterectomy and to healthy women. Methods
Patients Patients with cervical cancer stage IA1-IB1 who were eligible for RVT and stage IA1-IB2 who were eligible for RAH, and who attended the Department of Gynecology, Copenhagen University Hospital–Rigshospitalet and Herlev University Hospital were included from April 1, 2007 to December 1, 2009. The criteria for offering RVT have been almost unchanged for more than 10 years [13]. They are patients with stage IA1-IB1 cervical cancer, with a tumor
