[The impact of radiation therapy on sexual function]

Changes in the Vaginal Microbiome and Associated Toxicities Following Radiation Therapy for Gynecologic Cancers

Postmenopausal women often suffer from vaginal symptoms associated with atrophic vaginitis. Additionally, gynecologic cancer survivors may live for decades with additional, clinically significant, persistent vaginal toxicities caused by cancer therapies, including pain, dyspareunia, and sexual dysfunction. The vaginal microbiome (VM) has been previously linked with vaginal symptoms related to menopause (i.e. dryness). Our previous work showed that gynecologic cancer patients exhibit distinct VM profiles from healthy women, with low abundance of lactobacilli and prevalence of multiple opportunistic pathogenic bacteria. Here we explore the association between the dynamics and structure of the vaginal microbiome with the manifestation and persistence of vaginal symptoms, during one year after completion of cancer therapies, while controlling for clinical and sociodemographic factors. We compared cross-sectionally the vaginal microbiome in 134 women, 64 gynecologic patients treated with radiotherapy and 68 healthy controls, and we longitudinally followed a subset of 52 women quarterly (4 times in a year: pre-radiation therapy, 2, 6 and 12 months post-therapy). Differences among the VM profiles of cancer and healthy women were more pronounced with the progression of time. Cancer patients had higher diversity VMs and a variety of vaginal community types (CTs) that are not dominated by Lactobacilli, with extensive VM variation between individuals. Additionally, cancer patients exhibit highly unstable VMs (based on Bray-Curtis distances) compared to healthy controls. Vaginal symptoms prevalent in cancer patients included vaginal pain (40%), hemorrhage (35%), vaginismus (28%) and inflammation (20%), while symptoms such as dryness (45%), lack of lubrication (33%) and dyspareunia (32%) were equally or more prominent in healthy women at baseline. However, 24% of cancer patients experienced persistent symptoms at all time points, as opposed to 12% of healthy women. Symptom persistence was strongly inversely correlated with VM stability; for example, patients with persistent dryness or abnormally high pH have the most unstable microbiomes. Associations were identified between vaginal symptoms and individual bacterial taxa, including: Prevotella with vaginal dryness, Delftia with pain following vaginal intercourse, and Gemillaceaea with low levels of lubrication during intercourse. Taken together our results indicate that gynecologic cancer therapy is associated with reduced vaginal microbiome stability and vaginal symptom persistence.

M, Belaid A, Gargouri W, Nasr C. Évaluation de l’image du corps chez des femmes traitées pour un cancer utérin

Introduction : À l’heure actuelle, le retentissement des cancers utérins, ainsi que leur traitement sur l’image du corps, demeure un sujet peu étudié en Tunisie et souvent négligé aussi bien par les praticiens, les malades et leurs partenaires.

Méthodes : Il s’agit d’une étude transversale descriptive colligeant 100 patientes tunisiennes suivies à l’institut Salah- Azaïez pour un cancer de l’endomètre ou du col utérin confirmés histologiquement et non métastatiques, avec un recul supérieur à six mois. Nous avons utilisé l’échelle Body Image Scale (BIS) et Female Sexual Function Index (FSFI). Nous avons collecté les antécédents personnels et familiaux, et différentes données sociodémographiques des patientes.

Résultats : Dans notre étude, 40 % des patientes ont des troubles de l’image du corps. La moyenne du score BIS était de 12,03 avec des extrêmes allant de 0 à 30 avec un écarttype de 7,88. En analyse univariée, l’absence du soutien familial, l’altération de la relation de couple et de la relation sexuelle, la mauvaise tolérance de la chirurgie et la curiethérapie utérovaginale étaient significativement associées à l’altération de l’image corporelle. En analyse multivariée, le bas niveau socio-économique était le facteur indépendant protecteur du trouble de l’image du corps, et la dysfonction sexuelle était le facteur indépendant prédicteur de ce trouble.

Conclusions : Le manque de communication des patientes avec leur conjoint et avec l’équipe de soin constitue l’un des principaux obstacles lorsqu’il s’agit de reconnaître et de traiter ce problème. Des stratégies préventives visant à maintenir une image corporelle positive chez ces femmes devraient être entreprises.

Improving patients' understanding of terms and phrases commonly used in self-reported measures of sexual function

INTRODUCTION

There is a significant gap in research regarding the readability and comprehension of existing sexual function measures. Patient-reported outcome measures may use terms not well understood by respondents with low literacy.

AIM

This study aims to test comprehension of words and phrases typically used in sexual function measures to improve validity for all individuals, including those with low literacy.

METHODS

We recruited 20 men and 28 women for cognitive interviews on version 2.0 of the Patient-Reported Outcome Measurement Information System(®) (PROMIS(®) ) Sexual Function and Satisfaction measures. We assessed participants' reading level using the word reading subtest of the Wide Range Achievement Test. Sixteen participants were classified as having low literacy.

MAIN OUTCOME MEASURES

In the first round of cognitive interviews, each survey item was reviewed by five or more people, at least two of whom had lower than a ninth-grade reading level (low literacy). Patient feedback was incorporated into a revised version of the items. In the second round of interviews, an additional three or more people (at least one with low literacy) reviewed each revised item.

RESULTS

Participants with low literacy had difficulty comprehending terms such as aroused, orgasm, erection, ejaculation, incontinence, and vaginal penetration. Women across a range of literacy levels had difficulty with clinical terms like labia and clitoris. We modified unclear terms to include parenthetical descriptors or slang equivalents, which generally improved comprehension.

CONCLUSIONS

Common words and phrases used across measures of self-reported sexual function are not universally understood. Researchers should appreciate these misunderstandings as a potential source of error in studies using self-reported measures of sexual function. This study also provides evidence for the importance of including individuals with low literacy in cognitive pretesting during the measure development.