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Yang S, Ding Y, Li H, Wu S, Feng W, Wang Y, Wang X, Hua K. Impact of peritoneal vaginoplasty combined with radical hysterectomy on the quality of sexual life for patients with early-stage cervical cancer: trial protocol for a multi-center superiority randomized controlled trial. J Gynecol Oncol 2024; 35:e23. [PMID: 38037548 PMCID: PMC11107286 DOI: 10.3802/jgo.2024.35.e23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/03/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Radical hysterectomy (RH) is commonly used to treat early-stage cervical cancer in women of childbearing age and sexual dysfunction due to postoperative vaginal shortening is a major concern. The impact of intraoperative vaginoplasty on prognosis and quality of sexual life in patients with early-stage cervical cancer remains controversial and lacks high-level evidence. However, there are few reports on vaginoplasty after RH to lengthen vagina in patients. This prospective, multi-center, randomized controlled trial aims to explore the impact of peritoneal vaginoplasty with or without ovarian transposition after laparoscopic RH on sexual dysfunction in patients with early-stage cervical cancer. METHODS Eligible patients will be randomly assigned (1:1) to receive peritoneal vaginoplasty or not. The primary evaluation indicators are female sexual function index (FSFI) and male sexual satisfaction scale. The secondary evaluation indicators include EORTC QLQ-CX24, 2-year overall survival (OS), 5-year OS, 2-year progression-free survival (PFS), 5-year PFS and surgery-related complications. The trial will enroll 368 patients from 6 hospitals in China over a 3-year period and follow up for 5 years. TRIAL REGISTRATION Chinese Clinical Trial Registry Identifier: ChiCTR2000040610.
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Affiliation(s)
- Shimin Yang
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yan Ding
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Huaifang Li
- Department of Obstetrics and Gynecology, Tongji Hospital Affiliated to Tongji University, Shanghai, China
| | - Sufang Wu
- Department of Obstetrics and Gynecology, Shanghai General Hospital of Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weiwei Feng
- Department of Obstetrics and Gynecology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yudong Wang
- Department of Gynecologic Oncology, The International Peace Maternity & Child Health Hospital (IPMCH) of China Welfare Institute (CWI), Shanghai, China
| | - Xipeng Wang
- Department of Obstetrics and Gynecology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Keqin Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
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Qian M, Wang L, Xing J, Shan X, Wu J, Liu X. Prevalence of sexual dysfunction in women with cervical cancer: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2023; 28:494-508. [PMID: 35946648 DOI: 10.1080/13548506.2022.2110270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Cervical cancer (CC) is a common malignant gynaecological tumour. However, as survival rates have improved, increasing attention has focused on the quality of the survivors' sex lives. We conducted a meta-analysis to investigate the prevalence and severity of female sexual dysfunction (FSD) in women with CC. We searched the PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, and Wang Fang databases, and extracted data from all studies published up to December 2020 that evaluated sexual dysfunction in patients with CC with the female sexual function index (FSFI). Studies were screened according to specific inclusion and exclusion criteria, and the qualities of the included studies were evaluated. Sixteen studies with a total of 2009 women with CC, including 1306 women with FSD, were included in the meta-analysis. Among patients with CC, the incidence of FSD was 80% (95% confidence interval (95%CI) 0.74-0.87) and the average FSFI score was 20.25 (95%CI 18.96-21.53). These results revealed a high prevalence of FSD and poor sexual function among women with CC, suggesting a need to assess sexual function regularly in these women with CC to improve early recognition of FSD and thereby allow appropriate interventions to enhance the sex life of affected patients.
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Affiliation(s)
- Maolin Qian
- School of Medicine, Nantong University, Nantong, People's Republic of China
| | - Lan Wang
- School of Medicine, Nantong University, Nantong, People's Republic of China
| | - Jiajun Xing
- School of Medicine, Nantong University, Nantong, People's Republic of China
| | - Xiao Shan
- School of Medicine, Nantong University, Nantong, People's Republic of China
| | - Juan Wu
- Department of Gynecology, Affiliated Hospital of Nantong University, Nantong, People's Republic of China
| | - Xiaoqin Liu
- Department of Gynecology, Affiliated Hospital of Nantong University, Nantong, People's Republic of China
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Kisu I, Iida M, Shiraishi T, Banno K. Novel vaginoplasty technique involving the use of peritoneal flaps during laparoscopic radical hysterectomy for early-stage cervical cancer. J Gynecol Oncol 2022; 33:e19. [PMID: 35128853 PMCID: PMC8899872 DOI: 10.3802/jgo.2022.33.e19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/08/2021] [Indexed: 12/04/2022] Open
Abstract
Radical hysterectomy is often performed to treat early-stage cervical cancer in women of reproductive age, and sexual dysfunction due to postoperative vaginal shortening is a major concern [12]. Vaginoplasty using various techniques is commonly performed in patients with congenital vaginal agenesis [3]. However, there are few reports of vaginoplasty being performed for vaginal shortening after radical hysterectomy in a patient with cervical cancer [45]. We demonstrate a novel vaginoplasty technique in which peritoneal flaps are used during laparoscopic radical hysterectomy to prevent postoperative vaginal shortening and consequent sexual dysfunction in patients with early-stage cervical cancer. A 37-year-old woman with early-stage cervical cancer who wished to perform sexual activity postoperatively underwent laparoscopic radical hysterectomy and vaginoplasty. After radical hysterectomy, the residual vaginal length was 4 cm. The dissected peritoneum of pouch of Douglas (posterior peritoneal flap) was sutured to the posterior vaginal stump. The supravesical peritoneum was dissected from the ventral to the dorsal side to create an anterior peritoneal flap, which was inverted, pulled down, and sutured to the anterior vaginal stump. The anterior peritoneal flap and suprarectal peritoneum were sutured to create a 10-cm neovaginal vault. Subsequently, a methacrylic resin mold was inserted into the neovagina to prevent postoperative neovaginal stenosis. The patient had sexual intercourse 3 months postoperatively. She was satisfied with the sexual activity and experienced no vaginal shortening or stenosis. Our novel vaginoplasty technique is feasible and effective for preventing sexual dysfunction by lengthening the vagina during laparoscopic radical hysterectomy for early-stage cervical cancer.
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Affiliation(s)
- Iori Kisu
- Department of Obstetrics and Gynecology, Federation of National Public Service Personnel Mutual Aid Associations, Tachikawa Hospital, Tokyo, Japan
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Miho Iida
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Tetsuro Shiraishi
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Kouji Banno
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
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Vazquez S, Padilla-Iserte P, Marina T, Lago V, Matute L, Domingo S. Creatsas modified vaginoplasty as reconstructive treatment of vaginal stenosis due to vaginal or pelvic radiotherapy. Int J Gynecol Cancer 2020; 30:1249. [PMID: 32376742 DOI: 10.1136/ijgc-2020-001310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2020] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sheila Vazquez
- Department of Gynecology Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Pablo Padilla-Iserte
- Department of Gynecology Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Tiermes Marina
- Department of Gynecology Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Victor Lago
- Department of Gynecology Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Luis Matute
- Department of Gynecology Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Santiago Domingo
- Department of Gynecology Oncology, La Fe University and Polytechnic Hospital, Valencia, Spain
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Body Image, Sexuality, and Sexual Functioning in Women With Gynecologic Cancer: An Integrative Review of the Literature and Implications for Research. Cancer Nurs 2020; 44:E252-E286. [PMID: 32332264 DOI: 10.1097/ncc.0000000000000818] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cervical and uterine cancers are common in women. Diagnosis and treatment of these cancers can lead to significant issues with body image, sexuality, and sexual functioning. A comprehensive review can improve understanding of these 3 concepts, in turn enhancing identification and management. OBJECTIVES To (1) present the qualitative, descriptive, and correlational research literature surrounding body image, sexuality, and sexual functioning in women with uterine and cervical cancer; (2) identify gaps in the literature; and (3) explore the implications of the findings for future research. METHODS A comprehensive search of the literature was undertaken by searching PubMed, CINAHL, and PsycINFO using predetermined subject headings, keywords, and exploded topics. After a comprehensive evaluation using specific criteria, 121 articles were reviewed. RESULTS Qualitative studies provided information about women's issues with body image, sexuality, and sexual functioning, whereas quantitative studies focused primarily on sexual functioning. The literature lacks correlational studies examining body image and sexuality. Significant issues regarding communication and quality of life were noted, and few studies were based on clear conceptual models. CONCLUSION The state of the science gleaned from this review reveals that while much is known about sexual functioning, little is known about body image and sexuality. IMPLICATIONS FOR PRACTICE Further work is warranted to develop conceptual models and research on body image, sexuality, and sexual functioning as a foundation for interventions to improve quality of life.
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Hill AM, Davis KM, Clark-Donat L, Hammons LM, Azodi M, Silasi DA. The Effect of Vertical Versus Horizontal Vaginal Cuff Closure on Vaginal Length After Laparoscopic Hysterectomy. J Minim Invasive Gynecol 2017; 24:108-113. [PMID: 27702701 DOI: 10.1016/j.jmig.2016.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/13/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE: To determine whether vertical versus horizontal closure of the vaginal cuff during laparoscopic hysterectomy has an effect on postoperative vaginal length and pelvic organ prolapse. DESIGN A prospective randomized controlled trial. Subjects were randomly assigned to vertical or horizontal vaginal cuff closure at the time of total laparoscopic hysterectomy. Pelvic organ prolapse quantization (POP-Q) tests were performed before surgery, 2 to 4 weeks after surgery, and 3 to 4 months after surgery (Canadian Task Force classification I). SETTING An academic university-affiliated community hospital. PATIENTS Patients undergoing laparoscopic or robotic-assisted laparoscopic total hysterectomy for benign or malignant disease, excluding those undergoing radical hysterectomy or concomitant pelvic floor procedure. INTERVENTIONS Subjects were randomized into the vertical or horizontal vaginal cuff closure group. Total hysterectomy was completed with traditional laparoscopic techniques or with robotic assistance. A colpotomy ring was used in each subject. Vaginal cuff closure was performed with barbed suture in a running fashion according to the group assignment. MEASUREMENTS AND MAIN RESULTS A total of 43 subjects were enrolled and randomized. One patient was excluded because the vaginal cuff was closed vaginally, 1 cancelled surgery, and 1 was completed without a uterine manipulator. The mean change in vaginal length was -0.89 cm (standard deviation [SD] = 1.03) in the horizontal group and -0.86 cm (SD = 1.19) in the vertical group (p = .57). POP-Q evaluation revealed no differences between groups and an overall trend toward improved POP-Q measurements. The average duration of vaginal cuff closure did not differ (p = .45), and there were no intraoperative complications related to vaginal cuff closure. CONCLUSION Horizontal and vertical laparoscopic closure of the vaginal cuff after laparoscopic hysterectomy results in similar changes in vaginal length and other POP-Q scores.
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Affiliation(s)
- Amanda Marie Hill
- Department of Obstetrics and Gynecology, Yale New Haven Health-Bridgeport Hospital, Yale School of Medicine, New Haven, Connecticut.
| | - K Meryl Davis
- Department of Obstetrics and Gynecology, Yale New Haven Health-Bridgeport Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Lindsay Clark-Donat
- Department of Obstetrics and Gynecology, Yale New Haven Health-Bridgeport Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Lee Marvin Hammons
- Department of Obstetrics and Gynecology, Yale New Haven Health-Bridgeport Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Masoud Azodi
- Department of Obstetrics and Gynecology, Yale New Haven Health-Bridgeport Hospital, Yale School of Medicine, New Haven, Connecticut
| | - Dan-Arin Silasi
- Department of Obstetrics and Gynecology, Yale New Haven Health-Bridgeport Hospital, Yale School of Medicine, New Haven, Connecticut
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Xiao M, Gao H, Bai H, Zhang Z. Quality of life and sexuality in disease-free survivors of cervical cancer after radical hysterectomy alone: A comparison between total laparoscopy and laparotomy. Medicine (Baltimore) 2016; 95:e4787. [PMID: 27603383 PMCID: PMC5023906 DOI: 10.1097/md.0000000000004787] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of the present study was to evaluate the possible differences between total laparoscopy and laparotomy regarding their impact on postoperative quality of life and sexuality in disease-free cervical cancer survivors who received radical hysterectomy (RH) and/or lymphadenectomy alone and were followed for >1 year.We reviewed all patients with cervical cancer who had received surgical treatment in our hospital between January 2001 and March 2014. Consecutive sexually active survivors who received RH and/or lymphadenectomy for early stage cervical cancer were enrolled and divided into 2 groups based on surgical approach. Survivors were interviewed and completed validated questionnaires, including the European Organization for Research Treatment of Cancer Quality-of-Life Core Questionnaire including 30 items, the Cervical Cancer-Specific Module of European Organization for Research Treatment of Cancer Quality-of-Life Questionnaire including 24 items (EORTC QLQ-CX24), and the Female Sexual Function Index (FSFI).In total, 273 patients with histologically confirmed cervical cancer were retrospectively reviewed. However, only 64 patients had received RH and/or lymphadenectomy alone; 58 survivors meeting the inclusion criteria were enrolled, including 42 total laparoscopy cases and 16 laparotomy cases, with an average follow-up of 46.1 and 51.2 months, respectively. The survivors in the 2 groups obtained good and similar scores on all items of the European Organization for Research Treatment of Cancer Quality-of-Life Core Questionnaire including 30 items and Cervical Cancer-Specific Module of European Organization for Research Treatment of Cancer Quality-of-Life Questionnaire including 24 items, without significant differences after controlling for covariate background characteristics. To the date of submission, 21.4% (9/42) of cases in the total laparoscopy group and 31.2% (5/16) of cases in the laparotomy group had not resumed sexual behavior after RH. Additionally, the scores on the FSFI items were comparable between the 2 groups; however, the total FSFI scores were 19.7 and 17.4 for total laparoscopy and laparotomy survivors, respectively, both of which were less than the validated cutoff value of 26.6 for diagnosing female sexual dysfunction.Disease-free cervical cancer survivors after RH and/or lymphadenectomy were able to cope well, although RH could greatly impair females' sexual function regardless of surgical approach. Moreover, the long-term quality of life and sexual function of survivors seemed to be independent of the surgical approach chosen. Randomized controlled and longitudinal trials with larger populations are needed to better compare these issues between patients receiving laparoscopy and laparotomy.
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Affiliation(s)
| | | | | | - Zhenyu Zhang
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Correspondence: Zhenyu Zhang, Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, Capital Medical University, Gongti Nan Road, Chaoyang District, Beijing 100020, China (e-mail: )
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Vaginal extension improves sexual function in patients receiving laparoscopic radical hysterectomy. Gynecol Oncol 2016; 141:550-558. [PMID: 27085713 DOI: 10.1016/j.ygyno.2016.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/26/2016] [Accepted: 04/05/2016] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To investigate as to whether vaginal extension (VX) following laparoscopic radical hysterectomy (LRH) improves sexual function in patients with early-stage cervical cancer patients. METHODS A total of 216 patients with stage Ia1-IIa2 cervical cancer were recruited, 115 of them received LRH concurrently with VX (group VX) and the other 101, LRH only (group C). Demographic, clinicopathological, and peri-operative data were collected. The Female Sexual Function Index (FSFI) questionnaire was administrated before and one year after surgery. Serum estrogen and follicle-stimulating hormone levels were also measured one year after surgery. The total and domain-wise FSFI scores before and after surgery were compared. RESULTS Irrespective VX or not, all 6 domains of the FSFI scores in women with early-stage cervical cancer were significantly reduced one year after LRH. VX, however, significantly attenuated this reduction and improved all 6 FSFI domain scores, at the only cost of <20min longer operating time. In addition, more ovarian reserve and better pre-operational sexual function also contributed to the attenuation. The ovarian reserve was improved if ovarian preservation procedure was performed during LRH. CONCLUSIONS While the sexual function in patients receiving VX procedure does not fully achieve the pre-operational level, the improvement is nonetheless global and significant. Ovarian preservation procedure during LRH may also help improve the sexual function. Therefore, VX and ovarian preservation may be desirable for patients with early-stage cervical cancer who undergo RH.
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