Purpose: Vaginal dilator therapy is commonly used for the prevention of vaginal stenosis after radiation therapy among women with gynecologic cancers, facilitating more comfortable and feasible pelvic exams and improved sexual function. While adherence to dilator therapy is a known barrier, few data exist regarding factors contributing to non-adherence. Fewer data exist regarding the use of vibrating vaginal wands (VVW), which are increasingly utilized in this setting. Our objective was to determine adherence to VVW and patient-reported barriers to the use of VVW therapy.
Methods: A prospective cohort study was performed between September 2017 and December 2019 among women receiving radiation therapy for gynecologic cancers. Participants were provided with a VVW after radiation therapy and asked to record usage frequency and barriers to use in a study diary for up to 16 weeks. Patient-reported health-related quality of life and sexual health outcomes were evaluated at baseline and follow-up time points for up to 16 weeks.
Results: Among 51 enrolled participants, the overall adherence rate was 66% (95% CI:51.7 – 77.8%). The most frequently cited barriers were: 1) being too tired to use the vaginal wand; 2) thinking of the vaginal wand as a sex toy; 3) being reminded of their treatment and cancer; 4) being sick of using the vaginal wand; and 5) not being able to use the wand in the shower. Higher barrier scores were associated with decreased VVW usage. Increased patient-reported pain interference and lower sexual interest were significantly correlated with lower frequency of use.
Conclusion: Most patients adhere to VVW for up to 4 months following radiation therapy, however, barriers to use exist. Routine follow-up, support, and patient-oriented pre-emptive counseling by providers may improve adherence to VVW therapy among gynecologic cancer survivors.