Diagnostic Methods for Vaginal Stenosis and Compliance to Vaginal Dilator Use: A Systematic Review

• Published in: Journal of sexual medicine Vol. 18; no. 3; pp. 493 - 514
• Main Authors: Haddad, Natalia Carion, Soares Brollo, Leila Cristina, Pinho Oliveira, Marco Aurelio, Bernardo-Filho, Mario
• Format: Journal Article
• Language: English
• Published: Netherlands 01.03.2021
• Subjects: Constriction, Pathologic; Cross-Sectional Studies; Dilatation; Female; Humans; Prospective Studies; Retrospective Studies; Vaginal Diseases - diagnosis; Dilation; Vagina; Diagnosis; Patient Compliance; Constriction; Radiotherapy
• ISSN: 1743-6095; 1743-6109
• DOI: 10.1016/j.jsxm.2020.12.013

Vaginal stenosis (VS) is a common side effect of pelvic radiotherapy for gynecological cancer in women. It has a high incidence variability, likely due to unstandardized and subjective assessment methods. Furthermore, even though the worldwide standard treatment for VS is vaginal dilation, low compliance rates have been noted. To evaluate the parameters used to diagnose VS and to assess whether the lack of an objective measure of VS hampers vaginal dilator use. A systematic review in accordance with the PRISMA reporting guidelines was conducted. PubMed, EMBASE, and Web of Science databases were searched. Randomized trials and prospective, retrospective, and cross-sectional studies published from January 2011 to February 2020 were included. The main outcome of this study was a review of the published literature on assessment methods for VS and compliance to vaginal dilator use. Of the 28 articles obtained, only 7 used objective methods to measure the vaginal volume. 3 studies have demonstrated patient's concern with VS development and showed a high compliance to dilator use, whereas others reported several barriers to dilator use. Lack of an objective assessment method can be a predisposing factor for uncertain VS incidence rates and impair compliance to vaginal dilator therapy, leading to long-term VS and sexual dysfunction. This is the first systematic review on the heterogeneity of VS evaluation methods and compliance to vaginal dilator use. All studies were comprehensively evaluated by 2 reviewers. The limitations included the heterogeneity of the study designs and the unstandardized criteria used to classify stenosis or to evaluate compliance to dilator use. Although 3 well-known databases were used, the inclusion of more data sources could have increased the number of publications included in this review. VS is frequently diagnosed using subjective parameters. Few unstandardized objective methods are used to evaluate this condition. Regarding compliance to vaginal dilator use, there was a high dropout rate during follow-up and no consensus on starting time or ideal usage. Haddad NC, Soares Brollo LC, Pinho Oliveira MA, et al. Diagnostic Methods for Vaginal Stenosis and Compliance to Vaginal Dilator Use: A Systematic Review. J Sex Med 2021;18:493-514.