Guidelines for the prevention of vaginal stenosis in women with gynecological cancer after pelvic brachytherapy in radiotherapy services in Brazil

Introduction: Vaginal stenosis can occur after pelvic brachytherapy, leading to sexual dysfunction that makes gynecological examinations for cancer follow-up difficult or impossible. Objective: To evaluate measures to prevent vaginal stenosis after brachytherapy for gynecological cancers in radiotherapy centers in Brazil. Method: Observational cross-sectional study with data collection between June and December 2022, through a Google Forms questionnaire sent to public, philanthropic and private radiotherapy services in Brazil by e-mail. Results:A total of 43 responses were obtained, where 34 (79%) institutions reported performing pelvic brachytherapy and 33 (77%) reported advising patients on stenosis prevention. The main guidelines provided were the use of vaginal dilators (32-97%), stimulation of sexual activity with penetration (27-82%), pelvic physiotherapy (22-66%) and use of topical solutions (16-48%). In most radiotherapy centers, guidance is given at the first radiotherapy appointment, with the most frequent indication being the use of dilators, starting two weeks after the end of brachytherapy, continuing for more than 36 months, without discontinuation, three times a week, once a day, for 10 to 15 minutes. Conclusion: Most radiotherapy services in Brazil that carry out brachytherapy and took part in the study provide patients with guidance on preventing vaginal stenosis and the most common measure is use of vaginal dilators, in addition to stimulation of sexual activity with penetration, use of topical solutions and pelvic physiotherapy. (author)