This original study considers that with the advancements in the oncological treatment of gynecological cancer progress, there's a growing concern regarding the physical and functional complications that can affect survivors. Vaginal stenosis stands out as one of the most significant consequences, causing discomfort during sexual activity and hindering post-cancer gynecological follow-up exams. Additionally, the impact on sexuality triggers changes in body image. While there isn't a gold standard treatment for vaginal stenosis, pelvic physiotherapy offers therapeutic resources that can bring benefits in its resolution. Given these considerations, the hypothesis is that a pelvic physiotherapy program, including perineal massage, the use of vaginal dilators, and pelvic floor muscle training, could promote improvements in vaginal stenosis among women after gynecological cancer treatment.
Objective: To analyze the effects of a pelvic physiotherapy program on vaginal canal length, tone, and pelvic floor function in post-gynecological cancer survivors with vaginal stenosis.

In a prospective design, 34 women over 18 years diagnosed with different types of gynecological cancer (cervix, endometrium, ovaries, vulva, and vagina) were included. Participants had already completed oncological treatment at least 12 months prior and exhibited a reduction in vaginal canal length, measuring less than 8 cm, indicating vaginal stenosis. Two evaluations were conducted, one before and one after the intervention, involving specific gynecological physical exams. Vulvovaginal mucosa coloration was assessed through inspection, and perineal region palpation provided insight into the tone of the tendinous center of the perineum. Uni/bidigital vaginal palpation was performed to examine vaginal mucosa tone and bilateral muscle bundle symmetry, as well as to analyze pelvic floor function, classified into different functional grades using the Pelvic Floor Functional Assessment; vaginal canal length was measured by inserting silicone dilators. Initial evaluation also collected sociodemographic data, clinical-surgical history, and lifestyle habits. On the first day of intervention, an educational session on female pelvic anatomy and the impacts of oncological treatment on these structures was conducted to enhance participant body awareness and proprioception, encouraging adherence to the treatment program. The proposed physiotherapeutic intervention included perineal massage techniques, gradual vaginal canal dilation using vaginal dilators, and pelvic floor muscle training, applied in individualized sessions conducted weekly, lasting 50 minutes over 10 weeks. Sample size was determined based on a pilot study involving nine participants, aiming to achieve a statistical power of 80%, an alpha of 5%, and considering a 10% sample loss. It was estimated that at least 15 participants would be necessary to identify a statistically significant difference in vaginal canal length, using the centimeter value of vaginal canal length. Data analysis employed paired sample t-tests or Wilcoxon tests to compare vaginal canal length and pelvic floor function, with a significance level set at 0.05.

Twenty-one participants completed the pelvic physiotherapy program, with a mean age of 54 years and an average time since the end of oncological treatment of 5.42 years. Of the total study participants, 10 (47.6%) reported being sexually active, while 11 (52.4%) did not report sexual activity. An increase in pelvic floor functional levels was observed, and by the end of the intervention, all participants exhibited function grades between 3 and 5, indicating moderate to high perineal function. The tone of the tendinous center of the perineum before physiotherapy was hypotonic in seven participants (33.3%) and hypertonic in four (19.0%); after the program, 18 participants (85.7%) achieved normotonic tone. Regarding mucosa tone before physiotherapeutic intervention, four participants (19.0%) had hypotonicity, and eight (38.1%) had hypertonicity; by the end, 19 women (90.5%) had normotonic mucosa tone. Mucosa coloration was altered in three (14.3%) and four (4.8%) participants, being pale and hyperemic, respectively; after treatment, 18 (85.7%) women presented with pink vaginal mucosa. As for muscle bundles, nine women (42.9%) showed asymmetry in the initial assessment, but after intervention, all 21 participants exhibited bundle symmetry. At the end of the intervention, a significant increase in vaginal canal length (p <0.001) and substantial improvement in pelvic floor muscle function (p <0.001) were observed. Fourteen participants (66.7%) achieved complete resolution of vaginal stenosis after the pelvic physiotherapy program, indicating improved vaginal health.

Vaginal stenosis can be improved with a pelvic physiotherapy program, providing increased vaginal canal length and improved pelvic floor muscle function in post-gynecological cancer survivors. Pelvic physiotherapy has shown to be beneficial for physical changes in the vagina and perineal muscles, resulting in normalization of mucosa coloration and muscle tone.

This study developed and applied an individual and innovative pelvic physiotherapy program, which could be considered a comparative pilot study for future clinical trials on the differences between physiotherapeutic resources used in the treatment of vaginal stenosis.

Continence 12S (2024) 101365
DOI: 10.1016/j.cont.2024.101365