Abstract
Pelvic radiation represents a major therapeutic strategy, either as adjuvant or primary treatment in the management of cancer in women. This mainly concerns women with gynaecological malignancies: endometrial, cervical, vaginal, and vulva cancer; intestinal malignancies: rectal and anal cancer, and bladder cancer. Further, long-term breast cancer survivors may experience similar adverse effects after ovarian ablation accomplished by pelvic radiation. Finally, women treated with radiation for childhood cancer, e.g. Hodgkin lymphoma are at risk for ovarian failure and premature menopause; adverse effects that not only influence their fertile lifespan but also may have a negative effect on their sexual life [1]. The fact that the number of long-term cancer survivors has increased during the past 2–3 decades makes demands to health care providers to professionally handle late effects after pelvic radiation.
Keywords
- Adjuvant radiotherapy
- Androgen-deficiency syndrome
- Atrophic vaginitis
- Baseline score
- Benzydamine
- Brachytherapy
- Clinical meaningful difference
- Dyspareunia
- Epithelial damage
- European Organisation of Research and Treatment of Cancer (EORTC) Quality of life core questionnaire C30
- EORTC quality of life questionnaire colo-rectal module (QLQ CR38)
- EORTC quality of life questionnaire cervix module (CX24)
- External beam radiation, Faeces incontinence
- Female sexual dysfunction
- Female Sexual Function Index (FSFI)
- Fibrosis
- Hormone replacement therapy
- Hyperbaric oxygen therapy
- Hypoactive sexual disorder
- Induced menopause
- Interstitial radiation
- Interstitial implant
- Intracavitary brachytherapy
- Irradiation vaginitis
- Late radiation effects
- Local oestrogen
- Lubrication problems
- Methyl-testosterone
- Normal tissue tolerance
- Orgasmic problems
- Pelvic radiation for anal cancer
- Bladder cancer
- Cervical cancer
- Endometrial cancer
- Rectal cancer
- Vulva cancer
- Perineal implant
- Premature ovarian failure
- Psychosexual effects
- Psychosexual adjustment
- Quality of life
- Radiation toxicity
- Radical radiotherapy
- Radiotherapy
- Radio-necrosis
- Re-epithelisation
- Response shift bias
- Sexual dissatisfaction
- Sexual dysfunction
- Sexual enjoyment
- Sexual functioning
- Sexual function vaginal changes questionnaire (SVQ)
- Sexual rehabilitation
- Vaginal dryness
- Vaginal atrophy
- Vaginal mucositis
- Vaginal dilator
- Vaginal narrowing
- Vaginal shortening
- Vaginal stenosis
- Vaginal vault necrosis
- Vaginal adhesions
- Vulvectomy
- Vulvo-vaginal mucositis
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Green DM, Kawashima T, Stovall M, Leisenring W, Sklar CA, Mertens AC, et al. Fertility of female survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol. 2009;27(16):2677–85.
Rodningen OK, Overgaard J, Alsner J, Hastie T, Borresen-Dale AL. Microarray analysis of the transcriptional response to single or multiple doses of ionizing radiation in human subcutaneous fibroblasts. Radiother Oncol. 2005;77(3):231–40.
Andreyev J. Gastrointestinal symptoms after pelvic radiotherapy: a new understanding to improve management of symptomatic patients. Lancet Oncol. 2007;8(11):1007–17.
Bye A, Trope C, Loge JH, Hjermstad M, Kaasa S. Health-related quality of life and occurrence of intestinal side effects after pelvic radiotherapy – evaluation of long-term effects of diagnosis and treatment. Acta Oncol. 2000;39(2):173–80.
Grigsby PW, Russell A, Bruner D, Eifel P, Koh WJ, Spanos W, et al. Late injury of cancer therapy on the female reproductive tract. Int J Radiat Oncol Biol Phys. 1995;31(5):1281–99.
Majewski W, Tarnawski R. Acute and late toxicity in radical radiotherapy for bladder cancer. Clin Oncol (R Coll Radiol). 2009;21(8):598–609.
Marks LB, Carroll PR, Dugan TC, Anscher MS. The response of the urinary bladder, urethra, and ureter to radiation and chemotherapy. Int J Radiat Oncol Biol Phys. 1995;31(5):1257–80.
Birgisson H, Pahlman L, Gunnarsson U, Glimelius B. Adverse effects of preoperative radiation therapy for rectal cancer: long-term follow-up of the Swedish Rectal Cancer Trial. J Clin Oncol. 2005;23(34):8697–705.
Birgisson H, Pahlman L, Gunnarsson U, Glimelius B. Late adverse effects of radiation therapy for rectal cancer - a systematic overview. Acta Oncol. 2007;46(4):504–16.
Klee M, Thranov I, Machin PD. The patients’ perspective on physical symptoms after radiotherapy for cervical cancer [see comments]. Gynecol Oncol. 2000;76(1):14–23.
Lundby L, Jensen VJ, Overgaard J, Laurberg S. Long-term colorectal function after postoperative radiotherapy for colorectal cancer. Lancet. 1997;350(9077):564.
Jephcott CR, Paltiel C, Hay J. Quality of life after non-surgical treatment of anal carcinoma: a case control study of long-term survivors. Clin Oncol (R Coll Radiol). 2004;16(8):530–5.
Parkin DE, Davis JA, Symonds RP. Long-term bladder symptomatology following radiotherapy for cervical carcinoma. Radiother Oncol. 1987;9(3):195–9.
Jensen P, Groenvold M, Klee M, Thranov I, Petersen M, Machin D. Longitudinal study of sexual function and vaginal changes after radiotherapy for cervical cancer. Int J Radiat Oncol Biol Phys. 2003;56(4):937–49.
Bergmark K, Avall-Lundqvist E, Dickman PW, Henningsohn L, Steineck G. Vaginal changes and sexuality in women with a history of cervical cancer. N Engl J Med. 1999;340(18):1383–9.
Cull A, Cowie VJ, Farquharson DI, Livingstone JR, Smart GE, Elton RA. Early stage cervical cancer: psychosocial and sexual outcomes of treatment. Br J Cancer. 1993;68(6):1216–20.
Schover LR, Fife M, Gershenson DM. Sexual dysfunction and treatment for early stage cervical cancer. Cancer. 1989;63(1):204–12.
Bergmark K, Avall-Lundqvist E, Dickman PW, Henningsohn L, Steineck G. Patient-rating of distressful symptoms after treatment for early cervical cancer. Acta Obstet Gynecol Scand. 2002;81(5):443–50.
Denton AS, Maher EJ. Interventions for the physical aspects of sexual dysfunction in women following pelvic radiotherapy. Cochrane Database Syst Rev. 2003;(1):CD003750.
Barton DP. The prevention and management of treatment related morbidity in vulval cancer. Best Pract Res Clin Obstet Gynaecol. 2003;17(4):683–701.
Rubin P, Casarett GW. The Female Genital Tract. In: Rubin P, Casarett GW, editors. Clinical Radiation Pathology. Philadelphia: W.B. Saunders; 1986. p. 396–422.
Larsen EC, Muller J, Schmiegelow K, Rechnitzer C, Andersen AN. Reduced ovarian function in long-term survivors of radiation- and chemotherapy-treated childhood cancer. J Clin Endocrinol Metab. 2003;88(11):5307–14.
Larsen EC, Schmiegelow K, Rechnitzer C, Loft A, Muller J, Andersen AN. Radiotherapy at a young age reduces uterine volume of childhood cancer survivors. Acta Obstet Gynecol Scand. 2004;83(1):96–102.
Sprangers MA, Schwartz CE. The challenge of response shift for quality-of-life-based clinical oncology research. Ann Oncol. 1999;10(7):747–9.
Allal AS, Sprangers MA, Laurencet F, Reymond MA, Kurtz JM. Assessment of long-term quality of life in patients with anal carcinomas treated by radiotherapy with or without chemotherapy. Br J Cancer. 1999;80(10):1588–94.
Hendren SK, O’Connor BI, Liu M, Asano T, Cohen Z, Swallow CJ, et al. Prevalence of male and female sexual dysfunction is high following surgery for rectal cancer. Ann Surg. 2005;242(2):212–23.
Marijnen CA, van de Velde CJ, Putter H, Van den BM, Maas CP, Martijn H, et al. Impact of short-term preoperative radiotherapy on health-related quality of life and sexual functioning in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol. 2005;23(9):1847–58.
Berek SJ, Andersen BL. Sexual rehabilitation: SURGICAL and Psychological Approaches. In: Hoskins WJ, Perez CA, Young RC, editors. Principles and Practice of Gynecologic Oncology. Philadelphia: Lippencott-Raven Publishers; 1997. p. 551–65.
Schultz WCMW, Van de Wiel HBM, Hahn DEE, Bouma J. Psychosexual functioning after treatment for gynecological cancer: an integrative model, review of determinant factors and clinical guidelines. Int J Gynecol Cancer. 1992;2:281–90.
White ID. The assessment and management of sexual difficulties after treatment of cervical and endometrial malignancies. Clin Oncol (R Coll Radiol). 2008;20(6):488–96.
Pieterse QD, Maas CP, ter Kuile MM, Lowik M, van Eijkeren MA, Trimbos JB, et al. An observational longitudinal study to evaluate miction, defecation, and sexual function after radical hysterectomy with pelvic lymphadenectomy for early-stage cervical cancer. Int J Gynecol Cancer. 2006;16(3):1119–29.
Jensen P, Groenvold M, Klee M, Thranov I, Petersen M, Machin D. Early-stage cervical carcinoma, radical hysterectomy and sexual function: a longitudinal study. Cancer. 2004;100:97–106.
Juraskova I, Butow P, Robertson R, Sharpe L, McLeod C, Hacker N. Post-treatment sexual adjustment following cervical and endometrial cancer: a qualitative insight. Psychooncology. 2003;12(267):279.
Stead ML, Fallowfield L, Brown JM, Selby P. Communication about sexual problems and sexual concerns in ovarian cancer: qualitative study. BMJ. 2001;323(7317):836–7.
Ekwall E, Ternestedt BM, Sorbe B. Important aspects of health care for women with gynecologic cancer. Oncol Nurs Forum. 2003;30(2):313–9.
Schmidt CE, Bestmann B, Kuchler T, Longo WE, Kremer B. Ten-year historic cohort of quality of life and sexuality in patients with rectal cancer. Dis Colon Rectum. 2005;48(3):483–92.
Basson R, Berman J, Burnett A, Derogatis L, Ferguson D, Fourcroy J, et al. Report of the international consensus development conference on female sexual dysfunction: definitions and classifications. J Urol. 2000;163(3):888–93.
Basson R, Leiblum S, Brotto L, Derogatis L, Fourcroy J, Fugl-Meyer K, et al. Definitions of women’s sexual dysfunction reconsidered: advocating expansion and revision. J Psychosom Obstet Gynaecol. 2003;24(4):221–9.
Abitbol MM, Davenport JH. The irradiated vagina. Obstet Gynecol. 1974;44:249–56.
Abitbol MM, Davenport JH. Sexual dysfunction after therapy for cervical carcinoma. Am J Obstet Gynecol. 1974;119(2):181–9.
Bertelsen K. Sexual dysfunction after treatment of cervical cancer. Dan Med Bull. 1983;30 Suppl 2:31–4.
Bruner DW, Lanciano R, Keegan M, Corn B, Martin E, Hanks GE. Vaginal stenosis and sexual function following intracavitary radiation for the treatment of cervical and endometrial carcinoma. Int J Radiat Oncol Biol Phys. 1993;27(4):825–30.
Flay LD, Matthews JH. The effects of radiotherapy and surgery on the sexual function of women treated for cervical cancer. Int J Radiat Oncol Biol Phys. 1995;31(2):399–404.
Frumovitz M, Sun CC, Schover LR, Munsell MF, Jhingran A, Wharton JT, et al. Quality of life and sexual functioning in cervical cancer survivors. J Clin Oncol. 2005;23(30):7428–36.
Krumm S, Lamberti J. Changes in sexual behavior following radiation therapy for cervical cancer. J Psychosom Obstet Gynaecol. 1993;14(1):51–63.
Thranov I, Klee M. Sexuality among gynecologic cancer patients – a cross-sectional study [see comments]. Gynecol Oncol. 1994;52(1):14–9.
Lange MM, Marijnen CA, Maas CP, Putter H, Rutten HJ, Stiggelbout AM, et al. Risk factors for sexual dysfunction after rectal cancer treatment. Eur J Cancer. 2009;45(9):1578–88.
Pietrzak L, Bujko K, Nowacki MP, Kepka L, Oledzki J, Rutkowski A, et al. Quality of life, anorectal and sexual functions after preoperative radiotherapy for rectal cancer: report of a randomised trial. Radiother Oncol. 2007;84(3):217–25.
Fokdal L, Hoyer M, Meldgaard P, von der Masse H. Long-term bladder, colorectal, and sexual functions after radical radiotherapy for urinary bladder cancer. Radiother Oncol. 2004;72(2):139–45.
Caffo O, Fellin G, Graffer U, Luciani L. Assessment of quality of life after cystectomy or conservative therapy for patients with infiltrating bladder carcinoma: a survey by a self-administered questionnaire. Cancer. 1996;78(5):1089–97.
Zietman AL, Sacco D, Skowronski U, Gomery P, Kaufman DS, Clark JA, et al. Organ conservation in invasive bladder cancer by transurethral resection, chemotherapy and radiation: results of a urodynamic and quality of life study on long-term survivors. J Urol. 2003;170(5):1772–6.
Schover LR, Jensen SB. Assesing Sexual Problems in Medical Patients. Sexuality and Chronic Illness: A Comprehensive Approach. New York: The Guilford Press; 1988. p. 106–49.
Derogatis LR, Melisaratos N. The brief symptom inventory: an introductory report. Psychol Med. 1983;13(3):595–605.
Jensen PT, Klee MC, Thranov I, Groenvold M. Validation of a questionnaire for self-assessment of sexual function and vaginal changes after gynaecological cancer. Psychooncology. 2004;13(8):577–92.
Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26(2):191–208.
Zabora J, BrintzenhofeSzoc K, Jacobsen P, Curbow B, Piantadosi S, Hooker C, et al. A new psychosocial screening instrument for use with cancer patients. Psychosomatics. 2001;42(3):241–6.
Greimel ER, Winter R, Kapp KS, Haas J. Quality of life and sexual functioning after cervical cancer treatment: a long-term follow-up study. Psychooncology. 2009;18(5):476–82.
Greimel ER, Kuljanic VK, Waldenstrom AC, Duric VM, Jensen PT, Singer S, et al. The European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life questionnaire cervical cancer module: EORTC QLQ-CX24. Cancer. 2006;107(8):1812–22.
Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Warlam-Rodenhuis CC, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet. 2000;355(9213):1404–11.
Bradley S, Rose S, Lutgendorf S, Costanzo E, Anderson B. Quality of life and mental health in cervical and endometrial cancer survivors. Gynecol Oncol. 2006;100(3):479–86.
Jensen PT, Roed H, Engelholm SA, Rosendal F. Pulsed dose rate (PDR) brachytherapy as salvage treatment of locally advanced or recurrent gynecologic cancer. Int J Radiat Oncol Biol Phys. 1998;42(5):1041–7.
Jereczek-Fossa BA, Jassem J, Badzio A. Relationship between acute and late normal tissue injury after postoperative radiotherapy in endometrial cancer. Int J Radiat Oncol Biol Phys. 2002;52(2):476–82.
Klee M, Machin D. Health-related quality of life of patients with endometrial cancer who are disease-free following external irradiation. Acta Oncol. 2001;40(7):816–24.
Lalos O, Lalos A. Urinary, climacteric and sexual symptoms one year after treatment of endometrial and cervical cancer. Eur J Gynaecol Oncol. 1996;17(2):128–36.
Nout RA, Putter H, Jurgenliemk-Schulz IM, Jobsen JJ, Lutgens LC, van der Steen-Banasik EM, et al. Quality of life after pelvic radiotherapy or vaginal brachytherapy for endometrial cancer: first results of the randomized PORTEC-2 trial. J Clin Oncol. 2009;27(21):3547–56.
Nunns D, Williamson K, Swaney L, Davy M. The morbidity of surgery and adjuvant radiotherapy in the management of endometrial carcinoma. Int J Gynecol Cancer. 2000;10(3):233–8.
van de Poll-Franse LV, Mols F, Essink-Bot ML, Haartsen JE, Vingerhoets AJ, Lybeert ML, et al. Impact of external beam adjuvant radiotherapy on health-related quality of life for long-term survivors of endometrial adenocarcinoma: a population-based study. Int J Radiat Oncol Biol Phys. 2007;69(1):125–32.
Andersen BL, Hacker NF. Psychosexual adjustment after vulvar surgery. Obstet Gynecol. 1983;62(4):457–62.
Corney RH, Crowther ME, Everett H, Howells A, Shepherd JH. Psychosexual dysfunction in women with gynaecological cancer following radical pelvic surgery. Br J Obstet Gynaecol. 1993;100(1):73–8.
Green MS, Naumann RW, Elliot M, Hall JB, Higgins RV, Grigsby JH. Sexual dysfunction following vulvectomy. Gynecol Oncol. 2000;77(1):73–7.
Janda M, Obermair A, Cella D, Crandon AJ, Trimmel M. Vulvar cancer patients’ quality of life: a qualitative assessment. Int J Gynecol Cancer. 2004;14(5):875–81.
Oonk MH, van Os MA, de Bock GH, de Hullu JA, Ansink AC, van der Zee AG. A comparison of quality of life between vulvar cancer patients after sentinel lymph node procedure only and inguinofemoral lymphadenectomy. Gynecol Oncol. 2009;113(3):301–5.
Weijmar Schultz WC, Wijma K, Van de Wiel HBM, Bouma J, Janssens J. Sexual rehabilitation of radical vulvectomy patients. A pilot study. J Psychosom Obstet Gynaecol. 1986;5:119–26.
Weijmar Schultz WC, van de Wiel HB, Bouma J, Janssens J, Littlewood J. Psychosexual functioning after the treatment of cancer of the vulva. A longitudinal study. Cancer. 1990;66(2):402–7.
Fons G, Groenen SM, Oonk MH, Ansink AC, van der Zee AG, Burger MP, et al. Adjuvant radiotherapy in patients with vulvar cancer and one intra capsular lymph node metastasis is not beneficial. Gynecol Oncol. 2009;114(2):343–5.
Wong RK, Tandan V, De Silva S, Figueredo A. Pre-operative radiotherapy and curative surgery for the management of localized rectal carcinoma. Cochrane Database Syst Rev. 2007;(2):CD002102.
Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med. 2001;345(9):638–46.
da Silva GM, Hull T, Roberts PL, Ruiz DE, Wexner SD, Weiss EG, et al. The effect of colorectal surgery in female sexual function, body image, self-esteem and general health: a prospective study. Ann Surg. 2008;248(2):266–72.
ter Kuile MM, Brauer M, Laan E. The Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS): psychometric properties within a Dutch population. J Sex Marital Ther. 2006;32(4):289–304.
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365–76.
EORTC Quality of Life Group, EORTC Quality of Life Unit, editor. The EORTC QLQ-C30 manuals, reference values and bibliography. Brussels: EORTC Data Center; 2002.
Osoba D, Rodrigues G, Myles J, Zee B, Pater J. Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol. 1998;16(1):139–44.
Sprangers MA, te Velde A, Aaronson NK. The construction and testing of the EORTC colorectal cancer-specific quality of life questionnaire module (QLQ-CR38). European Organization for Research and Treatment of Cancer Study Group on Quality of Life. Eur J Cancer. 1999;35(2):238–47.
Whistance RN, Conroy T, Chie W, Costantini A, Sezer O, Koller M, et al. Clinical and psychometric validation of the EORTC QLQ-CR29 questionnaire module to assess health-related quality of life in patients with colorectal cancer. Eur J Cancer. 2009. doi:10.1016/j.ejca.2009.08.014.
Ryan DP, Compton CC, Mayer RJ. Carcinoma of the anal canal. N Engl J Med. 2000;342(11):792–800.
Young SC, Solomon MJ, Hruby G, Frizelle FA. Review of 120 anal cancer patients. Colorectal Dis. 2009;11(9):909–14.
Bartelink H, Roelofsen F, Eschwege F, Rougier P, Bosset JF, Gonzalez DG, et al. Concomitant radiotherapy and chemotherapy is superior to radiotherapy alone in the treatment of locally advanced anal cancer: results of a phase III randomized trial of the European Organization for Research and Treatment of Cancer Radiotherapy and Gastrointestinal Cooperative Groups. J Clin Oncol. 1997;15(5):2040–9.
John M, Flam M, Palma N. Ten-year results of chemoradiation for anal cancer: focus on late morbidity. Int J Radiat Oncol Biol Phys. 1996;34(1):65–9.
Tournier-Rangeard L, Mercier M, Peiffert D, Gerard JP, Romestaing P, Lemanski C, et al. Radiochemotherapy of locally advanced anal canal carcinoma: prospective assessment of early impact on the quality of life (randomized trial ACCORD 03). Radiother Oncol. 2008;87(3):391–7.
Oehler-Jänne C, Seifert B, Lutolf UM, Studer G, Glanzmann C, Ciernik IF. Clinical outcome after treatment with a brachytherapy boost versus external beam boost for anal carcinoma. Brachytherapy. 2007;6(3):218–26.
Roed H, Engelholm SA, Svendsen LB, Rosendal F, Olsen KJ. Pulsed dose rate (PDR) brachytherapy of anal carcinoma. Radiother Oncol. 1996;41(2):131–4.
Merseburger AS, Matuschek I, Kuczyk MA. Bladder preserving strategies for muscle-invasive bladder cancer. Curr Opin Urol. 2008;18(5):513–8.
Kaufman DS, Shipley WU, Feldman AS. Bladder cancer. Lancet. 2009;374(9685):239–49.
Henningsohn L, Wijkstrom H, Steven K, Pedersen J, Ahlstrand C, Aus G, et al. Relative importance of sources of symptom-induced distress in urinary bladder cancer survivors. Eur Urol. 2003;43(6):651–62.
Henningsohn L, Wijkstrom H, Dickman PW, Bergmark K, Steineck G. Distressful symptoms after radical radiotherapy for urinary bladder cancer. Radiother Oncol. 2002;62(2):215–25.
Braunstein GD, Sundwall DA, Katz M, Shifren JL, Buster JE, Simon JA, et al. Safety and efficacy of a testosterone patch for the treatment of hypoactive sexual desire disorder in surgically menopausal women: a randomized, placebo-controlled trial. Arch Intern Med. 2005;165(14):1582–9.
El Hage G, Eden JA, Manga RZ. A double-blind, randomized, placebo-controlled trial of the effect of testosterone cream on the sexual motivation of menopausal hysterectomized women with hypoactive sexual desire disorder. Climacteric. 2007;10(4):335–43.
Flöter A, Nathorst-Boos J, Carlström K, von Schultz B. Androgen status and sexual life in perimenopausal women. Menopause. 1997;4(2):95–100.
Lobo RA, Rosen RC, Yang HM, Block B, van der Hoop RG. Comparative effects of oral esterified estrogens with and without methyltestosterone on endocrine profiles and dimensions of sexual function in postmenopausal women with hypoactive sexual desire. Fertil Steril. 2003;79(6):1341–52.
Shifren JL, Braunstein GD, Simon JA, Casson PR, Buster JE, Redmond GP, et al. Transdermal testosterone treatment in women with impaired sexual function after oophorectomy. N Engl J Med. 2000;343:682–8.
Kokcu A, Cetinkaya MB, Yanik F, Alper T, Malatyalioglu E. The comparison of effects of tibolone and conjugated estrogen-medroxyprogesterone acetate therapy on sexual performance in postmenopausal women. Maturitas. 2000;36(1):75–80.
Laan E, van Lunsen RH, Everaerd W. The effects of tibolone on vaginal blood flow, sexual desire and arousability in postmenopausal women. Climacteric. 2001;4(1):28–41.
Nathorst-Boos J, Wiklund I, Mattsson L, Sandin K, von Schoultz B. Is sexual life influenced by transdermal estrogen therapy? Acta Obstet Gynecol Scand. 1993;72:656–60.
Nathorst-Boos J, Hammar M. Effect on sexual life – a comparison between tibolone and a continuous estradiol-norethisterone acetate regimen. Maturitas. 1997;26(1):15–20.
Ploch E. Hormonal replacement therapy in patients after cervical cancer treatment. Gynecol Oncol. 1987;26(2):169–77.
Suckling J, Lethaby A, Kennedy R. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2003;(4):CD001500.
Pitkin RM, VanVoorhis LW. Postirradiation vaginitis: an evaluation of prophylaxis with topical estrogen. Radiology. 1971;99(2):417–21.
Pitkin RM, JT Bradbury. The effect of topical estrogen on irradiated vaginal epithelium. Am J Obstet Gynecol. 1965;92:175–82.
Hintz BL, Kagan AR, Gilbert HA, Rao AR, Chan P, Nussbaum H. Systemic absorption of conjugated estrogenic cream by the irradiated vagina. Gynecol Oncol. 1981;12(1):75–82.
Bentivoglio G, Diani F. Use of topical benzydamine in gynecology. Clin Exp Obstet Gynecol. 1981;8(3):103–10.
Volterrani F, Tana S, Trenti N. Topical benzydamine in the treatment of vaginal radiomucositis. Int J Tissue React. 1987;9(2):169–71.
Kanaev SV, Baranov SB. The use of Tantum Rosa in the prevention and treatment of radiation-induced vaginitis and proctitis. Vopr Onkol. 1998;44(6):722–3.
Roberts WS, Hoffman MS, LaPolla JP, Ruas E, Fiorica JV, Cavanagh D. Management of radionecrosis of the vulva and distal vagina. Am J Obstet Gynecol. 1991;164(5 Pt 1):1235–8.
Williams Jr JA, Clarke D, Dennis WA, Dennis III EJ, Smith ST. The treatment of pelvic soft tissue radiation necrosis with hyperbaric oxygen. Am J Obstet Gynecol. 1992;167(2):412–5.
Feldmeier JJ, Heimbach RD, Davolt DA, Court WS, Stegmann BJ, Sheffield PJ. Hyperbaric oxygen an adjunctive treatment for delayed radiation injuries of the abdomen and pelvis. Undersea Hyperb Med. 1996;23(4):205–13.
Decruze SB, Guthrie D, Magnani R. Prevention of vaginal stenosis in patients following vaginal brachytherapy. Clin Oncol (R Coll Radiol). 1999;11(1):46–8.
Robinson JW, Faris PD, Scott CB. Psychoeducational group increases vaginal dilation for younger women and reduces sexual fears for women of all ages with gynecological carcinoma treated with radiotherapy [see comments]. Int J Radiat Oncol Biol Phys. 1999;44(3):497–506.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Jensen, P.T. (2011). Pelvic Radiation in Women. In: Mulhall, J., Incrocci, L., Goldstein, I., Rosen, R. (eds) Cancer and Sexual Health. Current Clinical Urology. Humana Press. https://doi.org/10.1007/978-1-60761-916-1_32
Download citation
DOI: https://doi.org/10.1007/978-1-60761-916-1_32
Published:
Publisher Name: Humana Press
Print ISBN: 978-1-60761-915-4
Online ISBN: 978-1-60761-916-1
eBook Packages: MedicineMedicine (R0)