By Elizabeth Akincilar, MSPT, Cofounder, PHRC Merrimack
Receiving a gynecological cancer diagnosis is wrought with emotions: fear, grief, confusion, anger, among others. Additionally, the number of medical providers that one will encounter throughout the treatment process is many. One of the important members of your interdisciplinary cancer care team is a pelvic floor physical therapist.
The five gynecological cancers are cervical, uterine, ovarian, vaginal, and vulvar, with uterine cancer being the most common and vaginal cancer being the least common. Gynecological cancers can affect the function of pelvic organs, surrounding tissue, muscles, and nerves during or after treatment. These changes can cause pain, discomfort, urinary and sexual dysfunction.
Fortunately, a simple procedure, the pap smear, has significantly reduced the incidence of cervical cancer in communities where pap smears are performed routinely. Identifying certain genetic conditions, such as Lynch Syndrome, has enabled the medical community to make recommendations to dramatically reduce the chances of developing a gynecological cancer. Yet, many people are still diagnosed with gynecological cancer, and many more are surviving due to advances in treatment. Unfortunately, surviving a gynecological cancer does not necessarily mean that one does not suffer after the treatment has concluded. Many survivors of gynecological cancers will suffer with pelvic pain, urinary incontinence and sexual dysfunction that can dramatically reduce their quality of life.
How does treatment for gynecological cancer lead to pelvic pain and dysfunction?
Treatment for gynecological cancer can include surgical intervention, radiation therapy and/or chemotherapy. Surgical interventions can inadvertently compromise muscles, tissue and nerves within the pelvis leading to pain and/or urinary, bowel and/or sexual dysfunction. Radiation therapy can damage the soft tissue within the pelvis leading to a shortening of the vagina, known as stenosis, which often causes pain with intercourse. Some types of chemotherapy can induce menopause, causing vaginal dryness and vulvar sensitivity which can cause pain with intercourse.
What are some common concerns related to gynecological cancers?
Treatment for gynecological cancers can cause a variety of local and systemic unwanted side effects. Some common concerns include urinary incontinence, pelvic pain and pain with sexual activity.
The most common urinary symptom post gynecological cancer treatment is urinary incontinence; however, people can also suffer with urinary retention, pain with urination (dysuria), urinary urgency and urinary frequency.
A study revealed that 34% of women treated for the three most common gynecological cancers (ovarian, uterine and cervical) report urinary incontinence.
Urinary incontinence ranges from 9-48% post surgical treatment for gynecological cancer and up to 55% in those who underwent radical hysterectomy. For those who underwent radiation therapy alone, 5-24% of those suffered with urinary incontinence. In those that underwent both a surgical intervention and radiation therapy, 29% suffered with urinary incontinence.
Pelvic pain is another fairly common symptom after treatment for gynecological cancer. Pelvic pain could include abdominal, vaginal, vulvar and/or urethral pain. However, most commonly, survivors of gynecological cancer report pain with sexual intercourse.
38% of those with cervical cancer will experience pelvic pain. More than half of gynecological cancer survivors suffer with dyspareunia, or pain with sexual intercourse.
Research has shown that radiation therapy has detrimental effects on both the pelvic floor muscles’ structure and function. Radiation therapy can cause a shortening or stenosis of the vagina which can lead to pain with intercourse, or dyspareunia.
A 2016 study concluded that pelvic floor disorders are prevalent among persons with suspected gynecological cancers and should be identified prior to treatment to provide more comprehensive rehabilitation post-operatively.
Pelvic Floor Physical Therapy and Sexual Dysfunction
Survivors of gynecological cancers can suffer with various types of sexual dysfunction, including pain with intercourse, loss of libido, and loss of sexual desire. They are also at risk for depressive symptoms and body image concerns which may affect how they perceive themselves. Both the pain and the psychological factors can contribute to sexual distress.
Pelvic floor physical therapy targets the consequences of oncological treatments by addressing the pelvic floor muscles and surrounding tissue with manual therapy while providing education, exercise prescription, helpful tools, and guidance to return to pain-free sexual activity.
Manual therapy aims to improve the mobility of the muscles and tissues in the pelvic floor to facilitate vaginal intercourse without pain. It is imperative for the person to be active in their recovery and feel empowered to help themselves after a period where many feel powerless. Pelvic floor physical therapists teach their patients how to utilize tools at home to facilitate their progress. Tools, such as dilators, can be helpful with the guidance of a pelvic floor physical therapist to help folks return to pain-free intercourse. Learn about the Milli, the expandable dilator on our blog. Aids, such as the Ohnut, can limit deep penetration during sexual intercourse to make intercourse better tolerated. Additionally, using the right lubrication can ease the discomfort of intercourse due to vaginal dryness. All personal lubricants are not created equal! Some lubricants can actually cause more vaginal dryness, the exact opposite of what they propose to do! This PHRC blog post is a must read to learn which lubrication is best. There are many different dilators, lubricants and other products that can assist a person in returning to pain-free, enjoyable intercourse. Check out this list for additional helpful products.
A 2022 study showed that multimodal pelvic floor physical therapy yielded both short term and long term benefits for those suffering with pain during intercourse, sexual functioning and urinary incontinence following gynecological cancer treatment.
Pelvic Floor Physical Therapy and Urinary Incontinence
Urinary incontinence is fairly common following gynecological cancer treatment. Fortunately, we have a plethora of research supporting the benefits of skilled pelvic floor physical therapy to improve urinary incontinence. Pelvic floor physical therapists utilize manual therapy techniques, manual or mechanical biofeedback, exercise prescription and behavior modification to successfully treat stress, urge and passive urinary incontinence. Urinary incontinence is typically due to motor dysfunction of the pelvic floor musculature. These muscles can be compromised with surgical interventions, radiation and chemotherapy. This can result in weak or uncoordinated muscles. Pelvic floor physical therapists utilize various techniques to retrain these muscles to improve strength, endurance and coordination, ultimately eliminating incontinence. Additionally, a pelvic floor physical therapist prescribes a home exercise program to facilitate rehabilitation, fostering independence and confidence in one’s body again. For a more comprehensive explanation on how pelvic floor physical therapy can successfully eliminate urinary incontinence, check out this post.
Surviving cancer is always the goal when undergoing treatment. Survival does not mean one has to endure the unwanted side effects of treatment, such as pelvic pain, urinary incontience and sexual dysfunction. Pelvic floor physical therapy treatment can help to resolve these symptoms and help survivors regain the quality of life they deserve.
Are you unable to come see us in person in the Bay Area, Southern California or New England? We offer virtual physical therapy appointments too!
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.
Melissa Patrick is a certified yoga instructor and meditation teacher and is also available virtually to help, for more information please visit our therapeutic yoga page.
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