Sexual rehabilitation after radiotherapy for gynaecological cancer

Suvaal, I. (2026)

Doctoral Thesis

This dissertation focuses on improving sexual functioning and quality of life for women treated with radiotherapy for gynaecological cancers. Radiotherapy, especially when combined with brachytherapy, can lead to vaginal changes such as stenosis, often resulting in sexual problems such as dyspareunia, and decreased sexual desire, arousal, and satisfaction. These problems are frequently accompanied by sexual distress and are influenced by a complex interaction of physical, psychological, and relational factors. Vaginal dilators are recommended to prevent stenosis, but compliance has been shown low.
This dissertation evaluates vaginal and sexual outcomes after radiotherapy and investigates the effectiveness and cost-effectiveness of a nurse-led sexual rehabilitation programme. Findings show that severe vaginal morbidity after intensive radio(chemo)therapy and brachytherapy is uncommon and most changes are mild. However, almost half of sexually active women still report vaginal or sexual problems and sexual distress, and clinical vaginal changes are only weakly associated with patient-reported outcomes, highlighting the biopsychosocial nature of sexual functioning.
The randomized multicentre SPARC-trial showed that sexual functioning initially declined after treatment but improved over 12 months in both the intervention and standard care groups, with no significant differences between them. The intervention was not more cost-effective than standard care, however with low costs in both groups. During the SPARC-trial, sexual rehabilitation after radiotherapy improved substantially, likely contributing to comparable outcomes between study groups. Best practice involves a sexual rehabilitation appointment one month after radiotherapy, including patient education and dilator guidance delivered by a trained nurse, with continued attention during follow-up in the first year after treatment.
Overall, the dissertation supports a shift towards personalised, biopsychosocial approaches to sexual rehabilitation for women treated with radiotherapy for gynaecological cancers. The nurse-led intervention demonstrated feasibility and clinical value, reinforcing its role as a key component of standard care.

• Sexual functioning
• Sexual distress
• Radiotherapy
• Brachytherapy
• Vaginal morbidity
• Dilator use
• Randomized Trial

• All authors: Suvaal, I.
• Supervisor: Creutzberg, C.L.; Kuile, M.M. ter
• Committee: Bleiker, E.M.A.; Lankveld, J.J.D.M. van; Poll-Franse, L.V. van de; Doorn, H.C. van; Kroon, C.D. de
• Qualification: Doctor (dr.)
• Awarding Institution: Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2026-03-05
• ISBN (print): 9789465371023
• DOI: doi:10.60602/1887-4295103
• Sponsorship: The SPARC study was supported by a grant from the Dutch Cancer Society - Alpe d’HuZes Fund (grant 10674). The EMBRACE vaginal morbidity substudy was supported through unrestricted grants and study sponsorship by Elekta AB and Varian Medical Systems.