(088) Surgical Reconstruction After Radiation Damage to the Vagina

Abstract Introduction Radiation as treatment for colorectal and gynecological cancers is life-saving and life-extending. Unfortunately, the damage incurred to the vaginal mucosa is reticent to most medical treatments. Vaginal estrogens and vaginal dilation can help to moisten and stretch, but often are not enough to help a woman regain sexual penetrative function without dyspareunia. Many women are able to find satisfying intimacy without vaginal penetration, but others indicate the desire to have penetrative intercourse without pain to improve their quality of life. Objective To follow the outcomes of surgical reconstruction after vaginal radiation on sexual function. Methods This study details a case series of 10 women who underwent vaginal reconstruction with autologous tissue grafts, tissue substitutes and sometimes a combination of both. They were followed over time for sexual function after surgery. Patients were given the FSFI at baseline and at six months post-operatively. Results Three patients had cervical cancer, one had vaginal invasive neoplasia, four had colorectal cancer, one had bone cancer, and one had endometrial cancer. Two had vesico-vaginal fistulas and two had recto-vaginal fistulas, which were repaired simultaneously. Seven of the ten women underwent pudendal thigh flap reconstructions, one had a peritoneum augmented vaginoplasty, two had surgery using tissue substitute (myriad and/or keracis). All patients were instructed to dilate with silicone based graduated dilators beginning at one week post-op. The patients who had tissue substitutes required re-operation within on year as they chose to undergo a larger reconstructive surgery. Most of the women were not yet sexually active at six months due to relationship changes, cancer recurrence, or lack of partner. One was sexually active for two years until she had a recurrence of her malignancy followed by venous thromboembolism and multiple complications and eventually death three years after the surgery. The patients with pudendal thigh flaps were able to dilate easier and with less pain. FSFI scores were incomplete. Conclusions Most women did best with a pudendal thigh flap for vaginal reconstruction as this vascular flap helps to maintain vaginal length, width and is amenable to dilation. The FSFI tool falls short for this population as they may not be frequently sexually active and their experience of pleasure and/or discomfort is complex due to the bio-psycho-social changes of cancer and cancer treatment. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Astellas, Johnson & Johnson Global Public Health.