ESTRO 2020 Abstract Book

S411 ESTRO 2020

central tumor should be treated with caution, and preferably in trials.

now 7 . Hypertonic pelvic floor muscles (PFM) can also contribute to the feeling of tightness and dyspareunia. Additionally, anxiety, stress, or pain often trigger an involuntary tension of the PFM. Exercises to contract and relax the PFM, perineal massage and breathing techniques are helpful to reduce the tension and can prevent secondarily induced vaginismus 2,8 . For patients with an already shortened vagina, sex positions that optimize the angle/depth of penetration, and allow for maximum movement control by the woman can be helpful 9 . Additionally, a “pain buffer” (soft silicone rings placed at the shaft of the penis) can adapt the length of the penis in cases of deep dyspareunia, and reduce anxiety to prevent a vicious circle of pain. The woman´s arousal and in particular orgasm before penetration (by masturbation or foreplay) can also reduce dyspareunia. The increased vaginal blood flow improves tissue oxygenation and might therefore enhance vaginal elasticity 10,11 . Additionally, relief of PFM tension and mental relaxation might both facilitate painless penetration. Loss of desire has multifactorial physical and psychological reasons and is often complex to diagnose and treat. Basic strategies include the provision of self-help educational material 12 and options for referral to specialists (nurses/psychologists with training in sexual health). Psychosocial education/counselling can be effective strategies for concerns regarding body image, intimacy/relationship, sexual functioning and satisfaction; and consideration should be given for including a women’s partner 1 . In a specialized sexual therapy setting, several evidence-based interventions have been proven to be effective, such as the sensate focus exercises (graded series of non-demand sensual touching exercises), experimenting with different sensations and stimuli within mindfulness-based approaches and cognitive-behavioral therapy (identifying and altering cognitions and behaviors that contribute to low sexual desire) 13 .

Teaching Lecture: Sexual rehabilitation and management of sexual problems after treatment for pelvic cancer

SP-0725 Sexual rehabilitation after treatment of gynecological cancer K. Kirchheiner 1 1 Medical University Vienna, Dept. of Radiation Oncology, Vienna, Austria Abstract text Pelvic radiotherapy for gynecological cancer is known to cause adverse physical and psychosocial changes that can lead to sexual functioning problems. According to the ASCO recommendations, it is vital to initiate the discussion about sexual health and dysfunction with the patient at the time of diagnosis, and continue to re-address it periodically throughout follow-up 1 . However, patients and providers are often reluctant to broach the topic, and therefore education and discussion is needed to bring sexual health into mainstream, and optimize quality of life outcomes. Commonly reported sexual problems encountered after treatment of gynecologic cancer are introduced, for which modern sexual rehabilitation strategies are described. Vaginal dryness/atrophy , due to the postmenopausal status after radiotherapy, lead to a lack of lubrication despite sexual arousal. During penile- vaginal intercourse, dry friction can cause micro-tears of the vaginal lining and result in dyspareunia. The application of local estrogen has shown to be highly effective for promotion of epithelial regeneration (provided not a hormone-sensitive tumor) 1 . Vaginal moisturizers support hydration of the vaginal tissue thereby reducing discomfort and pruritus. For all penetrative activities, the use of (water-based) lubricants with no irritating ingredients is recommended 2 . Vaginal adhesions are characterized as an early radiation-induced side effect, caused by the denudation of the vaginal epithelial mucosa. The strategy of regular vaginal dilation, initiated 4-6 weeks after completion of treatment, prevents adhesions by separating the vaginal walls. Providing medically approved dilators is regarded standard of care, not only to maintain sexual function, but also to improve ability to perform, and patient tolerance for, gynecological examinations 3 . As compliance rates with dilation are commonly reported to be low, individualized strategies are sometimes needed 3 . For patients with high reluctance, the overnight insertion of a tampon with vaginal moisturizer can be regarded as minimum requirement to separate the vaginal walls. For patients comfortable with using sexual devices, different vibrators (made of medical silicone) might be helpful to combine the mechanical aspect of dilation with more pleasurable sensations 4 . Modern products offer a variety of sizes, shapes and options for stimulation, for example both vaginal and clitoral 5 . Vaginal shortening/tightening , are the result of long-term fibrotic changes associated with hyalinization, disorganized elastosis, and collagen deposition in the extracellular matrix. These changes are a common cause of dyspareunia 3 . It is widely accepted that regular and long-term vaginal dilation (or penile-vaginal intercourse) will prevent or delay the development of vaginal stenosis 6 . However, the underlying mechanism of stretching the vaginal tissue and therefore promoting epithelial cell growth has not been fully elucidated by

SP-0726 Sexual rehabilitation and management of erectile dysfunction after treatment for male pelvic cancer L. Incrocci 1 1 Erasmus Medical Center Rotterdam, Department of Radiation Oncology, Rotterdam, The Netherlands