Sexual adjustment of patients undergoing Gracilis myocutaneous flap vaginal reconstruction in conjunction with pelvic exenteration

• Published in: Cancer 1996-11, Vol.78 (10), p.2229-2235
• Main Authors: Ratliff, Catherine R., Gershenson, David M., Morris, Mitchell, Burke, Thomas W., Levenback, Charles, Schover, Leslie R., Mitchell, Michele F., Atkinson, E. Neely, Wharton, J. Taylor
• Format: Article
• Language: English
• Subjects: Adaptation, Psychological; Adult; Aged; Biological and medical sciences; cervical carcinoma; Female; gracilis myocutaneous vaginal reconstruction; Humans; Medical sciences; Middle Aged; Pelvic Exenteration - rehabilitation; Postoperative Complications; Prospective Studies; sexual adjustment; Sexual Behavior - psychology; sexuality; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the genital tract and mammary gland; Surgical Flaps; Vagina - surgery
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/(SICI)1097-0142(19961115)78:10<2229::AID-CNCR27>3.0.CO;2-#

BACKGROUND Although the technique for gracilis myocutaneous vaginal reconstruction was first described in the mid‐1970s and has been used in conjunction with pelvic exenteration since that time, there is little available information regarding sexual adjustment after such a procedure. The purpose of this study was to assess the sexual adjustment of women who underwent pelvic exenteration and gracilis myocutaneous vaginal reconstruction at the study institution. METHODS In a prospective study design, 95 patients were identified who underwent pelvic exenteration and gracilis myocutaneous vaginal reconstruction at the study institution from 1977 through 1989 and a convenience sample was selected of 44 patients who completed a modified version of the Sexual Adjustment Questionnaire (SAQ) when they returned to the gynecologic oncology outpatient clinic for routine follow‐up care. A vaginal assessment was also performed by the attending physician. RESULTS Twenty‐one of 40 patients (52.5%) completing the questionnaire reported not resuming sexual activity after surgery; 19 patients reported resuming sexual activity between 1.5 months to 12 years postoperatively. Of the patients who resumed sexual activity, 84% did so within 1 year of surgery. The most common problems noted by patients in adjusting to sexual activity after surgery were self‐consciousness about the urostomy or colostomy and being seen in the nude by their partner, vaginal dryness, and vaginal discharge. The mean rank of preexenteration SAQ scores was 66.4, and the mean rank of postexenteration scores was 48.7 (P < 0.0001), demonstrating that sexual adjustment after exenteration was significantly poorer than before the surgery. On the basis of data gathered from a vaginal assessment form, 31 of 44 patients (70.4%) were judged to have a potentially functional neovagina. CONCLUSIONS Based on the findings of this questionnaire study, sexual adjustment is often significantly impaired in women after pelvic exenteration and gracilis myocutaneous vaginal reconstruction. Future modifications in surgical technique, more realistic patient counseling, and aggressive postoperative support will hopefully minimize such problems. Cancer 1996;78:2229‐35.