Rationale and Objectives
Most women with endometrial cancer (EC) have an excellent prognosis and may be cured.
However, treatment-related pelvic functional impacts may affect long-term quality
of life. To better understand these concerns, we explored correlations between patient-reported
outcomes and pelvic magnetic resonance imaging (MRI) features in women treated for
EC.
Materials and Methods
Women with histologic diagnosis of EC were consented preoperatively and completed
the validated Female Sexual Function Index (FSFI) and Pelvic Floor Dysfunction Index
(PFDI) questionnaires at preoperative, 6-week, and 6-month follow-up visits. Pelvic
MRIs with dynamic pelvic floor sequences were performed at 6 weeks and 6 months.
Results
A total of 33 women participated in this prospective pilot study. Only 53.7% had been
asked about sexual function by providers while 92.4% thought they should have been.
Sexual function became more important to women over time. Baseline FSFI was low, declined
at 6 weeks, and climbed above baseline at 6 months. Hyperintense vaginal wall signal
on T2-weighted images (10.9 vs. 4.8, p = .002) and intact Kegel function (9.8 vs.
4.8, p = .03) were associated with higher FSFI. PFDI scores trended toward improved
pelvic floor function over time. Pelvic adhesions on MRI were associated with better
pelvic floor function (23.0 vs. 54.9, p = .003). Urethral hypermobility (48.4 vs.
21.7, p = .01), cystocele (65.6 vs. 24.8, p < .0001), and rectocele (58.8 vs. 18.8,
p < .0001) predicted worse pelvic floor function.
Conclusion
Use of pelvic MRI to quantify anatomic and tissue changes may facilitate risk stratification
and response assessment for pelvic floor and sexual dysfunction. Patients articulated
the need for attention to these outcomes during EC treatment.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Academic RadiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Cancer facts and figures. American Cancer Society, Atlanta, GA2019
- NCCN clinical practice guidelines in oncology: uterine neoplasms. National Comprehensive Cancer Network (NCCN), 2019
- Gynecologic radiation oncology patients report unmet needs regarding sexual health communication with providers.J Cancer Res Clin Oncol. 2019; 145: 495-502
- Patient satisfaction with physician discussions of treatment impact on fertility, menopause and sexual health among pre-menopausal women with cancer.J Cancer. 2012; 3: 217-225
- Sexual morbidity in very long term survivors of vaginal and cervical cancer: a comparison to national norms.Gynecol Oncol. 2007; 106: 413-418
- Clitoral size and location in relation to sexual function using pelvic MRI.J Sex Med. 2014; 11: 1013-1022
- Female sexual function and the clitoral complex using pelvic MRI assessment.Eur J Obstet Gynecol Reprod Biol. 2014; 180: 180-185
- Association between penile dynamic contrast-enhanced MRI-derived quantitative parameters and self-reported sexual function in patients with newly diagnosed prostate cancer.J Sex Med. 2014; 11: 2581-2588
- Prevalence of symptomatic pelvic floor disorders among gynecologic oncology patients.Obstet Gynecol. 2013; 122: 976-980
- Urinary symptoms and impact on quality of life in women after treatment for endometrial cancer.Int Urogynecol J Pelvic Floor Dysfunct. 2009; 20: 159-163
- A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity.Med Care. 1996; 34: 220-233
- The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function.J Sex Marital Ther. 2000; 26: 191-208
- The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores.J Sex Marital Ther. 2005; 31: 1-20
- Short forms of two condition-specific quality-of-life questionnaires for women with pelvic floor disorders (PFDI-20 and PFIQ-7).Am J Obstet Gynecol. 2005; 193: 103-113
- MR imaging-based assessment of the female pelvic floor.Radiographics. 2014; 34: 1417-1439
- Sexual functioning among endometrial cancer patients treated with adjuvant high-dose-rate intra-vaginal radiation therapy.Int J Radiat Oncol Biol Phys. 2012; 84: e187-e193
- Quality of life and sexual functioning in endometrial cancer survivors.Gynecol Oncol. 2011; 121: 169-173
- Psychometric validation of the female sexual function index (FSFI) in cancer survivors.Cancer. 2012; 118: 4606-4618
- Clinical predictors of sexual function in gynecologic cancer survivors.in: Society of Gynecologic Oncology annual meeting. 2016 (San Diego, CA)
Article info
Publication history
Published online: April 24, 2023
Accepted:
March 22,
2023
Received in revised form:
March 16,
2023
Received:
December 11,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Published by Elsevier Inc. on behalf of The Association of University Radiologists
