Barriers to and facilitators of adherence to pelvic floor muscle exercises and vaginal dilator use among gynecologic cancer patients: a qualitative study

Abstract

Objective: Women with gynecologic cancer may suffer from pelvic floor dysfunction (PFD). Before radiotherapy, prehabilitation with pelvic floor muscle exercises (PFME) and vaginal dilator (VD) might prevent it and foster sexual life. This study aims to explore the experience of gynecologic cancer patients getting external beam radiation treatments regarding barriers to and facilitators of adherence to a prehabilitation program to prevent PFD.

Methods: This qualitative research with thematic content analysis included 11 women with gynecologic cancer and different levels of adherence to PFME and VD. Participants were interviewed based on a semi-structured script. The information was analyzed manually, assisted with Nvivo12® software, and triangulated with open coding.

Results: High self-motivation, desire to improve their health, symptoms of improvement, availability of time, the desire to resume sexual life, and the support of the partner were facilitators of adherence. The instructional exercise audio, clarity of the information, and closer communication with the physical therapist were also valued. The main barriers were general malaise secondary to oncological treatments, forgetfulness, lack of time, misinformation, lack of coordination with the treatment team, discomfort with the VD, and a feeling of shame. Feedback from the attending physician was a facilitator when present or a barrier when absent.

Conclusion: These barriers and facilitators should be considered when designing and implementing preventive programs with PFME and VD. Behavioral counselling should consider the desire to remain sexually active; in such cases, including the partner in the therapeutic process is appraised. Otherwise, the focus should be on benefits for maintenance of pelvic floor function.

Keywords: Gynecologic cancer; Health behavior; Pelvic floor muscle exercises; Qualitative research; Treatment adherence and compliance; Vaginal dilator.