Aesthetic Outcome and Psychosexual Distress After Treatment for Vulvar High-Grade Squamous Intraepithelial Lesions.
Journal
Journal of lower genital tract disease
ISSN: 1526-0976
Titre abrégé: J Low Genit Tract Dis
Pays: United States
ID NLM: 9704963
Informations de publication
Date de publication:
07 Nov 2023
07 Nov 2023
Historique:
medline:
7
11
2023
pubmed:
7
11
2023
entrez:
7
11
2023
Statut:
aheadofprint
Résumé
This study compared aesthetic outcome, psychosexual distress, and treatment satisfaction between women receiving surgical treatment or medical treatment with imiquimod for vulvar high-grade squamous intraepithelial lesion. This is an extended analysis of the multicenter, randomized noninferiority trial "topical imiquimod versus surgery for vulvar intraepithelial neoplasia." Patients were randomized to primary topical treatment or surgery and stratified by unifocal or multifocal disease. Digital photos of vulvar appearance were subsequently assessed for aesthetic outcome by 3 investigators blinded to group allocation. Psychosexual distress and treatment satisfaction were assessed with the Cervical Dysplasia Distress Questionnaire, the Sexual Activity Questionnaire, and the Client Satisfaction Questionnaire at baseline and follow-up. One hundred ten patients aged between 19 and 82 years were enrolled. Per-protocol analysis showed complete clinical response in 80% (37/46) using imiquimod, compared with 79% (41/52) after one surgical intervention. Photodocumentation at baseline and 6-month follow-up was available for 84 of these patients (44 imiquimod, 40 surgery). Blinded reviewer assessments of lesion size and lesion severity showed improvement from baseline to follow-up, with no differences between treatment groups. Sexual pleasure, discomfort, and distress remained stable from baseline to follow-up in both groups. Good aesthetic outcome of vulvar high-grade squamous intraepithelial lesion treatment can be achieved with imiquimod and surgery, consisting of ablation or local excision. Treatment satisfaction and stable psychosexual health may not be dependent on chosen treatment modality, but rather on counseling in accordance with patients' preferences.
Identifiants
pubmed: 37934148
doi: 10.1097/LGT.0000000000000785
pii: 00128360-990000000-00088
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023, ASCCP.
Déclaration de conflit d'intérêts
The authors have declared they have no conflicts of interest.
Références
Cendejas BR, Smith-McCune KK, Khan MJ. Does treatment for cervical and vulvar dysplasia impact women's sexual health? Am J Obstet Gynecol 2015;212:291–7.
Preti M, Joura E, Vieira-Baptista P, et al. The European Society of Gynaecological Oncology (ESGO), the International Society for the Study of Vulvovaginal Disease (ISSVD), the European College for the Study of Vulval Disease (ECSVD) and the European Federation for Colposcopy (EFC) Consensus Statements on Pre-invasive Vulvar Lesions. J Low Genit Tract Dis 2022;26:229–44.
Thuijs NB, van Beurden M, Bruggink AH, et al. Vulvar intraepithelial neoplasia: incidence and long-term risk of vulvar squamous cell carcinoma. Int J Cancer 2021;148:90–8.
Lebreton M, Carton I, Brousse S, et al. Vulvar intraepithelial neoplasia: classification, epidemiology, diagnosis, and management. J Gynecol Obstet Hum Reprod 2020;49:101801.
Shylasree TS, Karanjgaokar V, Tristram A, et al. Contribution of demographic, psychological and disease-related factors to quality of life in women with high-grade vulval intraepithelial neoplasia. Gynecol Oncol 2008;110:185–9.
Nagele E, Reich O, Greimel E, et al. Sexual activity, psychosexual distress, and fear of progression in women with human papillomavirus-related premalignant genital lesions. J Sex Med 2016;13:253–9.
Likes WM, Stegbauer C, Tillmanns T, et al. Correlates of sexual function following vulvar excision. Gynecol Oncol 2007;105:600–3.
Kobleder A, Nikolic N, Hechinger M, et al. Perceived health-related quality of life in women with vulvar neoplasia: a cross sectional study. Int J Gynecol Cancer 2016;26:1313–9.
Xavier J, Figueiredo R, Vieira-Baptista P. Vulvar high-grade squamous intraepithelial lesion and the risk of recurrence and progression to cancer. J Low Genit Tract Dis 2023;27:125–30.
Thuesen B, Andreasson B, Bock JE. Sexual function and somatopsychic reactions after local excision of vulvar intra-epithelial neoplasia. Acta Obstet Gynecol Scand 1992;71:126–8.
Trutnovsky G, Reich O, Joura EA, et al. Topical imiquimod versus surgery for vulvar intraepithelial neoplasia: a multicentre, randomised, phase 3, non-inferiority trial. Lancet 2022;399:1790–8.
Almadori A, Zenner N, Boyle D, et al. Development and validation of a clinical grading scale to assess the vulvar region: the Vulvar Architecture Severity Scale. Aesthet Surg J 2020;40:1319–26.
Narins RS, Brandt F, Leyden J, et al. A randomized, double-blind, multicenter comparison of the efficacy and tolerability of Restylane versus Zyplast for the correction of nasolabial folds. Dermatol Surg 2003;29:588–95.
Shinn E, Basen-Engquist K, Le T, et al. Distress after an abnormal Pap smear result: scale development and psychometric validation. Prev Med 2004;39:404–12.
Thirlaway K, Fallowfield L, Cuzick J. The Sexual Activity Questionnaire: a measure of women's sexual functioning. Qual Life Res 1996;5:81–90.
Schmidt J, Lamprecht F, Wittmann WW. Satisfaction with inpatient management. Development of a questionnaire and initial validity studies. Psychother Psychosom Med Psychol 1989;39:248–55.
Nagele E, Trutnovsky G, Greimel E, et al. Do different treatment strategies influence women's level of psychosexual distress? Observational cohort study of women with premalignant HPV-associated genital lesions. Eur J Obstet Gynecol Reprod Biol 2019;236:205–9.
Andersen BL, Turnquist D, LaPolla J, et al. Sexual functioning after treatment of in situ vulvar cancer: preliminary report. Obstet Gynecol 1988;71:15–9.
van Seters M, van Beurden M, ten Kate FJ, et al. Treatment of vulvar intraepithelial neoplasia with topical imiquimod. N Engl J Med 2008;358:1465–73.
van der Linden M, van Hees CL, van Beurden M, et al. The Paget Trial: topical 5% imiquimod cream for noninvasive vulvar Paget disease. Am J Obstet Gynecol 2022;227:250.e1–8.