Representations of Vaginal Symptoms in Cervical Cancer Survivors

Jennifer M. Tornatta MSN, RN; Janet S. Carpenter PhD, RN; Jeanne Schilder, MD; Higinia R. Cardenes, MD, PhD


Cancer Nurs. 2009;32(5):378-384. 

In This Article


Sample Description

The sample consisted of 26 women posttreatment for cervical cancer whose mean (SD) age was 52.4 (11.1) years and had a mean (SD) of 11.7 (2.0) years of education. Most were white (77%), partnered or married (47%), and sexually active (39%). The average length of their current relationship was 22 years (SD, 15.9 years). Most were diagnosed with stage I or II disease (72%) and were postmenopausal at diagnosis (60%). Women had received both chemotherapy and radiation (84%), chemotherapy only (12%), or surgery only (4%). The mean (SD) time since complete remission was 15.2 (10.8) months.

Symptom Representations

Table 1 shows severity ratings (means and SDs) for all symptoms and the percentage of participants rating each symptom as severe (ie, rating between 7 and 10 on the 10-point scale). On average, women perceived vaginal symptoms as mild to moderate; however, approximately one-third of ratings of 11 different symptoms were severe. The 4 symptoms rated as most severe included vagina feels narrow or tight, decrease in sexual desire, vagina feels short or smaller, and feel less feminine and/or desirable. In addition, 6 women named an "other" symptom; 5 reported bone, back, or vaginal pain and 1 reported facial hair growth. Mean (SD) severity for these other symptoms was 9.33 (1.63), with 83% rating the painful symptoms as severe.

Table 2 shows the frequency of symptoms rated as first, second, and third most bothersome. The top 3 most bothersome symptoms included painful intercourse (23%), decrease in sexual desire (15%), and vaginal dryness (12%).

Women were nearly evenly divided on beliefs about whether the treatment (52%) or the cancer (48%) caused their most bothersome symptom. A similar pattern was seen for the second most bothersome symptom-50% endorsed treatment as the cause, 46% endorsed cancer as the cause. For the third most bothersome symptom, 69% believed that treatment and 33% reported that cancer was the cause.

Table 3 shows descriptive statistics for symptom representations. Scores on the representation subscales indicate that women's most noticed symptoms were perceived as moderately severe, emotionally distressing, likely to last a long time, having negative consequences on their lives, and uncontrollable.

Quality of Life

Table 4 shows descriptive statistics for quality of life. Overall, the quality of life for cervical cancer survivors was below comparison data, with the exception of social well-being. This difference between our sample and the comparison data can be considered clinically significant.

Relationships between Representations and Quality of Life

Table 5 shows the relationships between symptom representations and FACT-G quality of life. The emotional and consequence representations for symptom 1 were significantly related to each quality-of-life dimension and total scores. This pattern was similar for symptoms 2 and 3.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.