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


Women posttreatment for cervical cancer report a wide variety of vaginal symptoms. Although mean symptom severity was moderate to mild overall, one-third of women reported severe vaginal symptoms including vagina feels narrow or tight, decrease in sexual desire, vaginal feels shorter or smaller, feel less feminine and/or desirable, intercourse less often, loss of vaginal lubrication, less enjoyment of intercourse, vaginal dryness, painful intercourse, loss of vaginal lubrication with intercourse, and inability to achieve orgasm. The most bothersome symptom was moderate in severity. However, results suggest that there is a great deal of individual variability in symptom identity. Women's other representations indicated that they perceived vaginal symptoms as mildly distressing, not long-lasting, having a neutral effect on their lives, and being associated with an indeterminate degree of perceived control.

Quality-of-life scores were higher than comparative data for social well-being but lower for all other dimensions (physical well-being, emotional well-being, and functional well-being) and for total scores. Although women's symptom representations reflected a neutral effect on their lives, their quality of life was below normative data to a degree consistent with a minimally important difference for physical well-being, emotional well-being, functional well-being, and total scores.[29] Thus, this sample had poorer quality of life than the comparison sample data.

In addition, results indicated that symptom representations were related to quality of life. The emotional and consequence representations for the most bothersome symptom were strongly correlated with scores for all dimensions and total quality of life. Similarly, emotional and consequence representations for the second and third most bothersome symptoms were strongly correlated with quality of life. All correlations were negative, suggesting that higher emotional distress and greater perceived consequences on women's lives were related to lower quality of life. In addition, for the third most bothersome symptom, the timeline representation of acceptance that a symptom would be long-lasting was related to higher physical well-being. It is interesting to note that emotional and consequences representations were significantly related to quality of life but identity (severity) representations were not. This suggests that interventions aimed at altering emotional and consequences representations may have a greater impact on quality of life than those aimed at identity representations.

Study limitations included the following. The sample size was small, which could have skewed the results. Because this was a master's thesis study, the timeline for study recruitment was limited. In addition, the available population was relatively small. This was a cross-sectional study, which did not allow for study of these variables over time.

Implications for Practice and Research

Women who are diagnosed with cervical cancer undergo a treatment process that can leave a variety of symptoms to manage and have consequences for quality of life. It is important for clinicians to educate women about using self-care strategies before and after treatment, including prescribed use of a vaginal dilator, douches, and vaginal lubrication. In this study, we did not measure for self-care treatment strategies, which would have allowed correlation with differences in symptom representation, symptom severity, and compliance of self-care strategies. However, it is likely that women with the most severe symptoms may have had the lowest use of self-care strategies. Clinicians can also assess women's understanding (representations), in particular, the emotional and consequence representations because they were negatively related to quality of life. Clinicians need to ask direct questions regarding vaginal symptoms because patients may not always initiate conversations related to this sensitive topic.

Future research should include repeating this study with a larger sample size and expanding this study to include other nonvaginal physical or emotional symptoms that women experience after treatment, including pain. It would also be beneficial to assess what coping mechanisms or self-treatment strategies women are using to cope with vaginal symptoms. An intervention to alter emotional and consequence representations seems to be a promising strategy for improving quality of life.


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