Vaginal development and sexual functioning in young women after stem cell transplantation, chemotherapy, and/or radiotherapy for childhood hematological diseases

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Abstract
To study vaginal development and sexual functioning in young women after childhood hemopoietic stem cell transplantation (HSCT) and radio/chemotherapy. Observational case–control study on 30 young sexually active women survived after HSCT and/or radio/chemotherapy for childhood malignancies or hematologic diseases and 48 controls matched for age. Female Sexual Function Index was lower (median 24.05, IQR = 17.30–28.30 vs. 29.00, IQR = 25.30–31.40, p = 0.001), Female Sexual Distress Scale higher (median 16.00, IQR = 8.00–23.00 vs. 2.00, IQR = 0.00–4.00, p < 0.001), vaginal length shorter (mean difference = 21.1 mm; 95% CI = 19.3–23, p < .001) and vaginal maturation index worst in cases than in controls. Subjects treated by irradiation before HSCT had lower FSFI (median 21.85, IQR = 9.60–31.10 vs. 24.90, IQR = 17.30–28.30) and shorter vaginal length (median 45.55, IQR = 42.60–45.80 vs. 50.10, IQR = 45.30–52.90) compared to those who had not received conditioning treatment (p-values = 0.004 and p = 0.05, respectively). Compared to untreated subjects, women receiving hormonal replacement therapy had higher overall FSFI (p = 0.02), lower FSDS (0.04), and better VMI. Gonadotoxic therapies have adverse effects on vaginal development, sexual functioning, and distress in young females. Hormonal replacement therapy should be shortly considered after main gonodatoxic treatments to improve vaginal and sex health.

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