Sexual adjustment of women undergoing pelvic exenteration with vaginal reconstruction

A total pelvic exenteration is an aggressive attempt to surgically cure the patient with cervical cancer. A total pelvic exenteration includes removal of the bladder, lower portion of the bowel, and the female reproductive organs (including the uterus, ovaries, fallopian tubes and vagina). The myocutaneous gracilis graft procedure is the preferred technique for neovaginal reconstruction. This study assesses the sexual adjustment of 40 women who have undergone pelvic exenteration at a 500-bed southwestern cancer center using a modified version of the Sexual Adjustment Questionnaire (SAQ) developed by Waterhouse and Metcalfe (1986), and a vaginal assessment form developed by the investigator. The Wilcoxon Signed Rank test was used to examine the difference in the mean ranks of the pre-exenteration and post-exenteration scores. The pre-exenteration score was 66.4 and the mean rank of post-exenteration score was 48.7, showing a significant difference at between the pre- and post-exenteration scores. This finding means that the sexual adjustment of women following pelvic exenteration is less than before surgery. The Spearman rho was performed to examine the influence of time on sexual adjustment. The Spearman rho coefficient was $r=-.03$ showing no relationship between length of time following exenteration and sexual adjustment. With the vaginal assessment form, the physicians reported 31 patients (70.4%) with functional vaginas. Based on data collected the following conclusions were derived: women who undergo pelvic exenteration with vaginal reconstruction experience a decrease in sexual adjustment, time following pelvic exenteration does not influence resumption of sexual activity, and 31 patients (70.4%) had anatomical functional vaginas capable of penetration.