Qualitative assessment of barriers and facilitators of vagina dilator use after pelvic radiotherapy in a tertiary cancer centre in Nigeria.

Abstract

e23262 Background: Pelvic radiotherapy (PRT) is an essential component of curative treatment for many gynaecological cancers. Still, it can also result in late side effects (SE) that impact long-term quality of life. SE include vaginal wall atrophy, bleeding, stenosis, and decreased vaginal length, which can lead to sexual dysfunction and difficulty with future pelvic exams. The late SEs are among the most distressing survivorship concerns for patients treated for gynaecological cancers. Vaginal dilator therapy (VDT) is commonly recommended following a course of PRT to prevent vaginal stenosis. However, many patients, especially older women, remain apprehensive about VDT, despite receiving counselling. The underlying reasons for non-use remain poorly understood. This study aimed to assess the barriers and facilitators to vaginal dilator use among women who receive PRT in Nigeria. Methods: Semi-structured telephone interviews were conducted with 16 women who had previously undergone PRT for gynaecological cancers at a tertiary cancer centre in Nigeria from 2024 to 2026. Interviews were analysed using inductive thematic analysis following Braun and Clarke’s methodology, followed by deductive mapping of identified factors onto the Consolidated Framework for Implementation Research (CFIR). Data collection and analysis were conducted concurrently until thematic saturation was reached. Results: Participants’ use of vaginal dilators was influenced by multiple factors across CFIR domains. At the individual level, perceptions of vaginal dilators as either medically necessary or sexually oriented influenced initiation and continued use. Pain/discomfort, bleeding, and vaginal discharge were commonly cited as reasons for discontinuation. Sociocultural and religious beliefs reportedly did not support the use of vaginal dilators but were overridden by perceived medical necessity. Family and spousal support facilitated adherence. Health system factors, including quality and timing-sensitive education, strongly influenced uptake, while inadequate follow-up limited sustained use. Conclusions: Barriers to vaginal dilator use after pelvic radiotherapy extend beyond individual patient factors and reflect broader sociocultural and health system influences. Implementation strategies that emphasise clear medical framing, patient-centred education delivered at appropriate time points, and follow-up may enhance sustained use.