Overcoming Pain after a Gynecologic Cancer: An Innovative Treatment that Changes Everything!

Dyspareunia, a pain felt during sexual intercourse, affects close to 70% of gynecologic cancer survivors. A major breakthrough developed at Université de Sherbrooke Cancer Research Institute (IRCUS) may offer a long-term solution to women who have been suffering from this condition for years. This innovative approach relies on a multimodal pelvic floor physiotherapy treatment of the pelvic floor, whose efficacy has been validated through several studies conducted by an interdisciplinary team.

A large-scale potential impact

Every year, over 8,000 Canadian women survive an endometrial or cervical gynecologic cancer. If the Sherbrooke treatment was better known and available, it could transform the life of thousands of women living with dyspareunia, even years after the end of their cancer treatments.

An innovative treatment based on multimodal physiotherapy

Unlike standard strengthening pelvic floor exercises, often called Kegel exercises, this treatment relies on an approach combining several modalities: education, manual therapy, biofeedback, home exercises, and the use of dilatators. The patients participating in the clinical study, conducted in Sherbrooke and Montreal, underwent twelve weekly 60-minute sessions of physiotherapy. The results are particularly encouraging as 90% of participants found a significant improvement regarding the pain intensity, sexual function and quality of life.

This pioneering treatment was developed by combining the unique expertise in perineal and pelvic physiotherapy of Mélanie Morin, Professor and Researcher at IRCUS and at the School of Rehabilitation of the Faculty of Medicine and Health Sciences (FMSS), with the expertise in gynecologic oncology of Dr. Paul Bessette and Dr. Korine Lapointe-Millot, both gynecologic oncologists at CIUSSS de l'Estrie-CHUS and Professors and Researchers at IRCUS. The team also included Marie-Pierre Cyr, an exceptional PhD student, whose dynamism was a key driver for these discoveries.

Understanding the root of the problem to better treat it

The research conducted by Pr. Morin's team has also allowed the identification of characteristics that are specific to the pelvic floor muscles of survivors of gynecologic cancer suffering from dyspareunia. Compared to women with no pelvic pain, these patients have muscles that are stiffer, less flexible and less coordinated. These observations confirm the need for the development of targeted treatments, such as multimodal physiotherapy, to relieve their symptoms efficiently.

Benefits that go beyond physical relief

The impact of the treatment is not limited to a decreased pain. A study published by the team showed that multimodal physiotherapy also contributes to improve sexual distress, pain-related anxiety, depressive symptoms and concerns relating to body image. Even more impressive, the benefits from this treatment are maintained one year after the sessions have ended, confirming its long-term efficacy.

A promising treatment, but still not easily accessible

Despite the positive results, and the patients' satisfaction, access to this treatment remains a challenge. Multimodal physiotherapy is not covered by the government. Patients must look to the private sector to benefit from it. However few physiotherapists are currently trained in this specific approach.

Dr. Paul Bessette and Dr. Korine Lapointe-Milot emphasize the importance to make these care more accessible.

Chemotherapy and radiation therapy offered to treat cancer are reimbursed by the government, but not the multimodal physiotherapy that treats their side effects and improves the quality of life after the disease.

Another challenge is that not all physiotherapists are aware of this technique or trained to use it.

A distress too often ignored

A qualitative study conducted by the team brought to light the hurdles that prevent survivors from seeking care. Resignation, lack of information and the feeling of not being taken care of, are among the main reasons of their prolonged suffering. Dyspareunia has a deep effect on the survivors' quality of life; it impacts their self-esteem, their intimacy, and their psychological well-being.

According to Guylaine Gélinas-Martel, who supports these patients, a multidisciplinary follow-up including sex therapy and psychological support is critical. The fear of a recurrence, or pain, may hinder the use of the recommended treatments, highlighting the need for appropriate support

IRCUS mission

By sharing these results, IRCUS hopes to raise the awareness of health care professionals and decision makers on the importance of integrating these treatments in the survivors' healthcare pathway. The aim is clear: reduce the cancer burden well beyond the disease itself and make a lasting improvement on the quality of life of the women who overcame it.

This project was carried out thanks to the collaboration of Chantale Dumoulin (Institut Universitaire de Gériatrie de Montréal), Annick Pina and Marie-Hélène Mayrand (University of Montreal Hospital Research Centre (CRCHUM), as well as Walter Henry Gotlieb (Jewish General Hospital).

This research was made possible thanks to the financial support from the Réseau québécois de recherche sur le vieillissement funded by the Fonds de recherche du Québec (FRQ).

Seven scientific articles support the integration of this treatment in the follow-up care of gynecologic cancer survivors.

- Gynecologic Oncology (link to the article)
- Physical Therapy & Rehabilitation Journal (link to the article)
- The Journal of Sexual Medicine (link to the article)
- PLoS One (link to the article)
- Physiotherapy (link to the article)
- International Urology Journal (link to the article)
- The Journal of Sexual Medicine (link to the article)

About Mélanie Morin
- Professor at the School of Rehabilitation of the FMSS
- Professor and Researcher at the Université de Sherbrooke Cancer Research Institute (IRCUS)
- Researcher at the CHUS Research Centre (CRCHUS)

A research that grows 10x!
It is not by chance that the Université de Sherbrooke stands out in research. Its secret? The judicious marriage of partnership, mutualization and interdisciplinarity: three strengths that now drive its recognition. Learn more on what propelled UdeS among the most prolific research universities in Canada.