Fertility
Female Genito-urinary Tract
The Uterus
Uterine development can be damaged by radiation therapy (RT).
The effect is especially severe if patients are young (pre-pubertal) at the time of therapy and are given high dose therapy.
RT causes:
- Decreased uterine growth with reduced:
- Uterine length
- Uterine blood flow
- Estrogen replacement therapy does not lead to any increase in endometrial thickness
- Scarring and reduced elasticity of the uterine wall
All these changes reduce the chances of successful completion of pregnancy with an increased risk of:
- Early pregnancy loss
- Premature labour
- Low birth weight babies
In a study looking at patients treated for Wilms tumor6, the conclusion was that fertility could be preserved in children with Wilms tumor after upper abdominal RT (10-20 Gy) that did not include the entire pelvis. In rare instances, fertility can be preserved after low-dose whole-abdominal RT (10.5 Gy). Childhood Wilms tumor survivors should be considered to be at a high risk for infertility and pregnancy-related complications during their reproductive years. Prompt obstetric evaluation was recommended for optimal prenatal, antenatal, and postnatal care.
The Vagina
Very high dose RT can cause:
- Abnormal vaginal development in a young child
- Fibrosis of the vagina
- Soft tissue necrosis of the vaginal wall
- Fistula formation (rectovaginal, vesicovaginal, urethrovaginal)
Scarring from the RT combined with early menopause can cause dyspareunia and a negative impact on sexual function secondary to painful intercourse and vaginal dryness
