Reduced symptoms of late radiation tissue injury of the vagina after treatment with hyperbaric oxygen therapy: A retrospective analysis of 19 patients

Introduction: Hyperbaric oxygen therapy (HBOT) is a well-established treatment for late radiation tissue injury (LRTI) of the pelvis, such as radiation-cystitis and -proctitis, but not for LRTI of the vagina. This study aims to describe the outcomes of patients with vaginal symptoms after HBOT. Methods: The records of all patients with LRTI of the vagina, referred for HBOT from a tertiary hospital, between 2010 and 2020 were retrospectively analyzed. Patients with a non-vaginal primary complaint, fistulas, or incomplete HBOT treatment (<20 sessions) were excluded. Outcomes included patient- and physician-reported symptoms (such as dyspareunia, dryness, bleeding, and anatomical changes) and quality-of-life questionnaires. Outcomes were assessed at baseline, after HBOT, 3 months after HBOT, and during yearly follow-up. Responders were defined as patients with ≥1 vaginal symptoms improving after treatment. Results: 19 Patients (median age 42) received an average of 40 sessions of HBOT (80 min of 100 % oxygen at 2.5 ATA). 15/19 patients (79 %) were responders at the end of treatment (median of 3 symptoms improving). The symptoms most responsive to HBOT were ulceration (89 %), dyspareunia (82 %), pain (71 %), and changes in anatomy like stenosis or fibrosis (80 %). Response was maintained during 3 month follow-up in 14/15 patients. No major adverse events of HBOT were reported. Conclusion: A majority of patients had a lasting improvement of vaginal complaints after HBOT in this study. Based on this study and the generic effects of HBOT in LRTI, HBOT should be considered as a treatment option for patients with ongoing complaints of the vagina due to LRTI.