{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T18:47:03Z","timestamp":1788202023911,"version":"build-2803163510"},"reference-count":83,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2022,1,25]],"date-time":"2022-01-25T00:00:00Z","timestamp":1643068800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100013228","name":"R\u00e9seau qu\u00e9b\u00e9cois de recherche sur le vieillissement","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100013228","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000156","name":"Fonds de Recherche du Qu\u00e9bec - Sant\u00e9","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000156","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Canadian Research Chair Tier II on Urogynecological Health and Aging"},{"name":"Canadian Foundation for Innovation"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>A large proportion of gynecological cancer survivors suffer from pain during sexual intercourse, also known as dyspareunia. Following a multimodal pelvic floor physical therapy (PFPT) treatment, a reduction in pain and improvement in psychosexual outcomes were found in the short term, but no study thus far has examined whether these changes are sustained over time.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Purpose<\/jats:title>\n<jats:p>To examine the improvements in pain, sexual functioning, sexual distress, body image concerns, pain anxiety, pain catastrophizing, painful intercourse self-efficacy, depressive symptoms and pelvic floor disorder symptoms in gynecological cancer survivors with dyspareunia after PFPT, and to explore women\u2019s perceptions of treatment effects at one-year follow-up.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This mixed-method study included 31 gynecological cancer survivors affected by dyspareunia. The women completed a 12-week PFPT treatment comprising education, manual therapy and pelvic floor muscle exercises. Quantitative data were collected using validated questionnaires at baseline, post-treatment and one-year follow-up. As for qualitative data, semi-structured interviews were conducted at one-year follow-up to better understand women\u2019s perception and experience of treatment effects.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Significant improvements were found from baseline to one-year follow-up on all quantitative outcomes (<jats:italic>P<\/jats:italic> \u2264 0.028). Moreover, no changes were found from post-treatment to one-year follow-up, supporting that the improvements were sustained at follow-up. Qualitative data highlighted that reduction in pain, improvement in sexual functioning and reduction in urinary symptoms were the most meaningful effects perceived by participants. Women expressed that these effects resulted from positive biological, psychological and social changes attributable to multimodal PFPT. Adherence was also perceived to influence treatment outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Findings suggest that the short-term improvements following multimodal PFPT are sustained and meaningful for gynecological cancer survivors with dyspareunia one year after treatment.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0262844","type":"journal-article","created":{"date-parts":[[2022,1,25]],"date-time":"2022-01-25T18:30:28Z","timestamp":1643135428000},"page":"e0262844","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":34,"title":["Improvements following multimodal pelvic floor physical therapy in gynecological cancer survivors suffering from pain during sexual intercourse: Results from a one-year follow-up mixed-method study"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4458-9016","authenticated-orcid":true,"given":"Marie-Pierre","family":"Cyr","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalie","family":"Dostie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal","family":"Camden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4594-5775","authenticated-orcid":true,"given":"Chantale","family":"Dumoulin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Bessette","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annick","family":"Pina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6227-6369","authenticated-orcid":true,"given":"Walter Henry","family":"Gotlieb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Korine","family":"Lapointe-Milot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-H\u00e9l\u00e8ne","family":"Mayrand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e9lanie","family":"Morin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,1,25]]},"reference":[{"key":"pone.0262844.ref001","volume-title":"SEER Cancer Statistics Review, 1975\u20132017","author":"N Howlader","year":"2020"},{"key":"pone.0262844.ref002","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1158\/1055-9965.EPI-16-0858","article-title":"Global cancer in women: burden and trends","volume":"26","author":"LA Torre","year":"2017","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"pone.0262844.ref003","doi-asserted-by":"crossref","first-page":"514 e1","DOI":"10.1016\/j.ajog.2010.08.004","article-title":"Pelvic floor disorders and sexual function in gynecologic cancer survivors: a cohort study","volume":"203","author":"TL Rutledge","year":"2010","journal-title":"Am J Obstet Gynecol"},{"key":"pone.0262844.ref004","doi-asserted-by":"crossref","first-page":"772","DOI":"10.3109\/0284186X.2014.1001036","article-title":"Reduced vaginal elasticity, reduced lubrication, and deep and superficial dyspareunia in irradiated gynecological cancer survivors","volume":"54","author":"K Stinesen Kollberg","year":"2015","journal-title":"Acta Oncol"},{"key":"pone.0262844.ref005","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1097\/AOG.0000000000001621","article-title":"Sexual health in women affected by cancer: focus on sexual pain","volume":"128","author":"D Coady","year":"2016","journal-title":"Obstet Gynecol"},{"key":"pone.0262844.ref006","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1007\/s11930-015-0053-y","article-title":"Female sexual pain disorders: a review of the literature on etiology and treatment","volume":"7","author":"S Bergeron","year":"2015","journal-title":"Curr Sex Health Rep"},{"key":"pone.0262844.ref007","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1126\/science.847460","article-title":"The need for a new medical model: a challenge for biomedicine","volume":"196","author":"GL Engel","year":"1977","journal-title":"Science"},{"key":"pone.0262844.ref008","first-page":"101","article-title":"Characterizing pelvic floor muscle function and morphometry in survivors of gynecological cancer who have dyspareunia: a comparative cross-sectional study","author":"MP Cyr","year":"2021","journal-title":"Phys Ther"},{"key":"pone.0262844.ref009","doi-asserted-by":"crossref","first-page":"251","DOI":"10.2217\/WHE.13.19","article-title":"A psychological view of sexual pain among women: applying the fear-avoidance model","volume":"9","author":"J Thomt\u00e9n","year":"2013","journal-title":"Women\u2019s health (London, England)"},{"key":"pone.0262844.ref010","doi-asserted-by":"crossref","first-page":"2274","DOI":"10.1111\/jsm.12252","article-title":"Do romantic partners\u2019 responses to entry dyspareunia affect women\u2019s experience of pain? The roles of catastrophizing and self-efficacy","volume":"10","author":"AJ Lemieux","year":"2013","journal-title":"J Sex Med"},{"key":"pone.0262844.ref011","doi-asserted-by":"crossref","first-page":"2425","DOI":"10.2147\/JPR.S126259","article-title":"Vulvodynia: a consideration of clinical and methodological research challenges and recommended solutions","volume":"10","author":"S Corsini-Munt","year":"2017","journal-title":"J Pain Res"},{"key":"pone.0262844.ref012","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1002\/pon.639","article-title":"Post-treatment sexual adjustment following cervical and endometrial cancer: a qualitative insight","volume":"12","author":"I Juraskova","year":"2003","journal-title":"Psychooncology"},{"key":"pone.0262844.ref013","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.ejon.2010.05.008","article-title":"Understanding sexuality in women with gynaecological cancer","volume":"15","author":"V Cleary","year":"2011","journal-title":"Eur J Oncol Nurs"},{"key":"pone.0262844.ref014","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.ejon.2013.10.007","article-title":"Understanding the impact of the treatment pathway upon the health-related quality of life of women with newly diagnosed endometrial cancer\u2014a qualitative study","volume":"18","author":"H Bowes","year":"2014","journal-title":"Eur J Oncol Nurs"},{"key":"pone.0262844.ref015","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.ejon.2009.09.004","article-title":"Quality of life and sexual functioning in gynecological cancer patients: results from quantitative and qualitative data","volume":"14","author":"N Reis","year":"2010","journal-title":"Eur J Oncol Nurs"},{"key":"pone.0262844.ref016","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1111\/j.1471-6712.2010.00778.x","article-title":"Life beyond cancer: women\u2019s experiences 5 years after treatment for gynaecological cancer","volume":"24","author":"RJ Sekse","year":"2010","journal-title":"Scand J Caring Sci"},{"key":"pone.0262844.ref017","doi-asserted-by":"crossref","first-page":"1679","DOI":"10.1007\/s00520-015-2925-0","article-title":"Cervical cancer survivors\u2019 and partners\u2019 experiences with sexual dysfunction and psychosexual support","volume":"24","author":"WM Vermeer","year":"2016","journal-title":"Support Care Cancer"},{"key":"pone.0262844.ref018","doi-asserted-by":"crossref","first-page":"1470","DOI":"10.1002\/pon.4317","article-title":"Sexual distress and associated factors among cervical cancer survivors: a cross-sectional multicenter observational study","volume":"26","author":"RM Bakker","year":"2017","journal-title":"Psychooncology"},{"key":"pone.0262844.ref019","first-page":"169","article-title":"Emotional and sexual concerns in women undergoing pelvic surgery and associated treatment for gynecologic cancer","volume":"4","author":"C Stabile","year":"2015","journal-title":"Transl Androl Urol"},{"key":"pone.0262844.ref020","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1016\/j.ygyno.2011.11.030","article-title":"A systematic review of sexual concerns reported by gynecological cancer survivors","volume":"124","author":"K Abbott-Anderson","year":"2012","journal-title":"Gynecol Oncol"},{"key":"pone.0262844.ref021","first-page":"112","article-title":"Consequences of gynecological cancer in patients and their partners from the sexual and psychological perspective","volume":"15","author":"D Izycki","year":"2016","journal-title":"Prz Menopauzalny"},{"key":"pone.0262844.ref022","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1200\/JCO.2017.75.8995","article-title":"Interventions to address sexual problems in people with cancer: American Society of Clinical Oncology Clinical Practice Guideline Adaptation of Cancer Care Ontario Guideline","volume":"36","author":"J Carter","year":"2018","journal-title":"J Clin Oncol"},{"key":"pone.0262844.ref023","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/j.ygyno.2015.11.010","article-title":"Maintaining sexual health throughout gynecologic cancer survivorship: a comprehensive review and clinical guide","volume":"140","author":"LB Huffman","year":"2016","journal-title":"Gynecol Oncol"},{"key":"pone.0262844.ref024","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.ajog.2019.08.043","article-title":"Management of genitourinary syndrome of menopause in female cancer patients: a focus on vaginal hormonal therapy","volume":"222","author":"KK Crean-Tate","year":"2020","journal-title":"Am J Obstet Gynecol"},{"key":"pone.0262844.ref025","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.sxmr.2017.02.003","article-title":"Systematic review of the effectiveness of physical therapy modalities in women with provoked vestibulodynia","volume":"5","author":"M Morin","year":"2017","journal-title":"Sex Med Rev"},{"key":"pone.0262844.ref026","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1080\/09593985.2016.1194651","article-title":"Clinical biopsychosocial physiotherapy assessment of patients with chronic pain: the first step in pain neuroscience education","volume":"32","author":"AJ Wijma","year":"2016","journal-title":"Physiother Theory Pract"},{"key":"pone.0262844.ref027","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1016\/j.ygyno.2020.09.001","article-title":"Feasibility, acceptability and effects of multimodal pelvic floor physical therapy for gynecological cancer survivors suffering from painful sexual intercourse: a multicenter prospective interventional study","volume":"159","author":"MP Cyr","year":"2020","journal-title":"Gynecol Oncol"},{"key":"pone.0262844.ref028","article-title":"Changes in pelvic floor morphometry and muscle function after multimodal physiotherapy for gynaecological cancer survivors suffering from dyspareunia: a prospective interventional study","author":"MP Cyr","year":"2021","journal-title":"Physiotherapy"},{"key":"pone.0262844.ref029","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1016\/j.jsxm.2021.02.014","article-title":"A prospective single-arm study evaluating the effects of a multimodal physical therapy intervention on psychosexual outcomes in women with dyspareunia after gynecologic cancer","volume":"18","author":"MP Cyr","year":"2021","journal-title":"J Sex Med"},{"key":"pone.0262844.ref030","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1177\/1740774506073105","article-title":"Cost-effectiveness as an outcome in randomized clinical trials","volume":"3","author":"MA Hlatky","year":"2006","journal-title":"Clinical trials (London, England)"},{"key":"pone.0262844.ref031","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1186\/s12913-018-3450-x","article-title":"Systematic review of economic evaluations of interventions for high risk young people","volume":"18","author":"K Edmunds","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"pone.0262844.ref032","first-page":"e186019-e","article-title":"Assessment of long-term follow-up of randomized trial participants by linkage to routinely collected data: a scoping review and analysis","volume":"1","author":"T Fitzpatrick","year":"2018","journal-title":"JAMA"},{"key":"pone.0262844.ref033","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1093\/ptj\/pzx006","article-title":"Is pelvic-floor muscle training a physical therapy or a behavioral therapy? A call to name and report the physical, cognitive, and behavioral elements","volume":"97","author":"HC Frawley","year":"2017","journal-title":"Phys Ther"},{"key":"pone.0262844.ref034","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.3389\/fpsyg.2016.01380","article-title":"How to measure the intervention process? An assessment of qualitative and quantitative approaches to data collection in the process evaluation of organizational interventions","volume":"7","author":"JS Abildgaard","year":"2016","journal-title":"Front Psychol"},{"key":"pone.0262844.ref035","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1177\/1356389013484203","article-title":"Using qualitative comparative analysis to understand complex policy problems","volume":"19","author":"T Blackman","year":"2013","journal-title":"Evaluation"},{"key":"pone.0262844.ref036","first-page":"48","article-title":"Treatment of women in the United States with localized, provoked vulvodynia: practice survey of women\u2019s health physical therapists","volume":"52","author":"D Hartmann","year":"2007","journal-title":"J Reprod Med"},{"key":"pone.0262844.ref037","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.jpain.2007.09.005","article-title":"Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations","volume":"9","author":"RH Dworkin","year":"2008","journal-title":"J Pain"},{"key":"pone.0262844.ref038","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/0304-3959(75)90044-5","article-title":"The McGill Pain Questionnaire: major properties and scoring methods","volume":"1","author":"R. Melzack","year":"1975","journal-title":"Pain"},{"key":"pone.0262844.ref039","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/00926230590475206","article-title":"The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores","volume":"31","author":"M Wiegel","year":"2005","journal-title":"J Sex Marital Ther"},{"key":"pone.0262844.ref040","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1080\/00926230701267852","article-title":"The female sexual function index: a methodological critique and suggestions for improvement","volume":"33","author":"HF Meyer-Bahlburg","year":"2007","journal-title":"J Sex Marital Ther"},{"key":"pone.0262844.ref041","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.jsxm.2018.02.020","article-title":"A systematic review of sexual distress measures","volume":"15","author":"P Santos-Iglesias","year":"2018","journal-title":"J Sex Med"},{"key":"pone.0262844.ref042","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1111\/j.1743-6109.2007.00672.x","article-title":"Validation of the female sexual distress scale-revised for assessing distress in women with hypoactive sexual desire disorder","volume":"5","author":"L Derogatis","year":"2008","journal-title":"J Sex Med"},{"key":"pone.0262844.ref043","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/S0959-8049(00)00353-1","article-title":"A body image scale for use with cancer patients","volume":"37","author":"P Hopwood","year":"2001","journal-title":"Eur J Cancer"},{"key":"pone.0262844.ref044","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1155\/2002\/517163","article-title":"A short version of the Pain Anxiety Symptoms Scale (PASS-20): preliminary development and validity","volume":"7","author":"LM McCracken","year":"2002","journal-title":"Pain Res Manag"},{"key":"pone.0262844.ref045","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1037\/1040-3590.7.4.524","article-title":"The Pain Catastrophizing Scale: development and validation","volume":"7","author":"MJL Sullivan","year":"1995","journal-title":"Psychol Assess"},{"key":"pone.0262844.ref046","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1097\/AJP.0b013e31819976e3","article-title":"Fear avoidance and self-efficacy in relation to pain and sexual impairment in women with provoked vestibulodynia","volume":"25","author":"G Desrochers","year":"2009","journal-title":"Clin J Pain"},{"key":"pone.0262844.ref047","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1002\/nau.20041","article-title":"ICIQ: a brief and robust measure for evaluating the symptoms and impact of urinary incontinence","volume":"23","author":"K Avery","year":"2004","journal-title":"Neurourol Urodyn"},{"key":"pone.0262844.ref048","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1111\/j.1471-0528.2006.00938.x","article-title":"Development and psychometric evaluation of the ICIQ Vaginal Symptoms Questionnaire: the ICIQ-VS","volume":"113","author":"N Price","year":"2006","journal-title":"BJOG"},{"key":"pone.0262844.ref049","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/S0304-3959(01)00349-9","article-title":"Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale","volume":"94","author":"JT Farrar","year":"2001","journal-title":"Pain"},{"key":"pone.0262844.ref050","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1002\/nau.23432","article-title":"Factors influencing long-term adherence to pelvic floor exercises in women with urinary incontinence","volume":"37","author":"M Venegas","year":"2018","journal-title":"Neurourol Urodyn"},{"key":"pone.0262844.ref051","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1111\/2041-210X.13434","article-title":"Robustness of linear mixed-effects models to violations of distributional assumptions","volume":"11","author":"H Schielzeth","year":"2020","journal-title":"Methods Ecol Evol"},{"key":"pone.0262844.ref052","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s12874-016-0144-0","article-title":"Single time point comparisons in longitudinal randomized controlled trials: power and bias in the presence of missing data","volume":"16","author":"EL Ashbeck","year":"2016","journal-title":"BMC Med Serv Res"},{"key":"pone.0262844.ref053","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-319-19425-7","volume-title":"Regression modeling strategies: with applications to linear models, logistic and ordinal regression, and survival analysis","author":"FJ Harrell","year":"2015","edition":"2"},{"key":"pone.0262844.ref054","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"V Braun","year":"2006","journal-title":"Qualitative research in psychology"},{"key":"pone.0262844.ref055","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1093\/ptj\/pzaa081","article-title":"The effect of pelvic floor muscle interventions on pelvic floor dysfunction after gynecological cancer treatment: a systematic review","volume":"100","author":"R Brennen","year":"2020","journal-title":"Phys Ther"},{"key":"pone.0262844.ref056","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/j.ygyno.2012.03.045","article-title":"Effect of a pelvic floor muscle training program on gynecologic cancer survivors with pelvic floor dysfunction: a randomized controlled trial","volume":"125","author":"EJ Yang","year":"2012","journal-title":"Gynecol Oncol"},{"key":"pone.0262844.ref057","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.ygyno.2013.10.024","article-title":"A pilot randomized control trial to evaluate pelvic floor muscle training for urinary incontinence among gynecologic cancer survivors","volume":"132","author":"TL Rutledge","year":"2014","journal-title":"Gynecol Oncol"},{"key":"pone.0262844.ref058","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1002\/cncr.30976","article-title":"Improvement in sexual function after ovarian cancer: effects of sexual therapy and rehabilitation after treatment for ovarian cancer","volume":"124","author":"SL Bober","year":"2018","journal-title":"Cancer"},{"key":"pone.0262844.ref059","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.prro.2019.07.001","article-title":"Literature review of vaginal stenosis and dilator use in radiation oncology","volume":"9","author":"S Damast","year":"2019","journal-title":"Pract Radiat Oncol"},{"key":"pone.0262844.ref060","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1007\/s00520-016-3453-2","article-title":"A nurse-led sexual rehabilitation intervention after radiotherapy for gynecological cancer","volume":"25","author":"RM Bakker","year":"2017","journal-title":"Support Care Cancer"},{"key":"pone.0262844.ref061","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.ygyno.2020.05.025","article-title":"A single-arm clinical trial investigating the effectiveness of a non-hormonal, hyaluronic acid-based vaginal moisturizer in endometrial cancer survivors","volume":"158","author":"J Carter","year":"2020","journal-title":"Gynecol Oncol"},{"key":"pone.0262844.ref062","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1007\/s11764-016-0585-9","article-title":"Vaginal and sexual health treatment strategies within a female sexual medicine program for cancer patients and survivors","volume":"11","author":"J Carter","year":"2017","journal-title":"J Cancer Surviv"},{"key":"pone.0262844.ref063","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.ejon.2015.09.009","article-title":"A home-based, nurse-led health program for postoperative patients with early-stage cervical cancer: a randomized controlled trial","volume":"21","author":"J Li","year":"2016","journal-title":"Eur J Oncol Nurs"},{"key":"pone.0262844.ref064","first-page":"819","volume":"28","author":"G Zhu","year":"2016","journal-title":"Effect of postoperative intervention on the quality of life of patients with cervical cancer"},{"key":"pone.0262844.ref065","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/j.ijrobp.2010.10.071","article-title":"Determination of prognostic factors for vaginal mucosal toxicity associated with intravaginal high-dose rate brachytherapy in patients with endometrial cancer","volume":"82","author":"AY Bahng","year":"2012","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"pone.0262844.ref066","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1016\/j.ijrobp.2012.01.064","article-title":"Severe late toxicities following concomitant chemoradiotherapy compared to radiotherapy alone in cervical cancer: an inter-era analysis","volume":"84","author":"V Gondi","year":"2012","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"pone.0262844.ref067","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.pain.2004.09.010","article-title":"The association between pain and disability","volume":"112","author":"JA Turner","year":"2004","journal-title":"Pain"},{"key":"pone.0262844.ref068","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.pain.2010.02.018","article-title":"Research design considerations for confirmatory chronic pain clinical trials: IMMPACT recommendations","volume":"149","author":"RH Dworkin","year":"2010","journal-title":"Pain"},{"key":"pone.0262844.ref069","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.jsxm.2015.12.003","article-title":"Effectiveness of cognitive-behavioral therapy and physical therapy for provoked vestibulodynia: a randomized pilot study","volume":"13","author":"C Goldfinger","year":"2016","journal-title":"J Sex Med"},{"key":"pone.0262844.ref070","doi-asserted-by":"crossref","first-page":"189.e1","DOI":"10.1016\/j.ajog.2020.08.038","article-title":"Multimodal physical therapy versus topical lidocaine for provoked vestibulodynia: a multicenter, randomized trial","volume":"224","author":"M Morin","year":"2021","journal-title":"Am J Obstet Gynecol"},{"key":"pone.0262844.ref071","first-page":"Cd005654","article-title":"Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women","volume":"10","author":"C Dumoulin","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0262844.ref072","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1111\/j.1743-6109.2009.01642.x","article-title":"Pelvic floor muscle assessment outcomes in women with and without provoked vestibulodynia and the impact of a physical therapy program","volume":"7","author":"E Gentilcore-Saulnier","year":"2010","journal-title":"J Sex Med"},{"key":"pone.0262844.ref073","doi-asserted-by":"crossref","first-page":"571","DOI":"10.2217\/WHE.14.51","article-title":"Fear avoidance and pain catastrophizing among women with sexual pain","volume":"10","author":"J Thomt\u00e9n","year":"2014","journal-title":"Women\u2019s health (London, England)"},{"key":"pone.0262844.ref074","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1080\/13697137.2020.1724942","article-title":"Pelvic floor muscle training: mechanisms of action for the improvement of genitourinary syndrome of menopause","volume":"23","author":"J Mercier","year":"2020","journal-title":"Climacteric"},{"key":"pone.0262844.ref075","doi-asserted-by":"crossref","first-page":"1955","DOI":"10.1111\/j.1743-6109.2009.01304.x","article-title":"A prospective study of pelvic floor physical therapy: pain and psychosexual outcomes in provoked vestibulodynia","volume":"6","author":"C Goldfinger","year":"2009","journal-title":"J Sex Med"},{"key":"pone.0262844.ref076","first-page":"24","article-title":"A phenomenological study of women who presented to a physiotherapy-led continence service with dyspareunia and were treated with trigger point massage","volume":"105","author":"N. Mackenzie","year":"2009","journal-title":"J Assoc Chart Physiother Women\u2019s Health"},{"key":"pone.0262844.ref077","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s11577-017-0454-1","article-title":"How to construct a mixed methods research design","volume":"69","author":"J Schoonenboom","year":"2017","journal-title":"Kolner Z Soz Sozpsychol"},{"key":"pone.0262844.ref078","doi-asserted-by":"crossref","first-page":"2798","DOI":"10.1111\/jan.14479","article-title":"The state of mixed methods research in nursing: a focused mapping review and synthesis","volume":"76","author":"FE Irvine","year":"2020","journal-title":"J Adv Nurs"},{"key":"pone.0262844.ref079","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1258\/jhsrp.2007.007074","article-title":"The quality of mixed methods studies in health services research","volume":"13","author":"A O\u2019Cathain","year":"2008","journal-title":"J Health Serv Res Policy"},{"key":"pone.0262844.ref080","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1097\/IGC.0b013e3182a80a65","article-title":"Self-reported sexual, bowel and bladder function in cervical cancer patients following different treatment modalities: longitudinal prospective cohort study","volume":"23","author":"QD Pieterse","year":"2013","journal-title":"Int J Gynecol Cancer"},{"key":"pone.0262844.ref081","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1097\/COC.0b013e318248d89d","article-title":"Sexual dysfunction in female cancer survivors","volume":"37","author":"M DeSimone","year":"2014","journal-title":"Am J Clin Oncol"},{"key":"pone.0262844.ref082","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1007\/s10508-008-9349-6","article-title":"Sexual self schema as a moderator of sexual and psychological outcomes for gynecologic cancer survivors","volume":"38","author":"KM Carpenter","year":"2009","journal-title":"Arch Sex Behav"},{"key":"pone.0262844.ref083","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1037\/0022-006X.65.2.221","article-title":"Sexual self-schema and sexual morbidity among gynecologic cancer survivors","volume":"65","author":"BL Andersen","year":"1997","journal-title":"J Consult Clin Psychol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0262844","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,25]],"date-time":"2022-01-25T18:31:12Z","timestamp":1643135472000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0262844"}},"subtitle":[],"editor":[{"given":"Diego","family":"Raimondo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,1,25]]},"references-count":83,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1,25]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0262844","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,25]]}}}