Primary Nursing Diagnosis

Altered sexuality patterns related to tissue damage, pain, and change in body structures OUTCOMES. Sexual functioning; Anxiety control INTERVENTIONS. Sexual counseling; Coping enhancement

U PLANNING AND IMPLEMENTATION Collaborative

Most often, the treatment of choice for VC is radiation therapy delivered either by external beam or internally (brachytherapy). Treatment decisions are made based on the extent of the lesion and the age and condition of the patient. Patients with early-stage disease are treated so that the malignant area is removed but the vagina is preserved. Laser surgery is often used during stages 0 and 1. Patients in the later stages of disease are treated with surgery or radiation. The type of surgery or radiation depends on the extent of the disease, the patient's desire to preserve a functional vagina, and the location of the lesion. A radical hysterectomy may be done with removal of the upper vagina and dissection of the pelvic nodes. Most patients receive total external pelvic radiation therapy to shrink the tumor before surgery or before internal intracavity radiation. Internal radiation with radium or cesium into the vagina can be provided for 2 to 3 days. Current survival rates are similar for patients with VC whether they are treated with radiation or surgery.

Collaborative postoperative management includes analgesics for pain relief and careful assessment for signs of postoperative infection or poor wound healing. Before discharge, discuss with the physician the patient's timetable for resumption of physical and sexual activity, and be certain that the patient understands any limitations. For the management of patients with internal radiation, see Uterine Cancer, p. 923.

Pharmacologic Highlights

Medication or

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