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Herman & Wallace Blog

September is Gynae Cancer Awareness Month

September is Gynae Cancer Awareness Month – but how aware are we as clinicians of the signs and symptoms, the epidemiology and the sequalae of treatment afterwards? As pelvic rehab specialists, we have the privilege of helping women live well after cancer treatment ends, both on a ‘local’ pelvic area (bladder, bowel, sexual and pelvic pain management strategies) but also on a more ‘global’ level – dealing with issues such as cancer related fatigue, bone health and cardiovascular concerns.

We know that women who are diagnosed with cancer of the vulva, vagina, cervix, endometrium or ovaries are treated with a combination of surgery, radiation or chemotherapy. However, with improving treatment and better survival rates, there is evidence that a variety of pelvic health concerns may arise for these women, both during and after treatment. (Hazewinkel et al 2010). For example, urinary incontinence is reported in 80% of women treated for endometrial cancer, with more severe symptoms and impact on quality of life in those who had adjuvant radiation (Erekson et al 2009) In Malone’s 2017 paper, ‘The patient’s voice: What are the views of women on living with pelvic floor problems following successful treatment for pelvic cancers?’, the author notes that ‘…there is currently a lack of knowledge regarding the effects of PFD on QoL in this cohort. Patients do not always report these problems to their health care providers and clinicians may underestimate symptoms…In the context of having survived cancer, PFD may be seen as relatively trivial. However, in the context of resuming normal living, the symptoms experienced by the survivors may be significant’.

This can present a clinical conundrum – often pelvic rehab therapists are nervous when working with a patient who has a current or previous gynecologic cancer diagnosis, but similarly oncology rehab specialists may have qualms about dealing with pelvic health issues, with the result that these women fall through the cracks and do not have their pelvic health issues managed properly (or at all). Theodore Roosevelt once said ‘No one cares how much you know, until they know how much you care’ and this is especially relevant for oncology pelvic rehab. Often you may be the first clinician to ask about bladder, bowel or sexual function or dysfunction. An understanding of the effects of cancer treatments on the pelvis is important but so too is the wealth of information you may already have about bladder, bowel and sexual health as well as neuroscience and pain education.

The most important thing is to ask these women about their pelvic health concerns – the National Coalition for Cancer Survivorship defined cancer survivorship as extending from ‘the time of diagnosis and for the balance of life’. An emphasis on quality of life has been emphasised – if we know that cancer survivors may not independently volunteer information about their pelvic floor dysfunction, it is our responsibility to ask the questions and comprehensively treat and advocate for these women, in order to help them live well after cancer treatment ends.


  1. Hazewinkel MH. Sprangers MA, Velden Jvd, Vaart CH, Stalpers LJ, Burger MP ‘Longterm cervical cancer survivors suffer from pelvic floor dysfunction symptoms: A cross-sectional matched cohort study’ Gynecol Oncol 2010;117(2):381-6
  2. Erekson EA, Sung VW, Disilvestro PA, Myers DL ‘Urinary symptoms and impact on quality of life in women after treatment for endometrial cancer’ Int Urogynecol J 2009;20(2):159-63
  3. Malone P, Danaher D, Galvin R, Cusack T ‘The patient’s voice: What are the views of women on living with pelvic floor problems following successful treatment for pelvic cancers?’ Physiotherapy Practice and Research 38(2017)93-102
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Upcoming Continuing Education Courses

Pelvic Floor Level 2B - Satellite Lab Course

Apr 10, 2021 - Apr 11, 2021

Nutrition Perspectives for the Pelvic Rehab Therapist - Remote Course

Apr 10, 2021 - Apr 11, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2B - Mequon, WI Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Health In Balance Physical Therapy

Pelvic Floor Level 1 - Satellite Lab Course

Apr 10, 2021 - Apr 11, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2B - Bozeman, MT Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Great Northern Physical Therapy

Pelvic Floor Level 1 - Self-Hosted

Apr 10, 2021 - Apr 11, 2021
Location: Self-Hosted Course

Pelvic Floor Level 2B - Annapolis, MD Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Encompass PT

Pelvic Floor Level 2B - Marietta, GA Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Southern Pelvic Health

Pelvic Floor Level 2B - Torrance, CA Satellite Course

Apr 10, 2021 - Apr 11, 2021
Location: Women's Advantage Inc

Lumbar Nerve Manual Assessment and Treatment - Remote Course

Apr 10, 2021 - Apr 11, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2B - Fort Smith, AR Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Arkansas Colleges of Heatlh Education

Pelvic Floor Level 1 - Missoula, MT Satellite Location (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Florence therapy and wellness

Pelvic Floor Level 2B - Doylestown, PA Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Central Bucks Physical Therapy LLC

Pelvic Floor Level 2B - Ann Arbor, MI Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Probility Physical Therapy

Pelvic Floor Level 2B - New Orleans, LA Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Ochsner Therapy and Wellness/Ochsner Health System

Pelvic Floor Level 2B - Worcester, MA Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Central Mass PT & Wellness

Pelvic Floor Level 2B - Buffalo, NY Satellite Course

Apr 10, 2021 - Apr 11, 2021
Location: CorrEra Physical Therapy

Pelvic Floor Level 2B - Self-Hosted

Apr 10, 2021 - Apr 11, 2021
Location: Self-Hosted Course

Pelvic Floor Level 1 - Greenville, SC Satellite Location (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: His Therapy

Pelvic Floor Level 1 - Fultondale, AL Satellite Location (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: TherapySouth Fultondale

Osteoporosis Management - Remote Course

Apr 10, 2021 - Apr 11, 2021
Location: Replacement Remote Course

Pelvic Floor Level 1 - Derby, CT Satellite Location (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Griffin Hospital

Pediatric Incontinence and Pelvic Floor Dysfunction- Remote Course (SOLD OUT)

Apr 16, 2021 - Apr 18, 2021
Location: Replacement Remote Course

Pediatric Incontinence - Grand Rapids, MI (Rescheduled)

Apr 17, 2021 - Apr 18, 2021
Location: Mary Free Bed Rehabilitation Hospital

Pregnancy Rehabilitation - Remote Course

Apr 17, 2021 - Apr 18, 2021
Location: Replacement Remote Course

Manual Therapy for the Abdominal Wall - Remote Course

Apr 17, 2021
Location: Short Form Remote Course

Pudendal Neuralgia and Nerve Entrapment - Remote Course

Apr 17, 2021 - Apr 18, 2021
Location: Replacement Remote Course

From Challenged and Concerned to Centered and Empowered

Apr 18, 2021
Location: Short Form Remote Course

Pelvic Floor Level 2B - Houston, TX

Apr 24, 2021 - Apr 25, 2021
Location: Texas Children’s Hospital

Pelvic Floor Level 2B - Garden City, NY Satellite Course (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: Metro Physical & Aquatic Therapy