Cancer can start in the cervix, uterus, rectum, or bladder and spread to the vagina. A typical treatment is radiation therapy which kills cancer cells directly. Pelvic radiation therapy can result in radiation-induced vaginal stenosis (VS), a common side effect of radiation therapy. Your vagina can narrow or stick together due to adhesions and scarring after treatment is complete.
What are the effects on the vagina after radiation treatment?
Thirty-eight percent of women treated with pelvic radiation therapy will experience vaginal stenosis. Radiation causes vaginal tissues to become inflamed and cells begin to die. As a result, scar tissue forms in the vagina, and the tissue becomes less elastic and flexible. The tissue has less blood flow and the ability to create lubrication, making for a dryer, stiff, and fibrotic vagina.
Why do I need to stretch my vagina?
You may experience increased pain and discomfort with activities involving vaginal penetration, such as gynecological examination, tampon insertion, and sexual activity. Vaginal stenosis can also reduce your quality of life and increase in severity over time if not addressed within the first year of radiation therapy.
Can physical therapy help?
A pelvic health physical therapist can complete an assessment and help you start vaginal dilator therapy. Vaginal dilators help you stretch your vagina and stimulate tissue growth by increasing blood flow to the area.
Research has shown that regular use of vaginal dilators is associated with lower rates of self-reported vaginal stenosis. Many international reviews highly recommend vaginal dilator therapy. Still, there is no gold standard for its use, such as frequency, duration, size, and insertion technique. Also, there is no consensus on whether vaginal dilator use is necessary for sexually active patients.
Many women will reduce the frequency or discontinue the use of vaginal dilators, even though this therapy is a lifetime maintenance tool. Patient education and psychosocial support are highly recommended regarding the risk of vaginal stenosis. Trained providers should teach the use of a vaginal dilator.
How do I use a vaginal dilator?
Vaginal dilators are typically cylinder in shape and come in kits with varying width dilators. You should always seek counsel from your healthcare provider before using a vaginal dilator after radiation therapy. Every woman will come with a unique set of circumstances that will affect her care and treatment.
Vaginal dilator therapy can start as early as four weeks after the last radiation treatment. It will all depend on how irritated your vaginal tissues are. As a maintenance program, you should complete this program at least three times a week for life. With regular therapy, you may use intercourse as a substitute for the dilator and notice tissue changes in 8-12 weeks.
Your physical therapist may recommend the following steps after a complete evaluation of your pelvic health.
- Wash your hands and dilator with soap and warm water before use.
- Apply water-soluble lubricant to the dilator.
- Find a comfortable position on your back or in standing. You may be more comfortable inserting the dilator while on your bed or shower. Do what works best for you.
- Relax.
- Insert the dilator gently into your vagina.
- Leave it in for at least 5-10 minutes.
- While waiting, you can practice your pelvic floor muscle contract and relaxation techniques.
- You can also move the dilator around the vagina around a “clockface.” Start at 12 o’clock and move to 6 o’clock. Then 3 o’clock to 9 o’clock.
- Start with a small width dilator and you can work up to larger width over time.
- Remove the dilator gently from your vagina.
- Wash your hands and dilator with soap and warm water.
- Allow the dilator to dry completely before storing it away.