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Vaginal changes after pelvic radiotherapy
Pelvic radiotherapy can affect the vagina in different ways. It may cause pain, bleeding or discomfort.
We hope the information on this page helps explain why you might have symptoms of vaginal changes and how to manage them. We are also here if you need some extra support or aren’t sure where to start.
About vaginal changes
Pelvic radiotherapy uses radiation to destroy cancer cells in that part of the body. It may also damage healthy cells and tissues in that area, which can include the vagina.
We know that changes to the vagina are common after pelvic radiotherapy, but we need larger studies to be confident in the exact numbers . The research we do have suggests between 3 and 7 in 10 (30% to 70%) patients have some level of vaginal stenosis after pelvic radiotherapy.
Symptoms of vaginal changes
Possible symptoms of vaginal changes include:
- vaginal stenosis – where scar tissue causes the vagina to become narrower, shorter and less flexible, and can cause the walls of the vagina to stick together
- vaginal dryness and irritation
- pain or discomfort during penetration, including sex and internal examinations
- vaginal bleeding – particularly after sex
- vaginal infections, such as thrush.
Medical treatments for vaginal changes
All of these symptoms can be hard to deal with and may have a major impact on your day-to-day life. You may also find them embarrassing to talk about, although it can help to remember that vaginal changes are common – even in those who haven’t had cervical cancer treatment.
Speaking with your healthcare professional
It is important that your healthcare professional tries to diagnose the underlying cause of the vaginal symptoms, rather than simply treating the symptom itself.
You can speak with:
- your GP
- your clinical nurse specialist (CNS)
- your cancer doctor (consultant).
It can help to speak to a healthcare professional you already know, trust and who has an understanding of your medical history.
Tell them that these vaginal changes started after pelvic radiotherapy treatment and how long they have lasted for. Explain the impact they are having on your life – be prepared to give all the details. You may like to write down what you experience day-to-day.
Read more about getting a diagnosis >
Possible treatments for symptoms
If you’re experiencing pain and discomfort, either during sex or in your day-to-day life, you may be recommended one of the following:
If you have vaginal dryness or the vaginal tissues are becoming thinner, your healthcare professional may prescribe:
- oestrogen creams, which you put on the vagina
- oestrogen pessaries, which you put directly into the vagina.
Tablets, creams and pessaries are also available to treat any vaginal infections that might occur as a result of vaginal dryness.
Dilators are commonly used after pelvic radiotherapy or brachytherapy, as well as for other conditions like involuntary pelvic floor spasms (vaginismus). Using dilators is sometimes called dilation therapy. You may already have been advised by your healthcare team to use dilators to keep the vaginal tissues stretchy and the vagina open.
How to use dilators
Dilation therapy involves gently inserting tampon-shaped plastic tubes (dilators) into your vagina. It aims to prevent or treat any narrowing of the vagina (vaginal stenosis). Dilators come in different sizes, so you can start with a very small one and build up as it becomes more comfortable.
It’s possible to practise dilation therapy using your fingers, vibrators or similar shaped devices. It’s a good idea to use lubricant to make it more comfortable.
You may find it useful or even arousing to practise dilation with your partner. This can be another way of building intimacy and reconnecting with your body together. But using a dilator doesn’t have to be sexual. You may find it more helpful to do a relaxing activity while you are dilating, such as, watching television, listening to music or practicing mindfulness.
When and why to use dilators
There is limited evidence on how effective dilation therapy is, but it is usually recommended based on the existing research . Your healthcare team will tell you how long and how frequently you should use dilators, as it depends on your treatment and personal situation. This could be between 3 minutes twice a week, to up to 10 minutes twice a day. Dilation is usually recommended for up to 2 years after your treatment, but there’s some evidence that it can be beneficial for longer than that .
Getting support
Your CNS should talk you through dilation therapy, and can give more personalised advice that’s tailored to your needs and circumstances. Don’t be afraid to ask for more information or advice if you’ve got any questions or concerns. You might find it useful to read our online Forum for dilation tips and experiences.
You may be prescribed hormone replacement therapy (HRT) if your vaginal changes are caused or made worse by early menopause.
If pelvic radiotherapy has caused early menopause, it is important to talk about HRT with your healthcare professional as soon as possible. HRT can help with many effects of early menopause so, if it is a possibility for you, the sooner you have it the better the benefit.
Vaginal changes can have a big impact on your sex life. A psychosexual therapist is an expert who can help with any problems relating to sex. They will listen to you and help you explore whether the problems are caused by something emotional, physical or both. Then you can discuss ways to manage these problems.
Your GP or hospital healthcare team can refer you to a psychosexual therapist. Sex therapy is not always available on the NHS, but it is worth checking what is available in your area.
Read about getting support with sex and relationships >
Impact of vaginal changes on your life
We hear from many women and people with a cervix who have found that vaginal changes have a big impact on their relationships – especially their sex life. This can be a particularly difficult change to navigate, as it involves the physical and emotional states of multiple people.
It’s important to remember that there is no right or wrong way to approach sex and intimacy after cervical cancer. It may not be a priority for you and that is okay. If you want to do it, these types of penetration can help to reduce or prevent the vagina becoming narrower:
- Having regular penetrative sex.
- Using a dilator, dildo or vibrator.
- Using a lubricated finger.
If you have already noticed changes to your vagina, you may find it most comfortable to start with a finger or small dilator and build up to larger sizes.
Lubricants and vaginal moisturisers can help with vaginal dryness, which may help to make sex and intimate touching more comfortable. Ask your GP or hospital healthcare team about getting free with a prescription.
We have a detailed section dedicated to sex and intimacy after cervical cancer that you and, if you have one, a partner may find helpful.
- Lisa McWilliams, Specialist Physiotherapist in Pelvic Health
Getting support for vaginal changes
We understand that vaginal changes can impact your day-to-day life, as well as your emotional wellbeing and confidence. It can feel like a big step to talk to a healthcare professionals about any symptoms you have, but it’s important that you get support based on your individual situation.
If you are not sure where to turn, you can give our free Helpline a call on 0808 802 8000. Our trained volunteers can talk through your options or simply listen to what’s going on.
Check our Helpline opening hours >
Sometimes connecting with others who have gone through a similar experience can be helpful. Our online Forum lets our community give and get support. You can read through the messages or post your own – whichever feels most comfortable.
Useful organisations
Women’s Health Concern
The patient-focused side of the British Menopause Society (BMS). Offers information and support about menopause and its symptoms.
Pelvic Radiation Disease Association (PRDA)
A UK charity providing information about PRD. Has an online community as well as hosting national and local events for people with PRD.
Action Radiotherapy
A UK charity dedicated to improving radiotherapy treatments. Provides information about radiotherapy, including side effects.
Thank you to all the experts who checked the accuracy of this information, and the volunteers who shared their personal experience to help us develop it.
References
- Araya-Castro, P. et al (2020). Vaginal Dilator and Pelvic Floor Exercises for Vaginal Stenosis, Sexual Health and Quality of Life among Cervical Cancer Patients Treated with Radiation: Clinical Report. Journal of Sex and Marital Therapy. 46;4. pp.513-527.
- Delishaj, D. et al (2018). Vaginal toxicity after high-dose-rate endovaginal brachytherapy: 20 years of results. Journal of Contemporary Brachytherapy. 10;6. pp.559-566.
- Martins, J. et al (2017). Factors associated with changes in vaginal length and diameter during pelvic radiotherapy for cervical cancer. Gynecologic Oncology. 296. pp.1125-1133.
- White, I. (2015). Sexual Difficulties after Pelvic Radiotherapy: Improving Clinical Management. Clinical Oncology. 27;11. pp.647-655.
- Miles, T. and Johnson, P. (2014). Vaginal dilator therapy for women receiving pelvic radiotherapy. Cochrane Database of Systematic Reviews.
- Incrocci, L. and Jensen, P. (2013). Pelvic Radiotherapy and Sexual Function in Men and Women. The Journal of Sexual Medicine. 10;S1. pp.53-64.
We write our information based on literature searches and expert review. For more information about the references we used, please contact info@jostrust.org.uk.