Vaginal Dilators for Radiation Therapy

Author: OncoLink Team
Last Reviewed: September 12, 2018

If you receive radiation therapy to the pelvis, your provider may recommend that you use a vaginal dilator to improve the elasticity of your vagina. This is important to make follow up examinations easier and more comfortable and prevent discomfort during sexual activity.  You should consider this as part of your health maintenance after completing radiation therapy. Your nurses and doctors can answer any questions or concerns you may have. Don't hesitate to ask them.

Why are  vaginal dilators needed?

After radiation treatment to the pelvic area, scar tissue begins to form in the vagina and the tissue becomes less elastic and dry. There may be shortening or narrowing of the vagina and decreased blood flow to the area. Scarring of the vaginal tissue results in adhesions, or areas where scar tissue forms, sealing the sides of the vagina together. This can make it difficult for the provider to perform vaginal exams and makes sexual intercourse difficult and uncomfortable.

What is a vaginal dilator?

A vaginal dilator is a smooth plastic or rubber cylinder, similar in shape to a large tampon. It is about 6 inches in length and comes in different widths. The vaginal dilator can help prevent scar tissue from forming, increase blood flow to the area and can help break down any scar tissue that has formed. This helps to make intercourse more comfortable, but also to make gynecological exams by your provider more comfortable as well, so it is recommended even if you do not plan to be sexually active. It is recommended that you use a dilator for the rest of your life, as scarring can occur at any time after treatment. Other devices, such as vibrators or dildos, offer a similar ability to prevent narrowing of the vagina.

Use and Care of Your Dilator

When should I use the dilator?

You can start using the dilator about 4 weeks after your last radiation treatment. This timeline will depend upon when vaginal irritation has decreased and your provider will advise you when to start. Use the dilator at least 3 times per week for life, unless your provider tells you otherwise. Sexual intercourse is helpful to avoid scar tissue and can be a substitute for the dilator, but it must be consistent to replace dilator use.

How do I use the dilator?

  • Wash the dilator with warm soapy water and rinse well.
  • Apply a water-soluble lubricant (examples include K-Y Jelly, Astro Glide, Sliquid, Slippery) to the rounded end of the dilator and a small amount to your vaginal opening.  Do not use oil based lubricants, lotion or Vaseline.
  • There are several positions to use a dilator. Choose what is most comfortable for you.
    • Lay on your back with your knees bent and slightly apart.
    • Stand with one leg raised on a chair or bed.
    • You may also use the dilator in the shower or lying in a bathtub of lukewarm water.
  • Relax the muscles of the pelvic floor. You may try a couple of squeezes (like you are trying to stop urine flow) and then allow those muscles to relax. Also, take a few deep breaths. While you inhale, your belly should expand. The belly should fall when you exhale.
  • Using your fingers, separate the skin outside the vagina as you would when inserting a tampon. Place the rounded end of the dilator into the vagina as far as possible. Your goal is to slide the round end of the dilator to the top of the vagina (which may take a while to achieve). Use firm and gentle pressure - do not use force. Sometimes, rotating the dilator during insertion makes it easier.
  • Leave the dilator in your vagina for 5-10 minutes. (The amount of time may vary; follow the instructions given by your provider). Gently squeeze the dilator with your pelvic muscles (don't squeeze so hard that you push the dilator out), and then allow those muscles to relax. Repeat this a few times. If you are feeling tense, take a few deep breaths to relax.
  • Gently move the dilator forward and backward, then side to side, then rotate.
  • If you are using different sized dilators, start with the smallest and work up to the largest as it is comfortable to do so.
  • Remove the dilator slowly while rotating the dilator one direction and the other.
  • Wash your hands and the dilator with warm water and soap. Let the dilator dry completely to prevent bacteria build-up.

What other tips can you give me?

  • Regular sexual intercourse, about 3 days per week, can also help to prevent vaginal complications and can be a substitute for using the dilator.
  • Other devices can be used in place of the vaginal dilator, such as vibrators or dildos, as they offer similar ability to prevent narrowing of the vagina. These items can be less expensive when bought from an adult specialty store.
  • Using the dilator just before intercourse can help reduce pain and vaginal tightness during intercourse.
  • You should not douche at any time.

What can I expect as I start using the dilator?

It may take 8-12 weeks to feel an increase in the size of the vaginal opening and a softening of the tissues. Be patient. You may find that your emotions are somewhat sensitive as you begin this process.   It may help to talk to your doctor, nurse or therapist. For most women, there is a period of adjustment, and then using the dilator becomes more routine. Talk to your health care team if you are having difficulty. They are there to help you.

At first you may have a small amount of bleeding or spotting after using the dilator or having intercourse. This is normal and can occur for several months. This should stop as the vaginal tissue begins to soften and stretch. Heavy bleeding or excessive pain is not normal and you should contact your provider if you experience this.

What should I notify my care team about?

Call you provider if you have signs of an infection such as:

  • Vaginal itching
  • Fever
  • Vaginal discharge with strong odor
  • Abdominal pain

 

This article is a general guide for vaginal dilator use. Make sure to follow the directions given to you by your provider and to contact your care team with any issues or concerns.

References

American Cancer Society. Treating Sexual Problems for Women with Cancer. Accessed at: https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/sexuality-for-women-with-cancer/problems.html

Carter, J., Goldfrank, D., & Schover, L. R. (2011). Simple strategies for vaginal health promotion in cancer survivors. The journal of sexual medicine, 8(2), 549-559.

Jefferies, H., Hoy, S., Mccahill, R., & Crichton, A. (2007). Guidelines On Vaginal Dilator Use After Pelvic Radiotherapy. Nursing Times, 103(30), 28-29.

Juraskova I, Lubotzky F (2015) Recovering after pelvic radiation therapy: a guide for women Available from: http://www.targetingcancer.com.au/wp-content/uploads/2015/10/Recovering-after-Pelvic-Radiation-Therapy-a-guide-for-women.pdf

Kachnic, L. A., Bruner, D. W., Qureshi, M. M., & Russo, G. A. (2017). Perceptions and practices regarding women’s vaginal health following radiation therapy: a survey of radiation oncologists practicing in the United States. Practical radiation oncology, 7(5), 356-363.

Katz, A. J. (2007). Breaking the silence on cancer and sexuality: A handbook for healthcare providers (pp. 203-11). Pittsburgh, PA: Oncology Nursing Society.

Miles, T., & Johnson, N. (2010). Vaginal dilator therapy for women receiving pelvic radiotherapy. The Cochrane database of systematic reviews, (9), CD007291.

Morris, L., Do, V., Chard, J., & Brand, A. H. (2017). Radiation-induced vaginal stenosis: current perspectives. International journal of women's health, 9, 273.

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