Vaginal Dilators for Radiation Therapy
Vaginal dilators are medical devices used to stretch the vaginal tissues. Your provider may suggest using a vaginal dilator if you have had radiation to the pelvis. The effects that radiation has on your vagina can be prevented or treated by using a vaginal dilator.
Why are vaginal dilators needed?
During radiation therapy treatment healthy vaginal tissue can become irritated and sore. As the tissue heals it can cause scar tissue to form in your vagina. This can cause changes to your vagina including vaginal dryness, narrowing, or shortening. These changes can make vaginal examinations and sexual intercourse uncomfortable. Using a vaginal dilator can prevent or treat these changes by:
- Preventing scar tissue from forming.
- Helping break down the scar tissue that has formed.
- Increasing blood flow to the area.
What is a vaginal dilator?
A vaginal dilator is a smooth plastic or rubber rod or cylinder. It is similar in shape to a large tampon. They come in many sizes, varying in length and width. Your provider will likely tell you to start with the smallest size and slowly increase (go up) the size as you feel comfortable. Your provider will decide at your 2-year follow-up appointment if you need to continue using a dilator for the rest of your life. This is common because scarring can occur any time after treatment. Vibrators, dildos, or sexual intercourse can also help widen and lengthen your vagina.
Use and Care of Your Dilator
When should I use the dilator?
Your provider will let you know when you can start using the dilator, but it will be between 4-8 weeks after your last radiation treatment. It will depend on how much pain, if any, you are in from your cancer treatment.
Use the dilator at least 3 times per week unless your provider tells you otherwise. Sexual intercourse can be used to replace the dilator. If you are not using the dilator, you should be having intercourse 3-5 times per week.
How do I use the dilator?
- Wash the dilator and your hands with warm soapy water and rinse well.
- Choose the position that is comfortable for you to use the dilator. There are several different positions.
- Lay on your back with your knees bent and legs apart.
- Stand with one leg raised on a chair or bed.
- You may also use the dilator in the shower or when lying in a bathtub of lukewarm water.
- Apply a water-soluble lubricant (examples include K-Y Jelly and Astro Glide) to the rounded end of the dilator. Do not use oil-based lubricants, lotion, or Vaseline. They can irritate (cause pain) the vaginal tissues.
- Relax your pelvic floor muscles. You can 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 outside skin of your vagina as you would when inserting a tampon. Place the rounded end of the dilator into your vagina as far as it will go without causing pain. Your goal is to slide the round end of the dilator to the top of the vagina. This may take a few tries. 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 5-15 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 back and forth, 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.
What other tips can you give me?
- Other devices that can be used in place of the vaginal dilator, such as vibrators or dildos, 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 increase the size of your vaginal opening and soften 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 an adjustment period before using the dilator becomes more routine. Talk to your health care team if you are having a hard time. They are there to help you.
A small amount of bleeding or spotting after using the dilator or having intercourse is normal. This can occur for several months. This should stop as the vaginal tissue begins to soften and stretch. If you have heavy bleeding or a lot of pain, you should contact your provider. This is not normal.
When should I contact my provider?
Call your provider if you have signs of an infection such as:
- Vaginal itching.
- Vaginal discharge with a strong odor.
- Abdominal pain.
- Heavy bleeding.
This article is a general guide for vaginal dilator use. Make sure to follow the directions given to you by your provider and contact your care team with any issues or concerns.
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.
Managing female sexual problems related to cancer. American Cancer Society. (2020, February 5). Retrieved August 22, 2022, from https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/sexuality-for-women-with-cancer/problems.html
Miles, T., & Johnson, N. (2014). Vaginal dilator therapy for women receiving pelvic radiotherapy. Cochrane Database of Systematic Reviews, (9).
Morris, L., Do, V., Chard, J., & Brand, A. H. (2017). Radiation-induced vaginal stenosis: current perspectives. International journal of women's health, 9, 273.