Vaginal Dilators After Radiation Treatment

Following radiation treatment for endometrial or cervical cancer, your doctor will likely recommend dilator therapy and it is important to consider this therapy as a vital part of your recovery. Using vaginal dilators after radiation treatment helps to restore elasticity to the vaginal walls, relax tight pelvic muscles, stretch scar tissue, and prepare the vagina for a return to pleasurable sex.  

How Pelvic Radiation Can Affect The Vagina

During pelvic radiation treatment, the delicate tissues surrounding the genitals can be damaged and irritated as a result of radiation beams. This can result in the genitals becoming inflamed and tender to touch, and often appearing pink like sunburned skin. 

The vaginal lining is also affected by the radiation beams, resulting in the skin of the vaginal walls becoming thinner and more prone to tearing. Although rare, open sores and vaginal ulcers can also occur after pelvic radiation therapy. 

Once radiation treatment comes to an end the skin irritation begins to heal but can form as scar tissue. As a result of scar tissue, the walls of the vagina become tougher and the vaginal canal can narrow. You can learn more about additional pelvic health symptoms related to cancer treatment.

Due to a combination of this initial irritation, swelling, and tenderness, followed by the formation of scar tissue and a narrowing of the vaginal walls; some women can experience painful sex months, and even years, after radiation treatment. 

What Is A Vaginal Dilator?

Vaginal dilators are medical devices designed to relax and gently stretch delicate vaginal tissues and rebuild women’s confidence regarding vaginal penetration. Made from either silicone or plastic, these tube-shaped devices range from the size of a pinky finger to an erect penis and are typically used in ascending sizes. 

In addition to being used for healing purposes after pelvic radiation treatment, dilator therapy can also treat pelvic floor disorders, conditions affecting the female reproductive organs, and relieve the discomfort of painful sex (dyspareunia). 

Why Using a Dilator Is Important After Radiation Treatment

Using vaginal dilators after radiation treatment is not merely important, it is vital to gently stretch scar tissue, restore elasticity to the pelvic and vaginal muscles, and re-open the vaginal canal. This type of physical rehabilitation for the genitals and pelvic floor is a key component of post-pelvic radiation recovery and is essential for healing over the ensuing months.   

As well as physically, vaginal dilators help endometrial and cervical cancer survivors psychologically too, by re-building their confidence around inserting something into the vagina. For some women, the pain, tenderness, and irritation experienced in the aftermath of pelvic radiation treatment can trigger a fear of vaginal penetration because their brain and muscle memory convince them that it will hurt. 

Using the incrementally ascending sizes in a set of vaginal dilators allows women to gradually and comfortably become used to inserting something into the vagina. This care and time spent healing the genitals and pelvic area can ease women into feeling self-assured about sex again.   

When Do You Start Using A Dilator After Radiation Treatment?

This can vary from case to case, however, it is typically recommended to start vaginal dilation therapy approximately two weeks after radiation treatment has ended. Your nurse, radiologist, or healthcare provider will recommend which size dilator is the best one to start with. If they don’t, you should ask. 

For the first two months, you would more than likely be advised to use a dilator for one to two minutes every day. After two months, your healthcare practitioner will let you know if you should continue with the same size dilator, or move up to the next size, as well as how many times you should practice per week. 

To ensure that you begin dilator therapy when it’s right for you, consult with your healthcare practitioner not only about when you should start using your dilator but also how regularly you should practice, and how long your sessions should last. 

Pelvic Muscles After Radiation Treatment

After radiation treatment, dilators are designed to relax tight vaginal muscles, gently stretch the scar tissue, and counteract the narrowing of the vaginal canal. If women don’t use a dilator after radiation treatment, sexual intercourse, pelvic exams, and inserting tampons can become uncomfortable and often painful. 

When pain is experienced during sex or a pelvic exam it can trigger the muscle memory in the vagina to expect pain and discomfort during vaginal penetration of any kind in the future. This psychological link between pain and intercourse causes the vaginal muscles to involuntarily constrict at the mere thought of something entering the vagina, meaning sex, pelvic exams, or tampon insertion can become severely painful and often impossible. 

Bottom line, embrace using a vaginal dilator after radiation treatment. It might feel uncomfortable to start with but the results are worth it in the long term. 

When To Call Your Doctor? 

Vaginal dilation is considered a safe and healing practice, however, complications can sometimes arise after radiation treatment, and it is important to consult with your doctor if you notice any of the following while using your dilator. 

• A medium to large amount of bleeding. (Light bleeding is normal when starting or moving up to the next size dilator.) 

• Severe pain that does not subside. (It is usual to experience some discomfort or pain when a dilator is initially inserted, but the pain should subside within a few minutes, leaving only a slight feeling of discomfort.)

• When you cannot insert the dilator at all. (A little resistance is typical, but if you cannot insert the dilator past the vaginal opening, call your doctor for a consultation.) 

• If you notice evidence of a vaginal infection, such as; itching, swelling, fever, or vaginal discharge that has an unpleasant odor.  

How To Use a Dilator After Radiation Treatment

Once your nurse, radiologist, or healthcare practitioner has determined the correct dilator starting size for you, they will advise you on how many times per week to practice regularly at home, and for how long.

In case you need a refresher while practicing at home, we’ve put together the following guide for using vaginal dilators correctly.

1. Always wash your vaginal dilator with warm water and soap before using it.
2. Designate a private place in your home where you feel safe and will not be interrupted.
3. Drizzle or rub a generous amount of water-based lubricant over the dilator as well as the entrance to your vaginal opening. (It is important to use a water-based lubricant to protect the medical-grade silicone of Intimate Rose Vaginal Dilators.
4. Select the size recommended to you by your gynecologist or pelvic floor physiotherapist.
5. Lie down on your back, on your bed, on a yoga mat, or on some comfortable blankets with your knees bent and feet planted on the floor. Some patients prefer to lie on their side with the knees bent and a cushion or pillow placed between the knees to support the upper leg.
6. As you inhale, allow your belly to expand and as you exhale, allow your belly to drop. Continue to consciously breathe like this for a few more breaths to relax the vaginal opening with each exhale. 
7. When you feel ready, bring the tip of the dilator to the vaginal opening, and during the next exhale, gently insert the tip. As you continue to breathe consciously, ease the dilator into the vagina with each exhale until the lip at the end reaches the vaginal entrance. 
8. Breathe deeply and calmly, relax your shoulders, allow your body to sink into the support beneath you, and keep the vaginal dilator inserted in the vagina for the time recommended by your healthcare practitioner.
9. Once you become comfortable inserting each size dilator, it's helpful to practice insertion in different positions to mobilize the organs around the vaginal canal and encourage gentle stretching of the tissues. As well as laying on your back or your side, recommended positions include a deep squat and a table-top position with your hands and knees on the floor.
10. With time, and upon the advice of your healthcare practitioner, it can also help to gently press a dilator against the walls of the vagina by imagining the opening of the vagina as a clock and slowly moving the dilator in a circular position. Pause at each “hour” of the clock, gently compressing the dilator against the vaginal wall in each position. (Always consult with your healthcare practitioner to verify that you are progressed enough in the healing process after radiation to commence this additional practice.

Conclusion

Vaginal dilators are recommended after radiation treatment for endometrial or cervical cancer to help heal and rejuvenate the pelvic area and genitals. In addition to relaxing tight pelvic muscles, dilators help to stretch scar tissue after radiation and re-instate a woman’s sexual confidence. 

If you will undergo, or have recently undergone, pelvic radiation treatment, it is important to commit to a regular dilator practice as part of your healing process. 

References

American Cancer Society – Endometrial Cancer - https://www.cancer.org/cancer/endometrial-cancer/about/what-is-endometrial-cancer.html

Mayo Clinic – Cervical Cancer - https://www.mayoclinic.org/diseases-conditions/cervical-cancer/symptoms-causes/syc-20352501

American Cancer Society - How Radiation Therapy Can Affect the Sex Life of Females with Cancer - https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/fertility-and-sexual-side-effects/sexuality-for-women-with-cancer/pelvic-radiation.html

National Library of Medicine - Vaginal dilator therapy for women receiving pelvic radiotherapy - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171967/

Medicine Journal & Research Articles - Vaginal dilator use to promote sexual wellbeing after radiotherapy in gynecological cancer survivors- https://journals.lww.com/md-journal/Fulltext/2022/01280/Vaginal_dilator_use_to_promote_sexual_wellbeing.46.aspx