After radiation treatment in the pelvic area, vaginal dilator therapy is typically recommended to counteract the effects of radiation on the vagina. Although a little discomfort may be experienced to start with, dilator therapy is a vital part of recovery after pelvic radiation treatment.
Pelvic Radiation Treatment: How the Vagina Reacts
While pelvic radiation treatment is carried out, the radiation beams can damage, dry out, and irritate the vaginal tissues, resulting in vaginal inflammation, discomfort, sores, and pain. The vaginal lining is also thinned by radiation, making it more susceptible to abrasions and micro-tears. Patients might also notice that the outer genital skin swells and turns red; on rare occasions, open sores or ulcers can form.
As the vaginal skin begins to heal from the irritation of radiation treatment, scar tissue often forms which makes the vaginal canal tighter, narrower, and sometimes shorter. This process is known as vaginal stenosis.
Over the days, weeks, and months after radiation treatment, these changes to the vaginal skin, tissues, and canal can worsen. For many, it can deteriorate to the point that inserting a tampon, sex toy, gynecological instrument, or having sex, can be extremely painful. If left untreated, excruciating pain during vaginal penetration can happen for years afterward, sometimes for the rest of a patient’s life.
To heal after pelvic radiation and return to a pleasurable sex life, vaginal dilator therapy should be regularly practiced in the aftermath of treatment.
What is Vaginal Dilator Therapy?
Vaginal dilators are tapered, tube-shaped, medical devices that are designed to gently and gradually stretch narrowed vaginal canals and relax tight pelvic muscles. For vaginal dilator therapy, dilators are typically prescribed in sets of increasing sizes that range from a small finger to the length and width of an erect penis.
By using the correct size dilators for your condition, blood flow to the vaginal tissues is progressively increased, the production of natural lubrication is improved, existing scar tissue is reduced, and the formation of new scar tissue is prevented. This, in turn, relieves vaginal tightness so that penetration becomes easier and women’s confidence in sex after pelvic radiation treatment is slowly reinitiated.
As well as aiding the recovery from pelvic radiation, vaginal dilator therapy is also effective for alleviating painful sex (dyspareunia) and treating the symptoms of female pelvic conditions like chronic pelvic pain, endometriosis, lichen sclerosis, vaginismus, vaginitis, vulvodynia, and several others.
Although they’ve been manufactured from other materials in the past, vaginal dilators are currently made from plastic or medical-grade silicone, of which the latter is considered more body-safe and toxin-free.
Our favorite dilators are the Intimate Rose Silicone Vaginal Dilator sets. Designed by a pelvic physical therapist who experienced a traumatic pelvic injury of her own, the medical-grade silicone is smooth comfortable, and FDA-approved. The price is also reasonable compared with other dilator sets, and the incremental size difference is perfect for comfortable dilator progression.
Why Dilator Therapy is Necessary After Pelvic Radiation
Vaginal dilator therapy after pelvic radiation is not only necessary but vital, for both physical and psychological healing in the months after treatment.
When it comes to physical healing, vaginal dilator therapy is used to widen a narrowing, or narrowed, vaginal canal. This is achieved by massaging and reducing scar tissue that has already formed and preventing more from developing. As a form of gently progressing therapy, vaginal dilation also improves blood flow to the vaginal tissues and restores elasticity to the pelvic and vaginal muscles.
Psychologically, vaginal dilator therapy can help patients mentally heal by alleviating any anxiety surrounding vaginal penetration. All too often, the vaginal pain and tightness experienced after pelvic radiation treatment can trigger a psychological reaction that causes the vaginal muscles to spasm at the mere prospect of penetration or sex.
The process of vaginal dilator therapy, however, can rebuild a woman’s confidence in painless penetration and encourage an outlook toward a happy and fulfilling sex life after treatment.
Nervous About Using Dilators After Pelvic Radiation?
Understandably, many women feel nervous about using dilators after pelvic radiation treatment. Radiation can make things tight, fragile, and sore down there, and inserting something that could increase the discomfort is probably the last thing patients feel like doing. But for healing purposes, it’s important to trust in the process of dilator therapy.
It’s a slow and gradual process after all, and specifically designed with fragile vaginal environments in mind.
In the aftermath of pelvic radiation, for instance, patients are typically encouraged to start with the smallest dilator in a set – usually the width and length of a lady’s pinkie finger. With the help of a generous amount of lube (only water-based lube if you’re using silicone dilators), dilators can be gently eased into the vagina.
For some, only the tip of the dilator might be inserted on the first try, and that is perfectly fine. By persevering, day by day, with patience, tenderness, and plenty of lube, the vaginal muscles will begin to relax enough to allow for insertion, and dilation therapy will get easier.
Only once the smallest dilator is painlessly inserted and held in place are patients encouraged to progress to the next size. And so, the process continues, until a dilator the size of an erect penis is comfortably inserted and patients are feeling confident about sexual intercourse again.
What Happens If Women Don’t Use Dilators After Pelvic Radiation?
Dilator therapy is a must after pelvic radiation therapy to improve blood flow to the vaginal muscles, restore elasticity to the vaginal tissues, reduce existing scar tissue, and prevent new scar tissue from forming. When women don’t use dilators after radiation treatment the vaginal canal narrows and shortens, resulting in painful sex, excruciating pelvic exams, and even tampon insertion becomes impossible.
When Should You Start with Dilator Therapy After Radiation Treatment?
Although it can vary depending on the patient's circumstances, healthcare providers normally advise starting dilator therapy 2-4 weeks after pelvic radiation treatment is completed.
Some protocols and oncologists will advise patients to begin dilator training during radiation treatment to prevent changes from occurring during the treatment. A nurse, pelvic physical therapist, or radiologist will usually discuss dilation with patients, while also recommending starting sizes, dilation time, and frequency schedules.
Anywhere from two to thirty minutes dilation per day is typically advised for the first 2-3 months after treatment. Based on progress and levels of comfort in using the smallest dilator, patients will either continue using the first dilator or move on to the next.
How Long Should You Use Dilators After Pelvic Radiation Treatment?
Patients who undergo pelvic radiation are advised to continue dilating a few times a week for the rest of their lives. Scar tissue, and the subsequent narrowing of the vaginal canal, are known to occur years after radiation treatment and dilating is the most effective way of preventing it.
Are There Any Risks Associated with Using Dilators After Pelvic Radiation?
There are very few risks involved in the safe and healing process of vaginal dilation. That said, complications can occur during pelvic radiation treatment that could signal concerns during the dilator therapy that comes afterward. Should you notice any of the following while performing dilation after pelvic radiation treatment, let your doctor know.
Insertion is not happening. Due to vaginal tightness and a narrowing of the vaginal canal, inserting dilators can meet with some resistance, particularly the first time. If it remains impossible to insert a dilator with plenty of lube after a few days of trying, contact your doctor.
Heavy bleeding. Some spotting or light bleeding can be expected upon inserting the first dilator, as well as when progressing to a bigger size dilator. However, this type of bleeding should never be heavy. If it is, speak with your doctor.
Lingering pain. Although it's normal to feel some discomfort when inserting dilators, this type of pain should fade to mild or manageable discomfort within minutes. If not, speak with your doctor.
Infection. Symptoms of a vaginal infection often include genital itching, unusual vaginal discharge, an unpleasant vaginal odor, genital swelling, or a burning sensation when peeing. If you notice any or all of the above, contact your healthcare provider for a diagnosis and treatment.
Vaginal dilators are an important part of the healing process after pelvic radiation treatment. In addition to improving blood flow to the area, preventing the growth of scar tissue, and relaxing tight vaginal muscles, dilators also help to rebuild women’s sexual confidence and prepare the vagina for enjoyable and pain-free sex after cancer.
If pelvic radiation is on your horizon, or you have recently undergone treatment, speak with your nurse, radiologist, or oncologist about vaginal dilator therapy. Committing to a regular and healing practice of vaginal dilation after radiation will save you from a world of discomfort in the future.
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 - Radiation-induced vaginal stenosis: current perspectives - https://pubmed.ncbi.nlm.nih.gov/28496367/
Intimate Rose – Vaginal Dilators - https://www.intimaterose.com/collections/vaginal-dilators
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
OncoLink – Vaginal Dilators for Radiation Therapy - https://www.oncolink.org/support/sexuality-fertility/sexuality/vaginal-dilators-for-radiation-therapy
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.