Radiation therapy to the pelvic area or some types of surgeries that involve the vagina can cause the vagina to become narrower and shorter. This is called vaginal stenosis.
A slightly shorter vagina is usually no problem at all. However, vaginal narrowing can cause:
- sex to be painful
- pelvic examinations to be uncomfortable
- Pelvic examinations are often an important part of follow-up after treatment for many gynecologic cancers.
Management
The walls of the vagina should be stretched a few times a week to help keep the vagina open. This can be done by:
- having sex regularly (a few times a week)
- using a vaginal dilator
It is very important to stretch the vagina by having sex or using a dilator for at least 6 to 12 months after finishing radiation therapy.
Vaginal dilator
A vaginal dilator is a plastic or rubber tube-like device that helps stretch out the vagina. It feels much like a large tampon. Dilators also help the woman relax the vaginal muscles. Vaginal dilators are often used after radiation to the lower pelvis, cervix or vagina.
Vaginal dilators may be bought with a prescription from the doctor. The healthcare team will give instructions about where to get a dilator, what size to get and how to use it. A woman may need to wear a special type of dilator in her vagina all day or night for a while, if she has had surgery to rebuild or reconstruct the vagina using skin grafts.
Dilators are used to prevent the vagina from shrinking, so a woman should not wait until her vagina is too tight to start using them, because they will not work as well. A dilator should be used even if a woman is not interested in having sex anymore. It will keep the vaginal walls stretched and open, which helps with pelvic examinations.
How to use a vaginal dilator
Use the dilator about 3 times a week.
- Apply a water-based lubricant to the dilator.
- Lie down on a bed. Bend the knees and spread the legs apart. Try to relax the muscles of the vagina.
- Gently and slowly put the dilator into the vagina, pointing it toward the small of the back.
- If the vagina feels tight, hold the dilator still and contract and relax the vaginal muscles. Once the vagina feels looser, push the dilator in farther. This process may need to be repeated a few times until the dilator is fully inserted.
- When the dilator is in as far as possible, leave it in for about 5 to 10 minutes. Push it back in if it slips out during this time.
- Remove the dilator and wash it with mild soap and water.
To stretch a very small vagina, a few dilators of different sizes can be used over time. Start with the smallest dilator and slowly work up to the larger ones, until the vagina is large enough to allow a penis to enter without pain. Scarring in the pelvis can develop over many years, so stretching the vagina often needs to be done for the rest of the woman’s life.
During sex
Try different positions during sex to find out which are most comfortable. The woman may want to try being on top, so that she can more easily control the depth of penetration.