Vaginal care after pelvic radiotherapy

The effects of radiotherapy treatment

Vaginal side-effects

One of the side-effects of radiotherapy to the pelvis is a change in the vaginal tissue, which leads to a narrowing and shortening of the vagina. This is called vaginal stenosis. The vagina may become less elastic, drier and tender, sometimes making sexual intercourse and pelvic examinations difficult and painful. Using a dilator regularly after treatment will keep the vagina open and the tissues more supple. Water-based lubricating gel can be used to help the dryness and can be used with the dilator or when having sexual intercourse.

What is a vaginal dilator?

A vaginal dilator is a smooth plastic tube, which comes in a variety of sizes. You will be provided with the sizes you require and some water based lubrication gel.

The photograph shows the dilators in their built up form. Both ends of the dilator can be used depending on what is comfortable for you.

When do I need to dilate my vagina?

You should begin to use the dilator approximately two weeks after your radiotherapy is finished, when any skin reaction has settled or when your Doctor or nurse advises you to. You should aim to use the dilator 3-4 times per week for about 10 minutes each time. You will need to use the dilator ideally for the first two years after radiotherapy to keep the tissues in the vagina supple.

It is important to say that it is never too late to start using the dilator, so don’t throw it away. You may need to use it at a later date.

How do I use the dilator?

1. Before using the dilator, wash in hot soapy water and rinse well to make sure all traces of soap are removed.
2. Find a comfortable position. This may be lying on the bed or in the bath with your knees bent and apart. You may find it more comfortable to stand with one leg raised on a chair. You will find the best position for yourself.
3. Apply the lubricating gel to the end of the dilator. This will make inserting the dilator easier. Always use either a water-based lubricant such as Sylk, Replens or silicone based lubricant. Do not use Vaseline, baby oil or other oil- based lubricants as these can irritate the vaginal walls.
4. Gently separate the outer walls of the vagina (the labia) and ease the dilator gently into the vagina. Take your time. The more relaxed you are, the easier it will be to insert. Do not use force to insert the dilator.
5. When the dilator is in as far as is comfortable, gently push it a little further and release. The dilator will automatically start to come out. Continue to apply a little pressure and allow the dilator to move in and out. Try to do this for about five minutes.
   
   Then, with the dilator in the vagina, gently rotate the dilator in a circular motion for about another five minutes.

6. Gently remove the dilator after use.
7. When you have removed the dilator, wash it with hot soapy water, rinse well and let it dry.

Commonly asked questions

Will it hurt to use the dilator or have intercourse?

It is quite normal at first for the vagina to be sore after radiotherapy. If you are unable to use your dilator or have sexual intercourse because it is too painful, please consult your doctor or nurse.

When can I have sexual intercourse?

You can have sexual intercourse during your radiotherapy as long as you are not having problems with bleeding, infection (discharge) or pain. However, you may find that it becomes uncomfortable as your treatment progresses and your vagina tissues become drier or your skin becomes sore.

If you had to stop having sexual intercourse during your radiotherapy, you can resume when you feel comfortable after your treatment has finished. If you have any questions about this ask your doctor or nurse.

With regards to contraception, please refer to the ‘Radiotherapy to the Female Pelvis’ leaflet for advice.

How can I relieve the dryness?

There are several creams and gels available, which will help with the dryness. These are available either on prescription or over the counter in pharmacies or on the internet.

Some examples of these are:

• Sylk – a natural water based lubricant.
• Yes – also a water based lubricant, but without glycerine.
• Replens – vaginal lubricant.
• Hormonal creams – available via prescription.

Is bleeding or spotting normal?

There may be some spotting of blood at the beginning or following your radiotherapy. This is normal. You may find that you need to wear a sanitary towel. If you have any heavy bleeding, please inform your radiographers, nurse or doctor during treatment or your GP if it is out of hours.

It is advisable to stop sexual intercourse or using a dilator until this problem settles.

Are there other ways of dilating my vagina?

Sexual intercourse, inserting your finger or using a vibrator will also dilate the vagina. However, even if you were having regular sexual intercourse, we still advise you continue to use the dilator as instructed above. The lubrication jelly, used to make insertion of the dilator easier, may also be used in sexual intercourse since the vagina may be dry and there may be less lubrication after radiotherapy.

If you are experiencing any difficulties relating to using the dilators, resuming sexual intercourse or other emotional or physical problems relating to your treatment or disease, please contact your clinical nurse specialist.

Strengthening your pelvic floor muscles

Another long term side-effect of pelvic radiotherapy is the more urgent need to use the toilet and difficulty in holding your bladder and bowels. This is because radiotherapy affects the muscles in your pelvic floor which we use when controlling your urges to pass water or faeces.

Performing pelvic floor exercises 3-4 times per day will help to strengthen these muscles and improve the sensation of urgency.

How to find your pelvic floor muscles:

• Squeeze the muscles around your back passage as if trying to stop passing wind.
• Next, squeeze the muscles around your front passage as if trying to stop passing urine.
• Finally, squeeze all these muscles together and as you tighten, lift them up inside you.

Two types of exercises:

• Slow exercises – Tighten the pelvic floor muscles and count to 5, then relax. Repeat this at least 10 times. As your pelvic floor muscles become stronger, you can increase the amount of time that you tighten them for.
• Quick exercises – Tighten the pelvic floor muscles and hold for 1 count only. Repeat at least 10 times.

Make sure that you do a mixture of both the slow and quick exercises throughout the day.

The ‘Squeezy NHS Pelvic Floor’ App is a helpful tool to remind and guide you through Pelvic Floor Exercises throughout the day. This can be downloaded for Apple and Android phones at a small cost.

Your treating radiographers will provide you with contact details for your local Clinical Nurse Specialists who can answer any questions you may have about the contents of this leaflet once your treatment is complete.

Leeds Cancer Support

Leeds Cancer Support complements care provided by your clinical team. We offer access to information and a wide range of support, in a welcoming environment for you, your family and friends.

We can be found in the information lounges in Bexley Wing and also in the purpose built Sir Robert Ogden Macmillan Centre.

The Sir Robert Ogden Macmillan Centre

This centre offers a variety of free health & wellbeing and supportive therapies for patients, their family members and carers. These include hypnotherapy, mindfulness coaching, acupuncture (for hot flushes) and pilates.

Contact numbers for Leeds Cancer Support
Information Lounge Level -2 Radiotherapy Department
Open from 8.00am – 6.00pm Tel: (0113) 206 7603
Information Centre Level 1 Outpatients Department
Open from 9.00am – 4.00pm. Tel: (0113) 206 8816
Sir Robert Ogden Macmillan Centre
Open from 09.00am – 4.00pm. Tel: (0113) 206 6498
All the above services can be emailed on:
[email protected]