Vaginal Dilator Therapy | Chris O'Brien Lifehouse

Vaginal dilator therapy

  • Vaginal Dilator Therapy

    Guidelines for the use of vaginal dilators in women receiving pelvic radiotherapy and brachytherapy treatments

    It is recommended that vaginal dilators are offered to patients undergoing radical radiotherapy to the pelvis as part of their cancer treatment, together with support and education. Prior to commencing pelvic radiotherapy treatment all patients should receive information about the effects of radiation on vaginal tissue, which is recorded within the informed consent process. Acute and late effects of radiotherapy on the vagina and the need for dilators should be discussed during the assessment and planning phase of radiotherapy practice

    These include:

    • The development of fibrosis on mucosal tissues leads to progressive narrowing of the vaginal canal, and vaginal stenosis in between 1.6-8o% of women
    • Decrease in elasticity of vagina
    • Loss of oestrogen either from the effects of the radiotherapy on the ovaries, or following
    • Oopherectomy, can also lead to loss of lubrication and vaginal dryness
    • Vascular changes to vaginal canal
    • Dyspareunia, UP to 15-20% of women never resume sexual intercourse
    • Negative effect on feelings of sexuality from cancer treatment

    The rationale for vaginal dilatation

    • Ensure sexual relations can continue or recommence post treatment
    • May reduce the incidence of discomfort or painful intercourse
    • May reduce potential difficulties with future partners if not in a sexually active relationship at the time of treatment
    • Allows the medical team to accurately examine and assess the vaginal vault or cervix as part of ongoing medical follow up, care and support
    • Offers the opportunity to discuss sexual fears/ myths associated with pelvic radiotherapy

    Timing of vaginal dilation

    Regular intercourse and /or the use of vaginal dilators may minimise vaginal changes, such as stenosis, which is associated with pelvic radiation treatment. These vaginal changes develop over time, up to 5 years post treatment and may subsequently impact on sexual function, sexual health and wellbeing as well as causing considerable distress for a woman and her partner. Information about the patient’s current sexual relationship and well being prior to treatment would facilitate subsequent treatment and support.

    Currently there is no clear research evidence concerning the optimum time to start vaginal dilatation. Some Cancer Centres encourage the use of dilators during treatment, but all women are advised to start using dilators regularly following their treatment. Until further research is undertaken, all women should be informed about the rationale for using dilators and advise their use post radiation treatment for an indefinite period.

    Dilator use during treatment

    Women choosing to use vaginal dilators and/or engage in sexual intercourse during treatment should be supported and offered appropriate advice. If a woman encounters any discomfort, bleeding or signs of infection, advice should be sought from the specialist team looking after her. There may also be symptoms, such as bleeding or discomfort, following a period of abstinence from intercourse and/or dilator use. The use of dilators may be recommenced following the initial recovery of the vaginal mucosa, probably around 2-4 weeks post treatment.

    Guidance on how to use vaginal dilators

    • Minimum use is three times weekly for an indefinite time period. Dilators can be used in conjunction with sexual intercourse to achieve a combined frequency of vaginal dilation as above
    • Women should be advised to find a private and comfortable place where she can relax and use the dilator. Dilators can be used in the shower or bath if this provides privacy, and/or allows the women to relax her pelvic floor muscles and therefore use the dilator more successfully. If applicable, her partner may also be encouraged to be involved
    • A water-soluble lubricant should be placed on the dilator and around the entrance to the vagina prior to insertion
    • There are various positions in which to use the dilator: the woman can be advised to either lie down on her back with knees slightly apart and bent, or stand with a leg raised on the side of the bed or bath to insert the dilator
    • Inserting the dilator into the vagina requires a firm, gentle pressure. Women should be advised to insert as deeply as is comfortable, without forcing the dilator
    • Once the dilator is inside the vagina it should be moved in a forward and backward motion, then a left to right motion. If possible gently rotating the dilator using the handle
    • Women may be offered a range of sizes according to their needs. It is usual to start with the smallest size and progress to the largest (size 4) in the days/weeks following treatment, as it is comfortable
    • If the woman has manual dexterity problems or other physical restrictions, information should be tailored to individual needs as she may find it difficult to rotate the dilator
    • Each use should be for 5-10 minutes, encouraging pelvic floor exercises during insertion. It may be helpful to provide the women with a written copy of pelvic floor exercises, together with a rationale for their use, to promote compliance and ensure they are taught correctly
    • The dilator should be removed slowly rotating in clockwise/anticlockwise movements as the woman is able
    • Vibrators may also be used in conjunction with the use of dilators
    • Slight vaginal loss and blood staining is not uncommon when using dilators. If a woman experiences heavy vaginal loss, or pain, then referral for advice should be sought from the appropriate health care professional providing care, on-going follow up and support
    • Douching is not usually advised
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