Vaginal dilator therapy for women receiving pelvic radiotherapy

Pelvic radiotherapy for gynaecological and anorectal cancer damages the vagina. It causes the vagina to shrink and can make the sides stick together. It has become established practice in the UK to recommend regular vaginal dilation during and after radiotherapy to try and prevent this. Dilation involves placing and rotating a phallus shaped appliance in the vagina approximately three times a week for about five minutes to stretch the skin. This review appraised all the literature and retrieved all available data on this topic to see if there was any evidence to support this practice. These data showed that dilation of the vagina was linked to a rare but serious risk of vaginal rupture and could trigger psychological damage in some women. There was no reliable data to show that dilation had any beneficial impact on sexual function or vaginal anatomy. However, there are case reports suggesting that dilation months or years after radiotherapy is associated with lengthening of the vagina and there is one study (with a high risk of bias) that implies that stenosis rates can be reduced by a stent (plastic phallus shaped tube) compared to a dilator. Other data imply that dilation does not reduce vaginal damage. We conclude that there are data to show that dilation may be harmful in rare cases and that there are insufficient data to confer benefit, so we cannot recommend its routine regular use. However, this is not the same as saying that occasional gentle vaginal examinations or intercourse during or soon after treatment will not prevent the vaginal walls sticking together and dilation after the inflammatory phase has settled may improve vaginal length.