Vaginal Health and Dysfunction

Introduction to Vaginal Dilator Therapy

The National Comprehensive Cancer Network recommends the use of vaginal dilators after radiation therapy to prevent vaginal stenosis, with initiation of use 2-4 weeks after completion of treatment, to improve quality of life and sexual function 1, 2, 3

Vaginal stenosis can occur due to various reasons, including radiation therapy, surgical interventions, hypoestrogenism, congenital anomalies, and postpartum trauma, leading to painful sexual intercourse, difficulties during gynecological examinations, sexual dysfunction, reduced quality of life, and predisposition to injuries and infections 4, 5, 6
External vaginal pain affects approximately 10-28% of women during their lifetime, with varying prevalence rates among postpartum women 7
Postpartum women have a higher prevalence of dyspareunia and require proactive assessment and management, according to the American College of Obstetricians and Gynecologists 7

Vaginal dilators are recommended as the primary treatment method for vaginal stenosis and should be used regularly to prevent recurrence, starting with the smallest size and gradually increasing the size 3, 5, 6
Vaginal moisturizers should be applied 3-5 times a week to the vagina, vaginal entrance, and external vulvar folds, and lubricants should be used during sexual activity to reduce dryness and discomfort 8, 9
Topical lidocaine (4%) can be used for persistent introital pain and dyspareunia 9, 8, 10
Low-dose vaginal estrogen may be considered for women with hormone-sensitive breast cancer who are symptomatic and do not respond to conservative measures, after careful discussion of risks and benefits, according to the American Society of Clinical Oncology 8, 9, 10
Vaginal dehydroepiandrosterone (DHEA) may be considered for women taking aromatase inhibitors, with caution when using hormonal preparations in patients with hormone-sensitive tumors 8, 10
Ospemifene can be considered for postmenopausal women without breast cancer history experiencing dyspareunia 8

A multidisciplinary approach involving gynecologists, physical therapists, and psychologists provides optimal results, with regular use of dilators necessary for maintaining vaginal patency and preventing recurrence of stenosis 3, 11
Pelvic floor physical therapy improves sexual pain, arousal, lubrication, orgasm, and satisfaction, and includes pelvic floor muscle training and relaxation techniques 11, 9, 8
Cognitive behavioral therapy (CBT) shows evidence of efficacy for sexual dysfunction, and addresses anxiety, fear, and psychological barriers to penetration 11, 9, 8
Collaboration between healthcare providers, including primary care physicians, gynecologists, pelvic floor physical therapists, and psychologists/sex therapists, is essential for optimal outcomes, as suggested by the National Comprehensive Cancer Network 10

Cancer survivors require treatment guided by the specific type of problem, with consideration of cancer history and current treatments, as recommended by the National Comprehensive Cancer Network 10
Caution should be exercised when using hormone-based treatments in patients with a history of hormone-sensitive cancers, and the risks and benefits should be discussed before using estrogen or DHEA preparations 9, 10
Referrals to specialists, such as urogynecologists or urologists for urinary incontinence, and colorectal surgeons for fecal incontinence, are recommended when necessary 8
Early intervention typically leads to better outcomes, especially with vaginal dilators, and referral to a specialist is recommended for persistent pain despite initial measures 9, 10, 8, 12