This information describes how to improve your vaginal health after radiation therapy and other cancer treatments.
Radiation therapy, certain types of pelvic surgeries, or menopause, can cause changes to your body. These changes can affect your vagina. It can become drier, less elastic, narrower, and shorter. You may or may not notice these changes. For example, if you are sexually active,vaginal intercourse may be painful. If you are not sexually active, this may not be a concern for you. However, these changes can make it hard for your doctor to do a pelvic exam. These exams are important to have after your treatment.
You can do a number of things to improve your vaginal health. Talk with your doctor or nurse about the options discussed below.
Internal Vaginal Moisturizers
Vaginal moisturizers are nonhormonal, over-the-counter products that help relieve vaginal dryness and discomfort. They are available in most drug stores or on the Internet. You can use any of the moisturizers listed below 2 to 3 times a week. However, many women will need to moisturize more often (3 to 5 times per week) after cancer treatment or sudden menopause. Apply the moisturizer at bedtime for the best absorption.
Vitamin E liquid capsules
- Using a pin, puncture each end of a vitamin E capsule. Insert the capsule into your vagina. Or, you can empty the capsule onto your finger and wipe the vitamin E inside your vagina.
Replens®; Hyalo GYN®
Carlson® KEY–E Suppositories; K-Y® Brand LIQUIBEADS™
- These are suppositories that are inserted into your vagina with a disposable applicator. You may want to put lubricant on the tip of the applicator to make insertion more comfortable.
External Vaginal Moisturizers
Many women experience dryness or irritation of the vulva. Using an external moisturizer can increase comfort. Natural oils such as vitamin E or coconut oil can be helpful. You can also use Replens® Long-Lasting Vaginal Moisturizer on your vulva.
Vaginal lubricants usually come in a liquid or gel form. They are used to supplement a woman’s own lubrication and minimize dryness and pain during sexual activity. Use these lubricants to make sexual intercourse more comfortable and pleasurable.
Apply the lubricant to the opening of your vagina and to whatever is being placed in or near your vagina, such as an applicator, dilator, finger, object, or a partner’s penis. Examples of lubricants include:
- Eros® Woman Water
- K-Y® Jelly
- Pjur® Woman Bodyglide (a silicone-based lubricant)
- Almond oil
- Coconut oil
Avoid colored, flavored, and warming lubricants, as well as those containing spermicides. Never use petroleum jelly or Vaseline®. They do not wash away easily and can increase your risk for vaginal infection or irritation.
You can use vaginal estrogen if your doctor says it is safe for you. Be sure to discuss the products described below with your doctor before using them.
- This medication comes in an applicator. Insert it into your vagina at bedtime for 14 days. Then, insert it into your vagina twice a week at bedtime.
- This medication comes as a vaginal ring. Insert the ring into your vagina and push it as far back as possible. Remove it after 90 days.
Vaginal Dilator Therapy
A vaginal dilator stretches your vagina and helps keep the tissues flexible. You can use it even if you are having vaginal intercourse. Vaginal dilator therapy is a resource you can use throughout your life. It will help to:
- Allow your healthcare provider to perform a more thorough pelvic exam
- Make it more comfortable for you to be examined
- Prevent your vagina from becoming too narrow
- Keep your vagina more elastic
- Allow you to have vaginal sex with less discomfort
Start using the dilator after you finish treatment. Your doctor or nurse will tell you when it’s safe to start and how often to use it. Your nurse will give you the dilator and teach you how to use it.
- Start using the dilator ____ weeks after your last radiation therapy treatment. Use it ____ time(s) a week.
- Start using the dilator ____ weeks after your surgery. Use it ____ time(s) a week.
Before using a dilator, use a vaginal moisturizer several times per week at bedtime. This will make it easier and more comfortable to stretch the tissues. When your vagina has moisture, it moves more easily.
Tell your doctor or nurse if you are experiencing pain when you use your dilator. He or she may:
Select a time and place in which you can have privacy and feel relaxed. Many women find their bedroom to be the most comfortable place for dilator therapy.
Lie down on your back with your knees bent at a 45-degree angle. They should be shoulder width apart. Rest your feet comfortably on the bed or couch. Make sure you can easily touch the opening of your vagina. Use a hand mirror if you need it.
Find your pelvic floor muscles and practice Kegel exercises, as instructed in the resource Pelvic Floor Muscle (Kegel) Exercises for Women.
Inserting a vaginal dilator
Inserting a vaginal dilator is simple and should not cause any discomfort if you do it slowly and gradually. Start with the smallest size dilator in your set. You can increase the size over time, which will help you have vaginal sex without discomfort.
- Apply lubricant to the dilator and to the opening of your vagina. Use a water-based lubricant such as Astroglide® or K-Y®. Do not use Vaseline®.
- Using gentle pressure, slowly insert the round end of the dilator into your vagina. Always insert it at a flat or slightly upward angle. Never insert it at a downward angle.
- Continue to insert the dilator until you feel some slight discomfort or muscle tension and then stop. The dilator should feel snug but not painful when you insert it into your vagina. Never use force or cause pain.
- Do a set of Kegel exercises, as instructed in the resource Pelvic Floor Muscle (Kegel) Exercises for Women. These exercises will help you relax your pelvic floor muscles and insert the dilator a little further. If it is still difficult to insert the dilator after doing Kegel exercises, take some deep breaths. Then, refocus on relaxing your pelvic floor muscles. Don’t worry if you can’t insert the dilator completely. With practice, you will be able to do this.
- Leave the dilator in place for 5 to 10 minutes.
- Gently push it back and forth to stretch the length of your vagina.
- Rotate the dilator gently in wide circles to stretch the width of your vagina. Repeat this at the back, middle, and opening of your vagina.
After you are done
Remove the dilator and wash it with hot, soapy water. Dry it with a clean towel after each use. Store it as instructed in your kit.
It is normal to have a small amount of bleeding when you use the dilator. A panty liner will be enough to manage this. If you have a lot of bleeding, such as bleeding that soaks up a sanitary napkin, call your doctor.
If you are prone to getting urinary tract infections (UTIs), you may want to urinate after dilator therapy.
If you have any questions or problems, talk with your doctor or nurse at your next appointment.
Goals of vaginal dilator therapy
When you can insert one size of a dilator completely into your vagina without any discomfort, it is time for you to start using the next size up. The goal is to slowly increase the size of your dilators, and if possible, reach the largest size without any discomfort.
You should practice dilator therapy several times per week. The more you do it, the more you will benefit. If you don’t have time during the week to practice, you should still try to do a set of Kegel exercises every day.
If you forget to do your dilator therapy or don’t have time one week, don’t give up. Try to start again as soon as possible. Developing a plan or routine for yourself can help you be successful.