Vaginal Stenosis: What It Is and How to Manage It

If you had radiation to your pelvic area you might be at risk for vaginal stenosis. According to cancernetwork.com 88% of woman who  had radiation for  cancer experiences stenosis if the vagina . Vaginal stenosis refers to the narrowing or loss of the vagina’s flexibility. Most of the time, the condition also comes with dryness which can cause pain and discomfort during sex or pelvic exams.

Causes of Vaginal Stenosis

In general, the causes of vaginal stenosis can be categorized into two types.

First is the congenital cause, relating to the insufficient prenatal suppression of the adrenal androgens. This leads to congenital adrenal hyperplasia.

The other set of causes is radiation-induced. Those who are undergoing pelvic radiation therapy for vaginal, uterine, and cervical cancers are mostly affected. Those undergoing brachytherapy are at risk, too. 

Now, how can radiation therapy cause vaginal stenosis?

Well, radiation therapy doesn’t directly cause it but its effects do. It causes dryness and thinning of the vaginal wall. It also triggers the formation of scar tissues, reduces the lubrication in the area, and minimizes the number and size of the small blood vessels within the organ.

As a result, vagina stenosis happens and the vaginal tissues become dry and really fragile.

Managing Vaginal Stenosis

Vaginal stenosis, when left unmanaged for a long time, can cause problems during sexual intercourse and physical examinations. One way to manage it is by using vaginal dilators.

These devices shouldn’t be used without the guidance and instructions of a health care professional. This is because vaginal dilators should be specific to an individual’s treatment plan as well as the procedures she will be undergoing.

In some cases, doctors may suggest the use of estrogen creams to promote better blood circulation in the area. Exercises may help, too.

When it comes to sex, not all patients are allowed to engage in sexual intercourse while they are undergoing treatment. The decision will be based on the doctor’s judgment.

For patients who are allowed to have intercourse, they may suddenly lose interest in it while undergoing radiotherapy as it often results in loss of confidence. For such cases, professional counseling is highly recommended.

It’s also important to stress that being intimate with a partner will not expose the other party to the after-effects of the patient’s therapy.

To make sexual intercourse more comfortable and enjoyable for partners, using a water-based lubricant is highly recommended. It makes penetration easier and it protects the fragile vaginal tissues.

If sexual intercourse is too painful and uncomfortable, you may need to use vaginal dilators. Another option is to wait for the damaged tissues to completely heal before resuming usual sexual activities.

Vaginal Dilator Therapy for Vaginal Stenosis

Vaginal dilators are tube-shaped devices that are designed to help stretch the vagina. Most of them are made of plastic but for those dealing with vaginal stenosis, silicone vaginal dilators are highly preferred.

Using vaginal dilators can take some time getting used to. If it’s your first time to use one, it’s recommended that you find a quiet place where you can try it alone. Pick a space where you feel comfortable and relaxed, like your bedroom.

Before you begin, take a few deep breaths and try to relax your pelvic floor muscles. Get into a comfortable position. Lying down with your feet flat on either a bed or a couch works. 

With your knees bent a little, spread your legs. If you are having a hard time keeping them shoulder-width apart, you can place a pillow beneath your knees.

Your position should be comfortable enough to let you touch your vaginal opening with your hand. If you find it hard to do, you can use a hand mirror so you can see the area. 

Locate your pelvic floor muscles and perform Kegel exercises. They can make dilator insertion easier.

Depending on your doctor’s advice, you may start with the smallest size dilator. Apply a bit of lubricant on its tip as well as your vaginal opening. As mentioned earlier, stick with water-based lubricants and avoid petroleum jelly.

With gentle pressure, you need to slowly insert the dilator’s round edge into the vaginal opening. Insert it towards the direction of your spine or at a downward angle. You can imagine it like inserting your tampon.

Continue inserting the device until you feel any tension or discomfort. If you do, stop and don’t force the dilator. Do a set of Kegel exercises to relax the muscles in your pelvic floor area and to allow the dilator to insert a bit further.

Once the device is in place, push it in and out of your vagina to stretch the area. Rotate it in circles to stretch its width, too. Do these steps for about 5 to 10 minutes. 

After you’re done, you can remove the dilator and wash it with hot, soapy water.

Using vaginal dilators may cause a bit of vaginal bleeding. You can wear a panty liner or a sanitary napkin for that. If you experience bleeding for more than one day, call your doctor.

It’s also encouraged that you pee after using a dilator. It’ll help prevent urinary tract infections.

It’s recommended that you practice dilator therapy about 3 to 4 times a week. As much as possible, don’t do it for two days in a row. If you are unsure about how frequent your therapy should be, you can talk to your doctor about it.