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Intervention Review

Vaginal dilator therapy for women receiving pelvic radiotherapy

  1. Tracie Miles*,
  2. Nick Johnson

Editorial Group: Cochrane Gynaecological Cancer Group

Published Online: 8 SEP 2010

Assessed as up-to-date: 15 JUL 2010

DOI: 10.1002/14651858.CD007291.pub2


How to Cite

Miles T, Johnson N. Vaginal dilator therapy for women receiving pelvic radiotherapy. Cochrane Database of Systematic Reviews 2010, Issue 9. Art. No.: CD007291. DOI: 10.1002/14651858.CD007291.pub2.

Author Information

  1. Royal United Hospital NHS Trust, Gynaecological Oncology, Bath, UK

*Tracie Miles, Gynaecological Oncology, Royal United Hospital NHS Trust, Combe Park, Bath, BA1 3NG, UK. tracie.miles@nhs.net. traciephd@hotmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 8 SEP 2010

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This is not the most recent version of the article. View current version (08 SEP 2014)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Many vaginal dilator therapy guidelines advocate routine vaginal dilation during and after pelvic radiotherapy to prevent stenosis (abnormal narrowing of the vagina). The UK Gynaecological Oncology Nurse Forum recommend dilation “three times weekly for an indefinite time period”. The UK patient charity Cancer Backup advises using vaginal dilators from two to eight weeks after the end of radiotherapy treatment. Australian guidelines recommend dilation after brachytherapy “as soon as is comfortably possible” and “certainly within four weeks and to continue for three years or indefinitely if possible”. However, dilation is intrusive, uses health resources and can be psychologically distressing. It has also caused rare but very serious damage to the rectum.

Objectives

To review the benefits and harms of vaginal dilation therapy associated with pelvic radiotherapy for cancer.

Search methods

Searches included the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, Issue 4), MEDLINE (1950 to 2008), EMBASE (1980 to 2008) and CINAHL (1982 to 2008).

Selection criteria

Any comparative randomised controlled trials (RCT) or data of any type which compared dilation or penetration of the vagina after pelvic radiotherapy treatment for cancer.

Data collection and analysis

The review authors independently abstracted data and assessed risk of bias. We analysed the mean difference in sexual function scores and the risk ratio for non-compliance at six weeks and three months in single trial analyses. No trials met the inclusion criteria.

Main results

Dilation during or immediately after radiotherapy can, in rare cases, cause damage and there is no persuasive evidence from any study to demonstrate that it prevents stenosis. Data from one RCT showed no improvement in sexual scores in women who were encouraged to practice dilation. Two case series and one comparative study using historical controls suggest that dilation might be associated with a longer vaginal length but these data cannot reasonably be interpreted to show that dilation caused the change in the vagina.

Authors' conclusions

Routine dilation during or soon after cancer treatment may be harmful. There is no reliable evidence to show that routine regular vaginal dilation during or after radiotherapy prevents the late effects of radiotherapy or improves quality of life. Gentle vaginal exploration might separate the vaginal walls before they can stick together and some women may benefit from dilation therapy once inflammation has settled but there are no good comparative supporting data.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

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.