Changes to the vagina

Treatments for vulvar cancer can also affect the vagina. Radiation therapy targeted to the vulva can make the area tender during treatment and for a few weeks afterwards. Over time, this irritation can cause scarring, which may make the vagina drier, narrower, shorter and less flexible (vaginal stenosis).

Surgery for vulvar cancer may cause scar tissue to form around the outside of the vulva, narrowing the entrance to the vagina. This can make penetration during sex painful.

Changes to your body can affect the way you feel about yourself (your self-esteem) and make you feel self-conscious. You may feel less confident about who you are and what you can do. Try to see yourself as a whole person (body, mind and personality) instead of focusing on the parts that have changed.

Tips for managing changes to the vagina

• It is important to keep the vagina open and supple, even if you don’t plan to be sexually active. As well as making sexual intercourse more comfortable, it makes it easier for your doctor to do regular cervical screening tests as well as vaginal examinations to check whether the cancer has come back.
• If cancer treatment has narrowed or shortened the vagina, you may be advised to use vaginal dilators to help keep the vagina open and prevent it from closing over.
• Vaginal dilators are tube-shaped devices made from plastic or silicone. They come in different sizes. Begin with the smallest and move to larger ones as each size becomes more comfortable.
• Make sure any soreness or inflammation has settled before you start using the first dilator. This is usually 2–6 weeks after treatment ends.
• Find a quiet, private place. Using a water-based lubricant, slowly insert a dilator into the vagina and leave it there for 5–10 minutes. You will need to do this 3–5 times a week, usually for many months.
• Using dilators can be challenging. Your nurse, doctor or pelvic floor physiotherapist will give you more detailed instructions about when and how to start using them. They will also provide the dilators or let you know where to buy them.
• Ask your doctor if applying a hormone cream or a vaginal moisturiser will help with vaginal discomfort and dryness. Hormone creams are available on prescription, while vaginal moisturisers are available over the counter from pharmacies.
• Some people like to use vibrators (available from sex shops and online) to gradually widen the vagina. Talk to your treatment team if you would prefer to use vibrators.
• Although dryness, shortening and narrowing of the vagina can make sexual intercourse uncomfortable or difficult, having sex regularly – if you are able to and want to – may help keep the vagina open.
• Extra lubrication may make sexual intercourse more comfortable. Choose a water- based or silicone-based gel without perfumes or colouring. See more tips on managing sexual changes.
• If you don’t have a sexual partner or don’t feel emotionally or physically ready to have sexual intercourse, talk to your doctor about using dilators to keep your vagina open.

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