From the Guidelines
Vaginal stenosis, a narrowing of the vaginal canal, can occur after radiation therapy, surgery, or certain medical conditions, and transplant therapy is not a standard treatment for this condition. The primary treatments for vaginal stenosis include vaginal dilator therapy, which should be started early after radiation treatment and continued regularly, as recommended by the NCCN guidelines 1. Patients should use dilators of gradually increasing sizes for 5-10 minutes, 3-4 times weekly for at least 12 months or indefinitely. Some key points to consider in the management of vaginal stenosis include:
- Vaginal moisturizers and lubricants like Replens or K-Y Jelly can help manage symptoms, as noted in the NCCN guidelines 1.
- Topical estrogen therapy (such as Estrace cream 0.01%, 0.5-1g applied vaginally 2-3 times weekly) may be beneficial for postmenopausal women without contraindications, as supported by studies 1.
- Regular sexual activity can also help maintain vaginal patency.
- For severe cases unresponsive to conservative measures, surgical interventions like vaginoplasty might be considered, as mentioned in the NCCN guidelines 1. Early intervention is crucial as stenosis can lead to sexual dysfunction, difficulty with gynecological examinations, and psychological distress, highlighting the importance of regular follow-up with healthcare providers to monitor progress and adjust treatment as needed 1. It is also important to note that pelvic floor muscle training may improve sexual pain, arousal, lubrication, orgasm, and satisfaction, as found in a small study of 34 survivors of gynecologic cancers 1. Additionally, vaginal androgens (ie, DHEA) can be considered for vaginal dryness or pain with sexual activity, although the evidence for their effectiveness is limited 1. Overall, the management of vaginal stenosis requires a comprehensive approach that addresses the physical, emotional, and psychological aspects of the condition, and healthcare providers should be aware of the various treatment options available to provide optimal care for their patients.
From the Research
Vaginal Stenosis and Transplant Therapy
- Vaginal stenosis is a common side effect of pelvic radiotherapy for gynecological cancer in women, with a high incidence variability due to unstandardized and subjective assessment methods 2.
- Vaginal dilator therapy is used to increase vaginal length and width, and to prevent or treat stenosis after vaginal surgery, and is an effective therapy for vaginal stenosis 3, 4.
- However, low compliance rates have been noted with vaginal dilator use, and the lack of an objective measure of vaginal stenosis can be a predisposing factor for uncertain incidence rates and impaired compliance to vaginal dilator therapy 2.
- A randomized clinical trial found that women who used vaginal dilators had a lower frequency and severity of vaginal stenosis assessed by the CTCAE scale after one year of treatment 5.
Treatment Options
- Topical estrogen, testosterone, and vaginal dilator therapy have been studied as options to prevent vaginal stenosis after radiotherapy in women with cervical cancer 5.
- A study found that topical estrogen therapy improved sexual function on the vaginal dryness and dyspareunia domains in a statistically significant manner, but did not have an impact on diminished sexual desire or activity 6.
- Vaginal dilator therapy has been shown to be effective in preventing radiation-induced vaginal stenosis, but there is no standard protocol for its use 4.
Compliance and Outcomes
- Compliance to vaginal dilator use is a significant issue, with high dropout rates during follow-up and no consensus on starting time or ideal usage 2.
- A systematic review found that few unstandardized objective methods are used to evaluate vaginal stenosis, and that the lack of an objective assessment method can be a predisposing factor for uncertain incidence rates and impaired compliance to vaginal dilator therapy 2.
- Prospective efforts to monitor and measure outcomes of patients who are prescribed vaginal dilator therapy are needed to guide practice 4.