Dilating the vagina to prevent damage from radiotherapy: systematic review of the literature

BACKGROUND: UK guidelines recommend routine vaginal dilation during and after pelvic radiotherapy to prevent stenosis. OBJECTIVE: To examine critically the evidence behind this guideline. SEARCH STRATEGY: Cochrane-style systematic review of the data and literature relevant to vaginal dilation and stenosis attributable to radiotherapy. SELECTION CRITERIA: Any and every measure of vaginal or sexual function after radiotherapy. DATA COLLECTION AND ANALYSIS: Numerous papers gave recommendations on dilation during or immediately after radiotherapy, but only seven contained relevant data. Case reports describe vaginal fistulas or psychological morbidity. Two trials showed that encouraging dilation increased compliance, but the first trial found no difference in sexual function scores. One comparative unmatched trial showed no advantage from inserting mitomycin C. A report of five women implied that stenosis can be treated by dilation many years after radiotherapy. One uncontrolled observational report involving 89 women showed that the median vaginal length 6-10 weeks after therapy was measured at 6 cm, but women tolerated a 9-cm measurer after 4 months of dilation experience. One retrospective report implied that dilation lowered stenosis rates, but the control group is not comparable. MAIN RESULTS: Dilation during or immediately after radiotherapy can cause damage, and there is no evidence that it prevents stenosis. Dilation might stretch the vagina if commenced after the inflammatory phase. AUTHOR'S CONCLUSIONS: Dilation might help treat the late effects of radiotherapy, but it must not be assumed that this applies to the acute toxicity phase. Routine dilation during treatment is not supported by good evidence.