Engineering Polymeric Biomaterials for Radiation-Induced Vaginal Injury After Cervical Cancer Therapy: Pathobiological Basis, Material Strategies, and Future Perspectives

Radiation-induced vaginal injury is an underrecognized complication of cervical cancer radiotherapy and evolves through a pathological continuum involving epithelial depletion, oxidative stress, chronic inflammation, microvascular dysfunction, extracellular-matrix remodeling, fibrosis, loss of tissue compliance, and vaginal stenosis. Current management remains largely supportive and is constrained by short local residence, limited anatomical adaptability, variable adherence, and insufficient control of radiation-specific tissue damage. This Mini-Review examines polymeric biomaterials for the prevention and repair of radiation-induced vaginal injury from a pathobiology–material–function perspective. Three complementary strategies are discussed: local polymeric formulations and mucoadhesive hydrogels for mucosal protection and sustained delivery; personalized dilators, stents, and adaptive devices for maintaining vaginal patency; and regenerative scaffolds and tissue-engineered constructs for restoring epithelial, vascular, stromal, and smooth-muscle compartments. Conventional hyaluronic-acid formulations have progressed furthest clinically, whereas responsive hydrogels, shape-adaptive devices, extracellular-matrix-derived materials, and cell- or exosome-based scaffolds remain predominantly preclinical. Importantly, much of the evidence derives from acute irradiation models, non-irradiated reconstruction studies, or engineering prototypes and therefore does not yet demonstrate durable reversal of chronic fibrosis or stenosis. Future development should prioritize stage-specific multifunctional interventions, fractionated irradiation models, standardized structural and functional outcomes, and rigorous oncological safety assessment. Acellular hydrogels, cell-free hybrid scaffolds, and removable drug-eluting devices may offer the most practical near-term translational routes.