Literature Review of Vaginal Stenosis and Dilator Use in Radiation Oncology

Abstract Background Guidelines for the care of women undergoing pelvic radiation therapy (RT) recommend vaginal dilator therapy (VDT) to prevent radiation-induced vaginal stenosis (VS), however, no standard protocol exists. This review seeks to update our current state of knowledge concerning VS and VDT in radiation oncology. Methods A comprehensive literature review (1972-2017) was conducted using search terms “vaginal stenosis,” “radiation” and “vaginal dilator.” Information was organized by key concepts including VS definition, time course, pathophysiology, risk factors and interventions. Results VS is a well described consequence of pelvic RT, with early manifestations as well as late changes evolving over several years. Strong risk factors for VS include RT dose and volume of vagina irradiated. Resultant vaginal changes can interfere with sexual function and correlational studies support the use of preventive VDT. The complexity of factors which drive non-compliance with VDT is well recognized. There is no prospective data to guide optimal duration of VDT and the consistency with which radiation oncologists monitor VS and manage its consequences is unknown. Conclusions This review provides information concerning VS definition, pathophysiology and risk factors and identifies domains of VDT practice which are under-studied. Prospective efforts to monitor and measure outcomes of patients who are prescribed VDT are needed to guide practice.