Pelvic radiation therapy

‘Pelvic malignancy’ can mean a malignant growth in your ovaries, uterus, vagina or other area in the pelvic bowl. Cancer naturally comes with its own set of problems.

Radition therapy in the pelvis specifically is troublesome because it affects the functioning of a critical aspect of your fertility and hormones, your ovaries, plus nearby areas like the vagina. Pelvic radiation therapy also affects your fertility. There are several delivery mechanisms for pelvic radiation therapy.

Vaginal brachytherapy – the cylinder

Vaginal brachytherapy is the use of a cylindrical container inserted into the vagina. The length of this cylinder varies, but the upper vagina is always treated, with the radiation mostly affecting just the vaginal tissue that is in contact with the device.

The bladder and rectum get less radiation exposure. This means side effects in the vaginal tissue are greater than for other methods of delivery. There are low-dose rate (LDR) and high-dose rate (HDR) brachytherapy used for endometrial cancers.

LDR cylinders are used daily for up to four days, with you staying still to keep the radiation from moving around during treatment. HDR takes less time, and is more intense, taking less than an hour to complete. Endometrial cancer is treated every day for at least three doses.

External beam radiation therapy

The other delivery method is external beam radiation therapy, beamed into the body from outside, as the name suggests. This is usually given five days in a week for four to six weeks.

You’ll get a special mould so you are sitting in the exact same place for each treatment, so the correct spot is beamed every time. This takes less than 30 minutes, but must be done every day.

The usual side effects for radiation therapy are tiredness, upset stomach or loose bowels, with chemotherapy as an adjunct therapy side-effects worse.

What happens to your vagina during radiation therapy

The vaginal and vulvar tissue are likely to get pink and swell up, looking and feeling a bit like sunburn. This can last for a few weeks, but as the tissue heals, scar tissue may form, and your vagina may become fibrous and thickened.

Sex can be painful, because the tissue isn’t very flexible. This thickening can also cause the vagina to become narrower, and sometimes seem closed up.

Radiation vaginitis

The vagina will probably become irritated, with this being uncomfortable, and a discharge leaking out. This is called radiation vaginitis, and can cause open sores. These sores are usually treated with oestrogen cream.

What happens to your vagina after radiation therapy

Thickening/tightening of the vaginal tissue

The immediate effects of radiation therapy make sex an unlikely proposition at best, however its the long-term effects of radiation therapy that cause the most vaginal problems.

Radiation therapy causes tissues to become less stretchy and more fibrous, causing thickening or tightening of the skin. The vagina can become less stretchy and narrower due to scar tissue formation, which can be an issue for sex: a dry, stiff vagina isn’t ideal for getting hot and slick.

Sometimes the scar tissue forms around the outside of your vagina, narrowing the opening. This can make penetration very painful, and is known as dyspareunia.

Treatment for a narrowed vagina (vaginal stenosis)

This is treated using vaginal dilators to stretch the vaginal tissue out, or in fact regular penetrative sex – three or four times per week is advisable. A combination of dilator and sex can be useful.

Keeping your vagina open isn’t just for sex, so even if you have decided to never have sex again and couldn’t care less, having your vaginal canal open means gynaecological exams and normal movement and function can be maintained. This is important, because sex isn’t the only use for our vaginal canal.

To stop your vagina from narrowing, you will be the proud owner of a pair of vaginal dilators that you will be taught how to use to stop the narrowing.

The dilators come in different sizes, starting off small and getting bigger. This device is used three times per week, for five or 10 minutes each time, with it being advisable to use them with a lubricant to make it less uncomfortable.

After a while, your vagina will be stretched enough to comfortably have sex. A vaginal moisturiser is also recommended.

Having sex regularly is really a great treatment, because the tissues become full of blood and are therefore revitalised in the most natural of ways, hormonally and externally. It will probably take a while to want anyone near you after treatment, but it is important that your vagina is kept open and as active as possible to help prevent closure.

Fistulas can develop, which are tunnels between flesh, particularly between the bowel and vagina.

Pelvic radiation’s impact on your libido

It’s normal to have a loss of sexual desire either during or after treatment, for lots of reasons, though as your body returns to normal balance, physical discomforts and impositions may get in the way. Psychological hindrances can also play a major role in a lack of sexual desire.

Ovarian function and a dry, irritated vagina

The ovaries can stop working properly (or at all) after radiation therapy, sometimes for the short-term, but generally if the ovaries are stopped from working, it’s permanent.

No ovarian function means oestrogen stops flowing, and that often means a dry, irritated vagina, called atrophic vaginitis. Atrophic vaginitis is an oestrogen-loss issue that typically occurs with natural or induced menopause.

  • Younger women get smaller doses of radiation in the pelvis, and ovarian function may be restored.
  • With cervical cancer, the damage is mostly likely to be permanent.
  • Women who undergo pelvic radiation are more than likely going to be infertile
  • Anyone under 50 should be on some form of birth control while undergoing radiation to avoid pregnancy

Because you will be thrown into early menopause, or have already gone through menopause anyway, the lack of oestrogen can cause vaginal dryness and atrophy, known as atrophic vaginitis. Early menopause is treatable with hormone therapy of some kind (locally applied or full HRT). Read more about vaginal atrophy.

There are also alternative options for those of you who don’t tolerate artificial hormone therapy or want to go down a more natural route.

Improving sexual function after radiation treatments

Your sex life going forward is going to need some work, but if you do it right now, it will be worth the effort in the future. Given, there are no guarantees, and some of you will be lucky to get away with your lives, if not your workable vaginas (which you can feel guilty about not feeling grateful for every second of every day).

There are sometimes specialised physical therapists who work with women just like you, and can give you some hints and tips. Radiation therapy does not have to mean the end of a satisfying sex life for everyone, but the sad fact is some women don’t recover satisfying sexual function. There are things you can do to improve your chances, however.

Sex during radiation treatment

It’s possible to have sex during radiation treatment so long as the tumour is not bleeding heavily. Your labia, clitoris and vagina will still feel the same as they used to, and achieving orgasm is technically just as easy as before.

The only interruptions to your sexual function will be any pain, discomfort or bleeding. It is usually advised, however, to let the swelling and irritation go down before attempting sex to reduce tearing of tissues as they heal.

Your lover will not ‘get’ radiation in their body, since the radiation dissipates immediately after treatment, unless you are being treated with an implant that stays inside your body for a few days.

If you have an implant, you will be advised to avoid sex while it is in, however you can resume normal sex after it is out, so long as your doctor approves.

What happens if my vagina is f**ked?

This can and does happen, and if you end up with a vagina that can’t do much of anything, you will need psychological support to help you through. A non-usable vagina can affect relationships and your physical comfort and confidence, and change the way you feel about life.

Learning how to live without your vagina, not just survive to breathe another day, is a worthy goal. Find other women like yourself, talk, cry, grieve, and find ways to manage.

You can still live a happy and fulfilling life without a vagina, but it will be a different life than the one you imagined.

Talk to your doctors about your sex life

Sex and a functioning vagina is important, so don’t leave it out of your conversations with your doctors. If you have questions, write them down and talk them over.

Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)