Vaginal dilator therapy for women receiving pelvic radiotherapy

Abstract

There is no reliable evidence to show that routine, regular vaginal dilation during radiotherapy treatment prevents stenosis or improves quality of life. Several observational studies have examined the effect of dilation therapy after radiotherapy. They suggest that frequent dilation practice is associated with lower rates of self reported stenosis. This could be because dilation is effective or because women with a healthy vagina are more likely to comply with dilation therapy instructions compared to women with strictures. We would normally suggest that a RCT is needed to distinguish between a casual and causative link, but pilot studies highlight many reasons why RCT methodology is challenging in this area.

A Pilot Retrospective Evaluation of Colpofix® Ovules for the Management of Radiation-Induced Vaginal Toxicity in Patients with Mid-Low Rectal and Anal Cancers

“…The temporal pattern recorded in this cohort aligns with the expected course of mucosal recovery after pelvic radiotherapy, in which acute inflammation typically peaks during treatment and gradually resolves in the following months. Within this context, the use of topical formulations containing hyaluronic acid and bioadhesive polymers-such as those included in Colpofix ® Ovules-may offer a biologically plausible supportive approach due to their hydrating and protective properties [14][15][16][17][18]. However, given the study design, the improvements observed here should be interpreted as temporal associations rather than treatment effects.…”

A Pilot Retrospective Evaluation of Colpofix® Ovules for the Management of Radiation-Induced Vaginal Toxicity in Patients with Mid-Low Rectal and Anal Cancers

“…The temporal pattern recorded in this cohort aligns with the expected course of mucosal recovery after pelvic radiotherapy, in which acute inflammation typically peaks during treatment and gradually resolves in the following months. Within this context, the use of topical formulations containing hyaluronic acid and bioadhesive polymers-such as those included in Colpofix ® Ovules-may offer a biologically plausible supportive approach due to their hydrating and protective properties [14][15][16][17][18]. However, given the study design, the improvements observed here should be interpreted as temporal associations rather than treatment effects.…”

Sexual function remains persistently low in women after treatment for colorectal cancer and anal squamous cell carcinoma

“…Referral to gynecology to discuss sexual health is recommended before or during pelvic radiation treatment; vaginal dilators are frequently recommended to prevent vaginal stenosis, although evidence of efficacy is limited. 29 Pelvic floor physical therapy may be helpful for chronic pelvic pain and dyspareunia following treatment. Most patients treated for CRC or ASCC will be in menopause related to age or treatment; vaginal lubricants and vaginal estrogen are safe treatments for vulvovaginal discomfort related to menopause, although efficacy data are limited.…”

Vaginal dilator use more than 9 months is a main prognostic factor for reducing G2‑late vaginal complications in 3D‑vaginal‑cuff brachytherapy (interventional radiotherapy)?

“…described similar results in patients receiving VD therapy [ 29 ]. Despite the lack of more multivariate analyses and the last Cochrane report on VD use being inconclusive, international guidelines recommend their use to reduce vaginal stenosis [ 4 , 30 ]. Nevertheless, the results of our multivariate analysis show that improving compliance with VD is helpful for preventing vaginal stenosis in PEC treated with VBT ± EBRT.…”

A Pilot Retrospective Evaluation of Colpofix® Ovules for the Management of Radiation-Induced Vaginal Toxicity in Patients with Mid-Low Rectal and Anal Cancers

“…The temporal pattern recorded in this cohort aligns with the expected course of mucosal recovery after pelvic radiotherapy, in which acute inflammation typically peaks during treatment and gradually resolves in the following months. Within this context, the use of topical formulations containing hyaluronic acid and bioadhesive polymers-such as those included in Colpofix ® Ovules-may offer a biologically plausible supportive approach due to their hydrating and protective properties [14][15][16][17][18]. However, given the study design, the improvements observed here should be interpreted as temporal associations rather than treatment effects.…”

Sexual function remains persistently low in women after treatment for colorectal cancer and anal squamous cell carcinoma

“…Referral to gynecology to discuss sexual health is recommended before or during pelvic radiation treatment; vaginal dilators are frequently recommended to prevent vaginal stenosis, although evidence of efficacy is limited. 29 Pelvic floor physical therapy may be helpful for chronic pelvic pain and dyspareunia following treatment. Most patients treated for CRC or ASCC will be in menopause related to age or treatment; vaginal lubricants and vaginal estrogen are safe treatments for vulvovaginal discomfort related to menopause, although efficacy data are limited.…”

Vaginal dilator use more than 9 months is a main prognostic factor for reducing G2‑late vaginal complications in 3D‑vaginal‑cuff brachytherapy (interventional radiotherapy)?

“…described similar results in patients receiving VD therapy [ 29 ]. Despite the lack of more multivariate analyses and the last Cochrane report on VD use being inconclusive, international guidelines recommend their use to reduce vaginal stenosis [ 4 , 30 ]. Nevertheless, the results of our multivariate analysis show that improving compliance with VD is helpful for preventing vaginal stenosis in PEC treated with VBT ± EBRT.…”

A Pilot Retrospective Evaluation of Colpofix® Ovules for the Management of Radiation-Induced Vaginal Toxicity in Patients with Mid-Low Rectal and Anal Cancers

“…The temporal pattern recorded in this cohort aligns with the expected course of mucosal recovery after pelvic radiotherapy, in which acute inflammation typically peaks during treatment and gradually resolves in the following months. Within this context, the use of topical formulations containing hyaluronic acid and bioadhesive polymers-such as those included in Colpofix ® Ovules-may offer a biologically plausible supportive approach due to their hydrating and protective properties [14][15][16][17][18]. However, given the study design, the improvements observed here should be interpreted as temporal associations rather than treatment effects.…”

Sexual function remains persistently low in women after treatment for colorectal cancer and anal squamous cell carcinoma

“…Referral to gynecology to discuss sexual health is recommended before or during pelvic radiation treatment; vaginal dilators are frequently recommended to prevent vaginal stenosis, although evidence of efficacy is limited. 29 Pelvic floor physical therapy may be helpful for chronic pelvic pain and dyspareunia following treatment. Most patients treated for CRC or ASCC will be in menopause related to age or treatment; vaginal lubricants and vaginal estrogen are safe treatments for vulvovaginal discomfort related to menopause, although efficacy data are limited.…”

Vaginal dilator use more than 9 months is a main prognostic factor for reducing G2‑late vaginal complications in 3D‑vaginal‑cuff brachytherapy (interventional radiotherapy)?

“…described similar results in patients receiving VD therapy [ 29 ]. Despite the lack of more multivariate analyses and the last Cochrane report on VD use being inconclusive, international guidelines recommend their use to reduce vaginal stenosis [ 4 , 30 ]. Nevertheless, the results of our multivariate analysis show that improving compliance with VD is helpful for preventing vaginal stenosis in PEC treated with VBT ± EBRT.…”