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What is the right way to use vaginal dialator after hysterectomy done for uterine cancer?

Mar 2013
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Practicing since : 1998
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I was diagnosed with uterine cancer and have since had a full hysterectomy including ovaries and tubes and was found to be Grade 1, Stage 2 - then had 24 treatments of external radiation and 2 internal treatments. My frustration is that I do not know if I am using a vaginal dilator properly - I am 58 and have never been sexually active - I found the 2 internals extremely painful to the point that the oncologist was willing to delay the second, but I encouraged her to continue because if it had been delayed, I do not think I would have had the second. I am following the instructions and believe that I am pushing it in as far as it will go, but I do not know - if I pushed too far could I cause damage? Yes it hurts but I do not get any pinkish discharge - I have my first follow up exam coming and what would happen if a pap test is required and it could not be done?
Posted Sun, 29 Dec 2013 in Women's Health
Answered by Dr. Aarti Abraham 52 minutes later
Brief Answer: DETAILED BELOW Detailed Answer: Hello Thanks for writing to us with your health concern. After the internal radiation, scar tissue tends to cause fibrosis, and apposition ( closure ) of the vaginal walls. A dilator is recommended for women post radiation, as you very well know. It takes time to get used to it, most women take 8 - 12 weeks to adjust to dilator use. Spotting is not always a norm, but might occur occasionally. If you haven't had it, by no means does it indicate that you are not using it optimally. You should try to let it go in , but not push it overtly. If pushed too far, it might damage the vaginal vault ( place where the vaginal wall has been stitched up ). ALso, using a water based jelly and lying down in a tub of lukewarm water while placing the dilator will help. There is always something called an ' adjustment phase ' - generally around 8 - 12 weeks, when you get physically and emotionally used to the use of the dilator. Would you let me know how long you have been using it. If it is going in to a certain extent, it is good enough ( more than half is fine too ) Regular sexual intercourse will also help you insert it easily. Generally, if you can insert more than two fingers inside your vagina, do not worry about stenosis. If stenosis occurs, then yes, regular surveillance of the vaginal vault would not be possible. It would be extremely difficult to diagnose a recurrence. If the vagina gets completely stenosed, then a Pap smear would not be possible. With partial stenosis, a smear might be attempted. In case the vagina DOES get stenosed, then surveillance would be only by a pelvic exam ( done rectally ) and regular ultrasound scans. This is never as satisfactory as regular Pap smears, so you should be highly motivated for dilator use. If it is not painful, let the entire dilator go in ( almost all of it - especially if it has been tailored and prescribed for your remnant vaginal length ). Do not worry about causing damage, because only pushing it very hard can cause this. For women in whom dilator use fails / non compliant women - options are hormonal creams ( again with attendant risks ) and as a last resort, surgery to treat vaginal adhesions. I would suggest that you give yourself time and continue to use it with dedication. Over weeks, you would surely adjust. All the best Please feel free to ask for further clarifications.
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