Prevention of vaginal stenosis in patients following vaginal brachytherapy

The assessment of patients following intracavitary irradiation administered as part of the treatment of gynaecological malignancy reveals vaginal sten osis in the majority. Vaginal dilators are available for daily insertion in an attempt to prevent the formation of adhesions. However, the design of t he dilator neglects the fact that the vagina is the most distensible in the upper third and hence many patients develop stenosis of the upper vagina. Many clinicians have abandoned the use of dilators and instead advise patie nts to have sexual intercourse to prevent the problem. In 1994, we designed a new vaginal stent, which was given to all patients w ho had received intracavitary irradiation with full instructions about its use. This stent was designed to suit better the true anatomy of the vagina and hence, with correct use, should prevent vaginal stenosis. A retrospecti ve study was undertaken to look at the incidence of vaginal stenosis and th is was compared with the incidence in patients using the new stent. The study revealed that 57% of the patients who were advised to have sexual intercourse had stenosis, whereas 11% of the patients using the stent had evidence of stenosis, which, however, was related to their incorrect use of the stent. In those who used the stent correctly there was no evidence of vaginal stenosis. Details of the design of the stent and the problems relat ing to those who used the stent incorrectly are presented. The findings of this study strongly support the continued use of this vagin al stent in patients who have undergone intracavitary irradiation as a mean s of preventing this common complication.