Pelvic Health Physical Therapy: an effective approach to prevent radiation-induced vaginal stenosis.
Pelvic Health Physical Therapy:
an effective approach to prevent radiation-induced vaginal stenosis.
Dr. Alison Ankiewicz, PT
October 11, 2018
Treatments of gynecological cancers as well as anorectal cancers typically involve pelvic radiation therapy or brachytherapy. A commonly observed side effect of RT/BT is vaginal stenosis contributing to painful sexual relations and in time abstinence. Many women are advised on using vaginal dilators after RT/BT to prevent vaginal shortening and stenosis, but women fail to use them due to fear, uncertainty or apprehension of pain.
Pelvic health physical therapy provides an effective and promising intervention for women in a warm and friendly environment. Using dilators independently without specific instruction or attempting to implement dilator use after stenosis has occurred is daunting and at times painful. There is no doubt this condition affects a woman’s psychological state, and to have the expectation of prevention or correction of vaginal stenosis independently limits the carry over or compliance of using vaginal dilators. Pelvic health physical therapy guides a woman to understanding their anatomy of their pelvic floor muscles, vaginal canal and benefits of dilators and appropriate use.
Research supports the efficacy of physical therapy for pelvic floor dysfunction with gynecological cancer survivors (Yang et al). Pelvic health physical therapists educate women on their pelvic floor muscles and tissue and will perform a thorough evaluation to assess each woman's posture and strength and tissue mobility. Education on the purpose of dilators and usage of the appropriate sized dilators in effective comfortable positions will be discussed. Developing a specific protocol with using the dilators, in addition to deep breathing and relaxation, stretching and appropriate strengthening will also be implemented. Progression in dilator width will gradually be introduced.
In some cases manual therapy which provides gentle soft tissue massage and stretching to the pelvic region internally and externally are effective. Instruction in muscle relaxation especially with insertion of dilators will be facilitated. Biofeedback for the pelvic floor muscles is an option to train woman on relaxation with insertion and progression of dilators. Pelvic health physical therapy offices work with woman one-on one and in some cases only one to times a week. Only a few sessions of therapy may be required but working closely with our clients and their physicians, painful sex and vaginal stenosis will be reduced.
Yang, E. J. et al Effect of a pelvic floor muscle training program on gynecological cancer survivors with pelvic floor muscle dysfunction: A randomized controlled trial. Gynecological oncology 2012, 125: 705-711.