Vaginal stenosis

Common indicators of vaginal stenosis include pain and bleeding during sexual intercourse along with other types of sexual dysfunction. Severe forms of vaginal stenosis can be associated with a complete inability to participate in sexual intercourse. Atrophy, scarring, and damage to the vaginal tissue due to vaginal stenosis can lead to dryness, inflammation, and decreased elasticity of the tissue. Lasting effects of vaginal stenosis could include impacts on psychological well-being in addition to physical limitations. Symptoms can worsen from post treatment ovarian failure or menopausal status, leading to reduced lubrication and increased thinning of the vaginal tissue. == Causes ==

Radiation-induced Uterine, vaginal, anal, rectal and cervical cancers are often treated with pelvic radiation therapy (RT), most commonly external beam radiation therapy (EBRT) or brachytherapy. It is one of the most prevalent side effects, affecting about one third of people undergoing pelvic radiation therapy. Radiation-induced stenosis can be a late reaction to treatment. Damage to the vaginal epithelium causes abnormal collagen production that leads to atrophy, loss of muscle, decreased blood flow, hypoxia, and fibrosis. Pallor, adhesions, and fragility can be observed along with loss of elasticity. Surgical procedures Several types of surgical procedures are hypothesized to cause vaginal stenosis. Episiotomies, which are surgical incisions sometimes used to assist childbirth, can lead to narrowing of the vaginal opening and long-term dyspareunia. There is approximately 13% chance of experiencing dyspareunia for at least 6 months after having undergone a routine episiotomy. When the tissue from the episiotomy does not heal properly, complications can include mucosal damage and scarring, which can contribute to the development of vaginal stenosis. Vaginal stenosis is the most common post-operative complication in people with congenital adrenal hyperplasia who have had genital reconstructive surgery in infancy or childhood. Vaginal stenosis can be an immediate complication or may arise later in adolescence. == Diagnosis ==

There are currently several grading scales that exist to assess vaginal stenosis but none have been well established. Two common grading scales are the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE) v4.0 and the Late Effects in Normal Tissues-Subjective, Objective, Management and Analytic Score (LENT-SOMA). These subjective parameters in combination with the variety of different grading scales used, cannot be interchanged in clinical practice. == Treatment ==

Vaginal Dilator Therapy (VDT) Stenosis of the vagina is typically treated with vaginal dilator therapy (VDT), but evidence is lacking for its efficacy. Vaginal dilators are smooth, cylindrical-shaped devices that promote stretching and relaxation of the vaginal tissue. Vaginal dilator therapy requires a consistent routine and may cause physical and/or psychological discomfort, which makes adherence to treatment difficult. Although there is no high level evidence, many guidelines and reviews suggest the use of vaginal dilator therapy after pelvic radiation therapy. Hyaluronic acid helps treat vaginal stenosis by retaining moisture to promote vaginal tissue repair. There are currently no known contraindications and is commonly used in clinical practice due to its high safety profile. There are limited studies around vaginal estrogen therapy in people with radiotherapy-induced vaginal stenosis due to concerns around an increased risk of tumor recurrence. Similarly, there has been one study conducted that suggests people treated with high dose radiation therapy have a lower likelihood of responding to estrogen treatment. == Epidemiology ==

The reported incidence of radiotherapy-induced vaginal stenosis varies widely, ranging from 1.2% to 88%. == See also ==