The impact of vaginal dilator use on vaginal stenosis and sexual quality of life in women treated with adjuvant radiotherapy for endometrial cancer

  • Sati Akbaba
  • Jan T. Oelmann-Avendano
  • David Krug
  • Nathalie Arians
  • Tilman Bostel
  • Juliane Hoerner-Rieber
  • Nils H. Nicolay
  • Juergen Debus
  • Katja Lindel
  • Robert FoersterEmail author
Original Article



Despite a lack of evidence and low compliance, current guidelines recommend the use of a vaginal dilator (VD) after pelvic radiotherapy (RT). We analyzed the effect of VD on vaginal stenosis (VS) and its influence on sexual quality of life (QoL) in women treated with adjuvant RT for endometrial cancer (EC).


Between 2014 and 2015, 56 consecutive patients were instructed to use a VD after completion of treatment. The maximum diameter of the comfortably introducible VD was measured before and at 1 year after treatment. The degree of VS was evaluated clinically, and sexual QoL was assessed with the European Organisation for Research and Treatment of Cancer (EORTC) sexual functioning items before RT, during RT, at 6 weeks, and at 1 year after RT.


One year after RT, mean VD diameter had decreased by 2.7 ± 3.2 mm (p < 0.001) and 36 patients (64.3%) had clinical VS (grade I–III). A larger decrease in VD diameter correlated with a higher degree of clinical VS (p < 0.001). VD use (p = 0.81), RT modality (p = 0.68), and adjuvant ChT (p = 0.87) had no influence on VD diameter. Sexual activity decreased during RT and increased beyond pre-RT values 1 year after RT (p < 0.001). Sexual enjoyment decreased continuously during and after completion of RT (p = 0.013) and was influenced negatively by a higher degree of clinical VS (p = 0.01).


Almost two thirds of patients developed clinical VS 1 year after adjuvant RT for EC, and sexual enjoyment was substantially reduced by VS. The use of a VD after RT may not serve to prevent sexual impairments and VS.


Endometrial cancer Radiotherapy Sexual quality of life Vaginal stenosis Vaginal dilator 

Einfluss der Anwendung eines Vaginaldilatators auf Vaginalstenose und sexuelle Lebensqualität nach adjuvanter Radiotherapie bei Frauen mit Endometriumkarzinom



Trotz fehlender Evidenzlage und geringer Compliance empfehlen die aktuellen Leitlinien die Anwendung eines Vaginaldilatators (VD) nach pelviner Radiotherapie (RT). Wir analysierten den Effekt eines Vaginaldilatators auf die Vaginalstenose (VS) und auf die sexuelle Lebensqualität (QoL) bei Frauen mit Endometriumkarzinom (EC) nach erfolgter adjuvanter RT.


Zwischen 2014 und 2015 wurden 56 Patientinnen instruiert, einen VD nach Beendigung der RT zu benutzen. Der maximale Durchmesser des am angenehmsten einführbaren VD wurde vor und 1 Jahr nach Therapie gemessen. Die Ausprägung der VS wurde 1 Jahr nach Therapie klinisch erfasst und die sexuelle QoL anhand der von der European Organisation for Research and Treatment of Cancer (EORTC) vorgegebenen sexuellen Funktionsfragen vor, während, 6 Wochen und 1 Jahr nach RT bestimmt.


Der mittlere VD-Durchmesser nahm 1 Jahr nach RT um 2,7 ± 3,2 mm ab (p < 0,001). Bei 36 Patientinnen (64,3%) konnten wir klinisch eine VS (Grad I–III) feststellen. Hierbei nahm der VD-Durchmesser mit höherer klinischer Ausprägung der VS ab. Die Anwendung des VD (p = 0,81), die RT-Modalität (p = 0,68) und eine adjuvante Chemotherapie (p = 0,87) hatten keinen Einfluss auf den VD-Durchmesser. Zudem nahm die sexuelle Aktivität während RT ab und stieg nach RT über den Ausgangswert hinaus (p < 0,001). Das sexuelle Vergnügen nahm kontinuierlich während und nach Beendigung der RT ab (p = 0,013) und korrelierte negativ mit einem höheren Grad an klinischer VS (p = 0,01).


Nahezu ein Drittel der Patientinnen entwickelten 1 Jahr nach adjuvanter RT eine VS und die sexuelle Lebensqualität zeigte sich aufgrund der VS beträchtlich reduziert. Durch Anwendung des VD nach RT können eine VS und die Verschlechterung der sexuellen Funktionalität möglicherweise nicht vermieden werden.


Endometriumkarzinom Radiotherapie Sexuelle Lebensqualität Vaginalstenose Vaginaldilatator 



We thank our Gynecologic Research Group members for their great effort.

Compliance with ethical guidelines

Conflict of interest

S. Akbaba, J.T. Oelmann-Avendano, D. Krug, N. Arians, T. Bostel, J. Hoerner-Rieber, N.H. Nicolay, J. Debus, K. Lindel, and R. Foerster declare that they have no competing interests.

Ethical standards

This study was approved by the independent ethical committee of the University of Heidelberg, Germany, on 21st of June 2016 (#S-269/2016) and was conducted with the Helsinki Declaration of 1975 in its most recently amended version. The requirement of informed consent was waived by the ethical committee due to the retrospective nature of this study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Sati Akbaba
    • 1
    • 2
  • Jan T. Oelmann-Avendano
    • 1
    • 2
  • David Krug
    • 1
    • 2
    • 4
  • Nathalie Arians
    • 1
    • 2
  • Tilman Bostel
    • 1
    • 2
    • 5
  • Juliane Hoerner-Rieber
    • 1
    • 2
  • Nils H. Nicolay
    • 1
    • 2
    • 3
    • 6
  • Juergen Debus
    • 1
    • 2
    • 3
  • Katja Lindel
    • 1
    • 2
    • 7
  • Robert Foerster
    • 1
    • 2
    • 8
    Email author
  1. 1.Department of Radiation OncologyUniversity Hospital HeidelbergHeidelbergGermany
  2. 2.Heidelberg Institute for Radiation Oncology (HIRO)National Center for Radiation Research in Oncology (NCRO)HeidelbergGermany
  3. 3.Cooperation Unit Radiation OncologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
  4. 4.Department of Radiation OncologyUniversity Hospital Schleswig-HolsteinKielGermany
  5. 5.Department of Radiation OncologyUniversity Hospital MainzMainzGermany
  6. 6.Department of Radiation OncologyFreiburg University Medical CenterFreiburgGermany
  7. 7.Department of Radiation OncologyStaedtisches Klinikum KarlsruheKarlsruheGermany
  8. 8.Department of Radiation OncologyUniversity Hospital ZurichZurichSwitzerland

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