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Side effects of radiotherapy for vaginal cancer

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This page is about the side effects of radiotherapy for vaginal cancer. There is information about

 

A quick guide to what's on this page

Side effects of radiotherapy for vaginal cancer

During your treatment course, and for a few weeks afterwards, you may have diarrhoea and may need to pass urine often. You may also have some pain or discomfort when you pass urine. These effects on the bladder are called radiation cystitis. You may also have skin soreness in the genital and groin area, or sickness. If you have diarrhoea or sickness, ask your doctor or nurse for medicine to help control it. If you have cystitis, try to drink plenty of fluids because this will help to reduce it.

Your skin is likely to become sore during your course of treatment. It may break or split. It is very important to tell your nurse, radiographer or specialist if your skin gets sore. You may need steroid cream to put on. You should also have painkillers if you need them.

Long term side effects

Long term side effects are effects that start months or years after treatment. Possible side effects include

  • An early menopause, because your ovaries stop working – you can have hormone replacement therapy if this happens
  • A narrower, drier and less stretchy vagina – you may be able to stretch your vagina with dilators
  • Swelling in the legs, called lymphoedema
  • Needing to pass urine more often
  • Loose and frequent bowel movements
  • Weakening of the bones in the pelvic area
  • Loss of fertility in young women

 

CR PDF Icon You can view and print the quick guides for all the pages in the treating vaginal cancer section.

 

 

Immediate side effects

During your treatment course, and for a few weeks afterwards, you may have

Diarrhoea

If you have diarrhoea, ask your doctor for medicines to help control it. Drink plenty of fluids to replace the liquid you have lost. 

Discomfort when passing urine and needing to pass it often

The radiotherapy can make the lining of the bladder inflamed. This is called radiation cystitis. It can make you feel very uncomfortable. You may have a lot of bladder pain and feel as though you need to pass urine all the time, even though you know you’ve only just been. Try to drink plenty of fluids because this will help. 

Skin soreness

Your skin in the radiation area is likely to become sore during your course of treatment. Although radiotherapy machines used these days generally cause less soreness than they used to, it is difficult to avoid it in such a sensitive body area. In mild cases, you may just have some soreness and reddening, similar to mild sunburn. If you get a more severe reaction, your skin may actually break down and weep.

Remember not to put any lotions, powders or creams on the skin in the treatment area without checking first with your radiotherapy department. If you have any soreness, the powders or creams may make things worse. Ask the staff in the radiotherapy department and they will give you something to soothe your skin if you need it.

Your nurse, radiographer or specialist will need to help you look after the area and try to make sure you don’t get an infection. You may need steroid cream to put on. Your doctor may also prescribe painkillers if the area is very sore. If your skin reaction is very bad, your treatment may be delayed for a week or two to allow you to recover.

Sickness

Sickness isn't very common with radiotherapy to the lowest part of the tummy (abdomen). If you do feel sick, do tell your radiographer, nurse or doctor. They can arrange for you to have anti sickness tablets to take before your treatment.

All these side effects usually disappear within a few weeks of finishing your treatment. There is detailed information about all the effects mentioned here in the section about radiotherapy side effects to the abdomen.

 

Long term side effects

Long term side effects are sometimes called late effects because they can start months or years after your treatment. Radiotherapy to the pelvis and vagina may cause some

Swelling of your legs and groin

Generally, radiotherapy tends to make body tissues in the treatment area less stretchy and more fibrous. You may have tightening or thickening of the skin.

One or both legs can swell if the radiotherapy affects the lymph nodes in the groin and stops fluid from being able to drain out of the legs. The swelling is called lymphoedema. In advanced vaginal cancer, this swelling is sometimes caused by the cancer, rather than treatment. If you think you are developing swelling, tell your specialist or your nurse straight away. They can refer you to a lymphoedema specialist for assessment. The sooner it is diagnosed, the easier lymphoedema is to treat. We have information about lymphoedema and its treatment.

Changes in your reproductive system

After your treatment you will find that your

  • Ovaries stop working, causing an early menopause
  • Vagina becomes less stretchy and narrower
  • Vaginal area becomes drier

If you had not had your menopause before treatment, the radiotherapy will stop your ovaries working. You will have an early menopause. You can take hormone replacement therapy (HRT) to replace the hormones that the ovaries made. But you will no longer be able to have children and this can be very difficult if you are young and had hoped to have a family. There is information about the effects of pelvic radiotherapy on fertility and your sex life in the radiotherapy side effects section. 

Radiotherapy can make scar tissue form. Scar tissue is more fibrous than healthy tissue. This means it is stiffer and less stretchy. If scar tissue forms around the outside of your vagina, it may narrow the entrance. You may then find that penetrative sex can be painful.

To prevent narrowing, your specialist nurse will teach you to stretch the vaginal opening with dilators. You usually start using them between 2 to 8 weeks after your radiotherapy ends, depending on the practice of your radiotherapy centre. The dilators are smooth cone shaped objects that you put into your vagina to stretch it. They come in sets of different sizes. You use them 3 times a week, for 5 to 10 minutes each time. You use them with a water soluble gel, such as Astroglide or Durex lube or KY jelly. You begin with one of a comfortable size and gradually use larger ones until your vagina is stretched enough for you to have sex comfortably. Your doctor, nurse or radiographer can give you a set of dilators. Moisturisers such as Replens can also help, you use these 2 or 3 times a week.  

If you are sexually active, you might like to involve your partner in using the dilators or have regular sexual intercourse. It is normal not to feel like sex for a while after treatment, so don't worry if you wait for a while. But it is important that your vagina is kept open. And there are gels and creams available to help reduce vaginal dryness. Ask your nurse about these.

There is information about these side effects and how to deal with them in the section about sex and fertility for women after radiotherapy.

Changes to your bladder or bowel

The treatment can make the bladder less elastic. It won't stretch as far and feels full sooner. So you may find that you have to pass urine more often. This doesn't happen to everyone, but it isn't possible to tell before your treatment who will have these effects and who won't.

You may have loose bowel motions and they may be more frequent. This is because the radiotherapy irritates the lining of the bowel. Tell your doctor if you have these side effects. You may be able to take medicine to firm up your bowel motions and make them less frequent.

Sometimes, radiotherapy to the pelvis can cause bleeding, which will show up in your bowel movements or urine. Over a period of months or years, the radiotherapy causes an overgrowth of small blood vessels. These are often near the skin surface, which can be delicate. So they are more likely to bleed. This can be worrying, but it is not often serious. If you notice this, do tell your doctors so they can check that the bleeding isn't caused by anything else. The delicate blood vessels are called telangiectasia (pronounced tell-an-gee-ek-tay-zee-ah).

Effects on pelvic bones

The radiotherapy may cause tiny cracks in the bones over many years. This can cause pain in the pelvic area or stiff hip joints. Let your doctor or specialist nurse know if you have pain in your pelvic bones. Very rarely, the pelvic bones may develop a break (fracture), which may need to be repaired with surgery.

 

If you have severe side effects

Very rarely, where immediate side effects are particularly severe, your doctor may want to stop treatment to allow you to recover. If you are troubled by short term or long term side effects, do speak to your radiographer, nurse or specialist. They will be able to help you.

The Pelvic Radiation Disease Association might be able to help you manage long term side effects of pelvic radiotherapy.

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Updated: 14 October 2013