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Pelvic & Vaginal Pain After Cancer Treatment

by Amanda Olson, DPT, PRPC

Many types of cancer require treatment that result in changes to the vaginal tissue and pelvic floor muscles. Gynecological cancers can require surgery, radiation to the pelvis and genitalia, and often chemotherapy. Likewise, breast cancer can be linked with gynecological cancer and often hysterectomy and hormone suppression therapy is a component of breast cancer treatment.

Hysterectomy and hormone suppression therapy result in immediate changes to the vaginal tissue. As estrogen is suppressed, the vaginal tissue receives less blood flow resulting in atrophy, dryness, and irritation. Radiation treatment to the pelvis and genitals can result in stenosis or narrowing of the vaginal or rectal canal. All of these treatments can result in atrophy of the pelvic floor muscles which can result in urinary incontinence and pain, particularly during sexual intercourse.

The good news is that there are remedies and treatments available to help restore the health of the vagina and pelvic floor muscles. Use of a vaginal or vulvar balm is highly recommended to moisturize the vulvar skin and vagina. Depending on your medical history, your doctor may deem it safe to use a certain form of estrogen cream. If this is not an option, other vaginal moisturizers can be helpful. Naturally made products help to reduce irritation and soothe dry, itchy, red, or irritated skin around the vaginal opening due to hormone changes, skin sensitivity, shaving, waxing, or pain after sex.

To address vaginal pain and difficulty with penetration, vaginal dilators are recommended. These medical devices come in various forms and materials for different purposes. For example, silicone dilators allow for gentle and progressive training of the vaginal tissue.

How to Use Vaginal Dilators

Dilators to treat Vaginal Pain and Pain with Sex

Vaginal dilators, also referred to as vaginal trainers, are used to restore vaginal width, depth, length and overall elasticity of the vagina. These devices allow for penetration for medical exams or sexual activity in women who have undergone cancer treatment. They are also useful for women experiencing other forms of pelvic floor dysfunction including pelvic muscle spasms. These devices are commonly recommended by a doctor or pelvic floor physical therapist after cancer treatments such as radiation, chemotherapy, and surgery.

Vaginal dilators are used to gently train the body- both the brain and the pelvic floor muscles to relax to allow penetration during sex. Dilator sizes vary to allow women to start where they are from smaller than a pinky finger to several inches wide and long to allow them to reach their goals for pain free penetration.

Dilator training should be done by using the following steps:

  1. Select a vaginal dilator that looks appropriate for you or that a health care provider has suggested.
  2. Wash the dilator with warm water and soap.
  3. Use one to two tablespoons of lubricant on the dilator. Water based lubricant is important to use on medical grade silicone dilators.
  4. Start your session lying on your back with your knees bent and feet planted. Some people may prefer to lie on their side instead or in the hands and knees position. The most important thing is to find a position that is comfortable that allows you to relax.
  5. Begin your training by breathing in and allowing your belly to expand, followed by exhaling and allowing your belly to slowly fall. The act of slowly exhaling can naturally open the vagina. Repeat the deep breathing pattern and continue to do so steadily and deliberately. Gently bring the vaginal dilator to the opening of the vagina and carefully insert.
  6. Keep the vaginal dilator inserted in the vagina and repeat the slow, deep breathing cycle for fifteen to twenty minutes or the length of time recommended by your healthcare provider.

If you experience discomfort, visual imagery is helpful for relaxing the pelvic floor muscles around the "imagine that the vagina is like an umbrella, opening and expanding," or "imagine that the vagina is like an elastic band, flexible and mobile”.

Dilator training should not be painful. Mild discomfort during the stretching process is expected, but pain should never reach beyond a 2/10 where “0” is no pain at all and 10 is pain so excruciating that you need to go to the emergency room. It is also important to know that progressing from one dilator to the next can take time- sometimes several weeks in between. The progress will be slow and steady, and you will reach your goals. Give yourself grace and patience.

To find products mentioned in this article and for resources on dilator training visit

To find a Pelvic Physical Therapist in your area visit;

Written by Amanda Olson, DPT, PRPC, Certified Pelvic Floor Physical Therapist
President and Chief Clinical Officer at Intimate Rose


Learn more about how to thrive sexually during and after cancer in your personalized Wellness Plan. Learn more and start your journey to sexual wellness in the Rosy App today!

Dr. Amanda Olson is a dedicated and passionate Doctor of Physical Therapy specializing in pelvic floor health. She is also the pelvic expert behind Intimate Rose, a women’s health brand working to improve the health of women worldwide. She is the author of the book Restoring the Pelvic Floor for Women.