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Obstetrics and Gynegology2023№12
Vaginal dilaters in the prevention...

Vaginal dilaters in the prevention and treatment of stenosis and vaginal pain syndromes

DOI
https://dx.doi.org/10.18565/aig.2023.296

Dikke G.B., Ostromenskiy V.V., Shcherbatykh E.Yu.

F.I. Inozemtsev Academy of Medical Education, Saint Petersburg, Russia

This article presents up-to-date information on the use of vaginal dilators in gynecology, taking into account the indications for their use and effectiveness. 
The findings of 36 articles found in the databases Medline, Scopus, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, eLibrary were analyzed over the period 2014–2023 using keywords.
The results of the analysis showed that there are the following indications for the use of vaginal dilators: condition after radiation therapy for cancer of the vulva, cervix, uterus, anogenital area (high risk of vaginal stenosis); scars/stenosis after episiotomy or perineal rupture during childbirth, vaginoplasty surgery (neovagina, vaginal hypoplasia/agenesis, or Mayer–Rokitansky–Küster–Hauser syndrome); dyspareunia, vaginismus, vulvodynia, sclerosing complications of skin diseases of the external genitalia (sclerotic lichen, lichen planus). The use of vaginal dilators is effective in 75–81% of patients for the prevention of vaginal stenosis after radiation therapy for cancer of the genitalia and anogenital area; it is effective in the treatment of hypoplasia/agenesis of the vagina in 75%, and is also effective in stenosis caused by sclerotic lichen and lichen planus. The success of therapy depends on informing and educating patients.
Conclusion: The analysis of studies published over the past 10 years has shown the possibility of using vaginal dilators for various diseases, in particular for the prevention of vaginal stenosis after radiation therapy in patients treated for gynecological cancer, postpartum injuries, after gynecological operations on the vulva and vagina, as well as for stenosis caused by sclerotic lichen and lichen planus. Informing and educating patients influence the success of therapy. The use of vaginal dilators should become more widespread in clinical practice.

Authors’ contributions: Dikke G.B. – developing the design of the study, selection of publications on the subject of the article, analysis of the obtained data, writing the text of the manuscript; Ostromenskiy V.V., Shcherbatykh E.Yu. – search for publications, analysis of the data obtained for compliance with the inclusion criteria.
Conflicts of interest: The authors report no conflicts of interest and guarantee that the article is the original work of the authors.
Funding: The article was published with the support of Pentcroft Pharma Company.
For citation: Dikke G.B., Ostromenskiy V.V., Shcherbatykh E.Yu. Vaginal dilaters
in the prevention and treatment of stenosis and vaginal pain syndromes. 
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (12): 181-188 (in Russian)
https://dx.doi.org/10.18565/aig.2023.296

Keywords

vaginal dilators
vaginal stenosis
cancer radiation therapy
neovagina
vaginal hypoplasia/agenesis
genito-pelvic pain/penetration disorder
lichen sclerosis
lichen planus
Full text (in Russian)

References

  1. Varytė G., Bartkevičienė D. Pelvic radiation therapy induced vaginal stenosis: a review of current modalities and recent treatment advances. Medicina (Kaunas). 2021; 57(4): 336. https://dx.doi.org/10.3390/medicina57040336.
  2. Mirabeau-Beale K., Hong T.S., Niemierko A., Ancukiewicz M., Blaszkowsky L.S., Crowley E.M. et al. Clinical and treatment factors associated with vaginal stenosis after definitive chemoradiation for anal canal cancer. Pract. Radiat. Oncol. 2015; 5(3): e113-e118. https://dx.doi.org/10.1016/j.prro.2014.09.003
  3. Morris L., Do V., Chard J., Brand A.H. Radiation-induced vaginal stenosis: current perspectives. Int. J. Womens Health. 2017;9: 273-9.https://dx.doi.org/10.2147/IJWH.S106796.
  4. Kirchheiner K., Nout R.A., Lindegaard J.C., Haie-Meder C., Mahantshetty U., Segedin B. et al; EMBRACE Collaborative Group. Dose-effect relationship and risk factors for vaginal stenosis after definitive radio(chemo)therapy with image-guided brachytherapy for locally advanced cervical cancer in the EMBRACE study. Radiother. Oncol. 2016; 118(1): 160-6. https://dx.doi.org/10.1016/j.radonc.2015.12.025.
  5. Суворова В.А., Доброхотова Ю.Э., Ильина И.Ю., Венедиктова М.Г., Саранцев А.Н., Морозова К.В. Генитоуринарные расстройства после комбинированного и комплексного лечения рака органов женской половой сферы. Акушерство и гинекология. 2016; 11: 28-33. [Suvorova V.A., Dobrokhotova Yu.E., Ilyina I.Yu., Venediktova M.G., Sarantsev A.N., Morozova K.V. Genitourinary disorders after combined and complex treatment of cancer of the female genital organs. Obstetrics and Gynecology. 2016; (11): 28-33 (in Russian)]. https://dx.doi.org/10.18565/aig.2016.11.28-33.
  6. Солопова А.Г., Москвичева В.С., Блбулян Т.А., Макацария А.Д., Дудина А.Н., Мэн М. Реабилитация больных раком вульвы. Акушерство и гинекология. 2019; 12: 188-92. [Solopova A.G., Moskvicheva V.S., Blbulyan T.A., Makatsaria A.D., Dudina A.N., Men M. Rehabilitation of patients with vulvar cancer. Obstetrics and Gynecology. 2019; (12): 188-92 (in ussian)].https://dx.doi.org/10.18565/aig.2019.12.188-192.
  7. Солопова А.Г., Дадак К., Власина А.Ю., Москвичёва В.С., Идрисова Л.Э., Макацария А.Д., Блбулян Т.А. Сексуальное здоровье онкогинекологических больных. Акушерство и гинекология. 2019; 10: 75-80. [Solopova A.G., Dadak K., Vlasina A.Yu., Moskvicheva V.S., Idrisova L.E., Makatsariya A.D., Blbulyan T.A. Sexual health of gynecological cancer patients. Obstetrics and Gynecology. 2019; (10): 75-80 (in Russian)]. https://dx.doi.org/10.18565/aig.2019.10.75-80.
  8. Pergialiotis V., Bellos I., Fanaki M., Vrachnis N., Doumouchtsis S.K. Risk factors for severe perineal trauma during childbirth: An updated meta-analysis. Eur. J. Obstet. Gynecol. Reprod. Biol. 2020; 247: 94-100. https://dx.doi.org/10.1016/j.ejogrb.2020.02.025.
  9. Huber M., Malers E., Tunón K. Pelvic floor dysfunction one year after first childbirth in relation to perineal tear severity. Sci. Rep. 2021; 11(1): 12560. https://dx.doi.org/10.1038/s41598-021-91799-8.
  10. Gün İ., Doğan B., Özdamar Ö. Long- and short-term complications of episiotomy. Turk. J. Obstet. Gynecol. 2016; 13(3): 144-8.https://dx.doi.org/10.4274/tjod.00087
  11. İnan C., Ağır M.Ç., Sağır F.G., Özer A., Özbek Ö., Dayanır H. et al. Assessment of the effects of perineoplasty on female sexual function. Balkan Med. J. 2015; 32(3): 260-5. https://dx.doi.org/10.5152/balkanmedj.2015.15073.
  12. Gommesen D., Nøhr E., Qvist N., Rasch V. Obstetric perineal tears, sexual function and dyspareunia among primiparous women 12 months postpartum: a prospective cohort study. BMJ Open. 2019; 9(12): e032368.https://dx.doi.org/10.1136/bmjopen-2019-032368.
  13. Dietrich J.E. Review of surgical neovagina techniques and management of vaginal stricture. J. Pediatr. Adolesc. Gynecol. 2022; 35(2): 121-6.https://dx.doi.org/10.1016/j.jpag.2021.10.001.
  14. Kozato A., Karim S., Chennareddy S., Amakiri U.O., Ting J., Avanessian B. et al. Vaginal stenosis of the neovagina in transfeminine patients after gender-affirming vaginoplasty surgery. Plast. Reconstr. Surg. Glob. Open. 2021;9(10 Suppl): 75. https://dx.doi.org/10.1097/01.GOX.0000799480.71688.ab.
  15. Суркичин С.И., Круглова Л.С., Аполихина И.А. Склерозирующий лихен вульвы. Акушерство и гинекология. 2021; 8: 160-5. [Surkichin S.I., Kruglova L.S., Apolikhina I.A. Lichen sclerosus of the vulva. Obstetrics and Gynecology. 2021; (8): 160-5 (in Russian)]. https://dx.doi.org/10.18565/aig.2021.8.160-165.
  16. Аполихина И.А., Плахова К.И., Соколова А.В., Чернуха Л.В. Склерозирующий лихен вульвы. 2020; 9 (Приложение): 8-13. [Apolikhina I.A., Plakhova K.I., Sokolova A.V., Chernukha L.V. Lichen sclerosus of the vulva. 2020; 9(Supplement): 8-13 (in Russian)].
  17. Gautam M.M., Singh V., Nadkarni N.J., Patil S.P. Anogenital lichen sclerosus. Indian J. Sex Transm. Dis. AIDS. 2020; 41(1): 1-9. https://dx.doi.org/10.4103/ijstd.IJSTD_49_17.
  18. Chow M.R., Gill N., Alzahrani F., Schuurmans S.N., Dytoc M.T. Vulvar lichen planus-induced vulvovaginal stenosis: A case report and review of the literature. SAGE Open Med. Case Rep. 2023; 11: 2050313X231164216.https://dx.doi.org/10.1177/2050313X231164216.
  19. Shankar A., Patil J., Luther A., Mandrelle K., Chakraborty A., Dubey A. et al. Sexual dysfunction in carcinoma cervix: assessment in post treated cases by LENTSOMA scale. Asian Pac. J. Cancer. Prev. 2020; 21(2): 349-54.https://dx.doi.org/10.31557/APJCP.2020.21.2.349.
  20. Seehusen D.A., Baird D.C., Bode D.V. Dyspareunia in women. Am. Fam. Physician. 2014; 90(7): 465-70.
  21. Pithavadian R., Chalmers J., Dune T. The experiences of women seeking help for vaginismus and its impact on their sense of self: An integrative review. Womens Health (Lond). 2023; 19: 17455057231199383. https://dx.doi.org/10.1177/17455057231199383.
  22. International Society for the Study of Vulvovaginal Disease (ISSVD). Vulvodynia. 2021. 5 р. https://www.issvd.org/
  23. Pukall C.F., Goldstein A.T., Bergeron S., Foster D., Stein A., Kellogg-Spadt S. et al. Vulvodynia: Definition, Prevalence, Impact, and Pathophysiological Factors. J. Sex Med. 2016; 13(3): 291-304. https://dx.doi.org/10.1016/j.jsxm.2015.12.021.
  24. Liu M., Juravic M., Mazza G., Krychman M.L. Vaginal dilators: issues and answers. Sex Med. Rev. 2021; 9(2): 212-20. https://dx.doi.org/10.1016/j.sxmr.2019.11.005.
  25. Miles T., Johnson N. Vaginal dilator therapy for women receiving pelvic radiotherapy. Cochrane Database Syst. Rev. 2014; 2014(9): CD007291.https://dx.doi.org/10.1002/14651858.
  26. Tahseen R., Ahmed Y., Tariq M., Abrar S., Ali N. Compliance and clinical efficacy of vaginal dilator after radiotherapy for cervical and endometrial malignancies. Ecancermedicalscience. 2023; 17: 1545. https://dx.doi.org/10.3332/ecancer.2023.1545.
  27. Law E., Kelvin J.F., Thom B., Riedel E., Tom A., Carter J. et al. Prospective study of vaginal dilator use adherence and efficacy following radiotherapy. Radiother. Oncol. 2015; 116(1): 149-55. https://dx.doi.org/10.1016/j.radonc.2015.06.018.
  28. Martins J., Vaz A.F., Grion R.C., Costa-Paiva L., Baccaro L.F. Topical estrogen, testosterone, and vaginal dilator in the prevention of vaginal stenosis after radiotherapy in women with cervical cancer: a randomized clinical trial. BMC Cancer. 2021; 21(1): 682. https://dx.doi.org/10.1186/s12885-021-08274-w.
  29. Haddad N.C., Soares Brollo L.C., Pinho Oliveira M.A., Bernardo-Filho M. Diagnostic methods for vaginal stenosis and compliance to vaginal dilator use: a systematic review. J. Sex Med. 2021; 18(3): 493-514. https://dx.doi.org/10.1016/j.jsxm.2020.12.013.
  30. Charatsi D., Vanakara P., Evaggelopoulou E., Simopoulou F., Korfias D., Daponte A. et al. Vaginal dilator use to promote sexual wellbeing after radiotherapy in gynecological cancer survivors. Medicine (Baltimore). 2022; 101(4): e28705. https://dx.doi.org/10.1097/MD.0000000000028705.
  31. Åkeflo L., Elmerstig E., Bergmark K., Dunberger G. Barriers to and strategies for dealing with vaginal dilator therapy - Female pelvic cancer survivors' experiences: A qualitative study. Eur. J. Oncol. Nurs. 2023; 62: 102252.https://dx.doi.org/10.1016/j.ejon.2022.102252.
  32. Bakker R.M., Mens J.W., de Groot H.E., Tuijnman-Raasveld C.C., Braat C., Hompus W.C. et al. A nurse-led sexual rehabilitation intervention after radiotherapy for gynecological cancer. Support Care Cancer. 2017; 25(3): 729-37. https://dx.doi.org/10.1007/s00520-016-3453-2.
  33. Matos S.R.L., Lucas Rocha Cunha M., Podgaec S., Weltman E., Yamazaki Centrone A.F., Cintra Nunes Mafra A.C. Consensus for vaginal stenosis prevention in patients submitted to pelvic radiotherapy. PLoS One. 2019; 14(8): e0221054. https://dx.doi.org/10.1371/journal.pone.0221054.
  34. Bakker R.M., ter Kuile M.M., Vermeer W.M., Nout R.A., Mens J.W., van Doorn L.C. et al. Sexual rehabilitation after pelvic radiotherapy and vaginal dilator use: consensus using the Delphi method. Int. J. Gynecol. Cancer. 2014; 24(8): 1499-506. https://dx.doi.org/10.1097/IGC.0000000000000253.
  35. Morgan O., Lopez M.D., Martinez A.J.C., Marshall D.C., Schnur J.B. Systematic review of comparisons between plastic and silicone dilators: revealing a knowledge gap. Sex Med. Rev. 2022; 10(4): 513-9. https://dx.doi.org/10.1016/j.sxmr.2022.06.008.
  36. Committee on Adolescent Health Care. ACOG Committee Opinion No. 728: Müllerian agenesis: diagnosis, management, and treatment. Obstet. Gynecol. 2018; 131(1): e35-e42. https://dx.doi.org/10.1097/AOG.0000000000002458.
  37. Callens N., De Cuypere G., De Sutter P., Monstrey S., Weyers S., Hoebeke P. et al. An update on surgical and non-surgical treatments for vaginal hypoplasia. Hum. Reprod. Update. 2014; 20(5): 775-801. https://dx.doi.org/10.1093/humupd/dmu024.
  38. Cheikhelard A., Bidet M., Baptiste A., Viaud M., Fagot C., Khen-Dunlop N. et al; French MRKH Study Group. Surgery is not superior to dilation for the management of vaginal agenesis in Mayer-Rokitansky-Küster-Hauser syndrome: a multicenter comparative observational study in 131 patients. Am. J. Obstet. Gynecol. 2018; 219(3): 281.e1-281.e9. https://dx.doi.org/10.1016/j.ajog.2018.07.015.
  39. Kang J., Chen N., Song S., Zhang Y., Ma C., Ma Y. et al. Sexual function and quality of life after the creation of a neovagina in women with Mayer-Rokitansky-Küster-Hauser syndrome: comparison of vaginal dilation and surgical procedures. Fertil. Steril. 2020; 113(5): 1024-31.https://dx.doi.org/10.1016/j.fertnstert.2020.01.017.
  40. Adeyemi-Fowode O.A., Dietrich J.E. Assessing the experience of vaginal dilator use and potential barriers to ongoing use among a focus group of women with Mayer-Rokitansky-Küster-Hauser syndrome. J. Pediatr. Adolesc. Gynecol. 2017; 30(4): 491-4. https://dx.doi.org/10.1016/j.jpag.2017.02.002.
  41. Miles K., Miles S. Low dose, high frequency movement based dilator therapy for dyspareunia: retrospective analysis of 26 cases. Sex Med. 2021; 9(3): 100344. https://dx.doi.org/10.1016/j.esxm.2021.100344.
  42. Ter Kuile M.M., Melles R., de Groot H.E., Tuijnman-Raasveld C.C., van Lankveld J.J.D.M. Therapist-aided exposure for women with lifelong vaginismus: a randomized waiting-list control trial of efficacy. J. Consult. Clin. Psychol. 2013; 81(6): 1127-36. https://dx.doi.org/10.1037/a0034292.
  43. Schlaeger J.M., Glayzer J.E., Villegas-Downs M., Li H., Glayzer E.J., He Y.et al. Evaluation and treatment of vulvodynia: state of the science. J. Midwifery Womens Health. 2023; 68(1): 9-34. https://dx.doi.org/10.1111/jmwh.13456.
  44. Nair P.A. Vulvar lichen sclerosus et atrophicus. J. Midlife Health. 2017; 8(2): 55-62. https://dx.doi.org/10.4103/jmh.JMH_13_17.
  45. Suárez-Marquez E., Garcia-Rodriguez L.F., Treviño-Rangel L., Guerrero-Putz M.D. Labial adhesion secondary to lichen sclerosus masked by vulvar hailey-hailey disease. J. Menopausal. Med. 2022; 28(3): 136-8.https://dx.doi.org/10.6118/jmm.22020.
  46. Hasegawa M., Ishikawa O., Asano Y., Sato S., Jinnin M., Takehara K. et al. Diagnostic criteria, severity classification and guidelines of lichen sclerosus et atrophicus. J. Dermatol. 2018; 45(8): 891-7. https://dx.doi.org/10.1111/1346-8138.14171.
  47. Krapf J.M., Mitchell L., Holton M.A., Goldstein A.T. Vulvar lichen sclerosus: current perspectives. Int. J. Womens Health. 2020; 12: 11-20.https://dx.doi.org/10.2147/IJWH.S191200.
  48. Marfatia Y., Surani A., Baxi R. Genital lichen sclerosus et atrophicus in females: An update. Indian J. Sex Transm. Dis. AIDS. 2019; 40(1): 6-12.https://dx.doi.org/10.4103/ijstd.IJSTD_23_19.
  49. Lewis F.M., Tatnall F.M., Velangi S.S., Bunker C.B., Kumar A., Brackenbury F. et al. British Association of Dermatologists guidelines for the management of lichen sclerosus. Br. J. Dermatol. 2018; 178(4): 839-53.https://dx.doi.org/10.1111/bjd.16241.
  50. De Luca D.A., Papara C., Vorobyev A., Staiger H., Bieber K., Thaçi D. et al. Lichen sclerosus: The 2023 update. Front. Med. (Lausanne). 2023; 10: 1106318. https://dx.doi.org/10.3389/fmed.2023.1106318.
  51. Sharma N., Malhotra S.K., Kuthial M., Chahal K.S. Vulvo-vaginal ano-gingival syndrome: Another variant of mucosal lichen planus. Indian J. Sex Transm. Dis. AIDS. 2017; 38(1): 86-8. https://dx.doi.org/10.4103/0253-7184.203432.
  52. Khurana A., Tandon S., Marfatia Y.S., Madnani N. Genital lichen planus: An underrecognized entity. Indian J. Sex. Transm. Dis. AIDS. 2019; 40(2): 105-12. https://dx.doi.org/10.4103/ijstd.IJSTD_45_196 Pt 1):832-6.
  53. Russell C.B., Welch K.C., Saunders N.A., Haefner H.K., Schmidt P.C. Outcomes after lysis of adhesions and dilator placement for treatment of vulvovaginal agglutination due to lichen planus. J. Low Genit. Tract. Dis. 2023; 27(2): 152-5. https://dx.doi.org/10.1097/LGT.000000000000.

Received 18.12.2023

Accepted 21.12.2023

About the Authors

Galina B. Dikke, Dr. Med. Sci., Professor, Department of Obstetrics and Gynecology with a Course of Reproductive Medicine, F.I. Inozemtsev Academy of Medical Education, 22 Liter M, Moskovskiy Ave., Saint Petersburg, 190013, Russia, galadikke@yandex.ru, https://orcid.org/0000-0001-9524-8962
Vladimir V. Ostromenskiy, PhD, Head of the Department of Obstetrics and Gynecology with a course of reproductive medicine, F.I. Inozemtsev Academy of Medical Education, 22 Liter M, Moskovskiy Ave., Saint Petersburg, 190013, Russia, ostromenskyvv@gmail.com, https://orcid.org/0000-0001-8290-5767
Evgenia Yu. Shcherbatykh, PhD, Assistant of the Department of Obstetrics and Gynecology with a course in reproductive medicine, F.I. Inozemtsev Academy of Medical Education, 22 Liter M, Moskovskiy Ave., Saint Petersburg, 190013, Russia, scherbatyh@ru486.ru
Corresponding author: Galina B. Dikke, galadikke@yandex.ru

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