Side effects of external radiotherapy for vaginal cancer

The side effects of radiotherapy for vaginal cancer include loose poo (diarrhoea), tiredness, and skin changes. There are immediate side effects and long term side effects.

Immediate side effects

You start to develop side effects during your treatment. When they start depends on the type of radiotherapy you are having and your plan of treatment.

Side effects tend to get worse as treatment progresses. They usually begin to improve 1 or 2 weeks after treatment ends.

Everyone is different and the side effects vary from person to person. You might not have all of the side effects mentioned.

Diarrhoea

You may notice that your poo becomes softer or you might have diarrhoea Open a glossary item. Let your healthcare team know if you have this. They might give you medicines to help control it. Drink plenty of fluids to replace the liquid you have lost.

Passing wind

Sometimes radiotherapy causes you to pass wind more often than usual. Wind is also called flatus, flatulence, or farting. This might cause pain in your tummy. Talk to your healthcare team if this is a problem for you. They can offer advice on how to cope and may be able to prescribe medicines to help.

Discomfort passing urine

Radiotherapy can make the lining of the bladder inflamed. This is called radiation cystitis. 

It can make you very uncomfortable. You might have bladder pain or a burning feeling when you pee. It may feel as though you need to pee all the time, even though you know you’ve only just been. Try to drink plenty of fluids because this will help.

Speak to your healthcare team if you have pain or feel you need to pee more often.

Skin changes

During external radiotherapy, your vagina or skin in the treatment area is likely to become sore. This is a sensitive part of the body, so some soreness is difficult to avoid.

You might have some soreness, dry skin or itching. Your skin may become red or darker, similar to mild sunburn. Sometimes the skin might break down or start peeling. This can cause the area to weep. 

Check with your radiotherapy team before using any lotions, powders or creams on the treatment area. They will give you advice at the start of your treatment about what creams to use to keep your skin moisturised. This helps to minimise the risk of side effects. 

Ask the radiotherapy staff if there is anything you can use to soothe the area if you need to. You can help to reduce any soreness by:

  • not soaking in a hot bath 
  • patting skin dry with a towel rather than rubbing it 

Your doctor might prescribe a steroid cream to put on. You can have painkillers if you need them.

Your treatment might be stopped for a week or two if your skin reaction is very bad. 

Tiredness (fatigue)

You might feel tired during your treatment. It tends to get worse as the treatment goes on. You might also feel weak and lack energy. Rest when you need to.

Tiredness can carry on for some weeks after the treatment has ended. It usually improves gradually.

Various things can help you to reduce tiredness and cope with it, such as exercise. Some research has shown that taking gentle exercise can give you more energy. It's important to balance exercise with resting.

Feeling or being sick

You might have some sickness if you have external radiotherapy to the lower part of the tummy. But this is not common.

Tell your healthcare team if you feel sick. They can arrange for you to have anti sickness tablets.

Long term side effects

Most side effects gradually go away in the weeks or months after treatment. But some side effects can continue or might start some months or years later.

Your doctors will try their best to make sure you have as few side effects as possible. But some people are more sensitive than others to radiation.

Changes to your ovaries

Radiotherapy to this area will stop your ovaries from working if you have not already had your menopause Open a glossary item. This means your periods gradually stop and you become infertile. It is important that you continue to use effective contraceptives during radiotherapy. Your healthcare team will tell you when it is safe to stop.

You might get symptoms of the menopause. These may be more severe than the natural menopause. You might be able to take hormone replacement therapy (HRT) after treatment. There are gels and creams available that can help with vaginal dryness. Speak to your doctor about taking HRT. 

If you have already had your menopause, your ovaries stopped working before your treatment. So the radiotherapy won't make as much difference to you.

It might be possible to move your ovaries away from the treatment area before radiotherapy begins. This is called ovarian transposition. It is usually done by keyhole surgery Open a glossary item. Ovarian transposition may prevent early menopause. This is not suitable for everyone having radiotherapy for vaginal cancer. Do speak to your healthcare team for more information. 

Vaginal changes

Radiotherapy can make scar tissue form. Scar tissue is stiffer and less stretchy than healthy tissue. It might form around the outside of your vagina and this might narrow the entrance. You may find that penetrative sex and internal examinations can be painful.

Using dilators

To prevent narrowing of the vagina your specialist nurse will teach you to stretch the vaginal opening with dilators. 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 with a water soluble gel.

You usually start using them between 2 to 8 weeks after your radiotherapy ends. Your radiotherapy team will tell you when you start and how often you should use them.

You start with one of a comfortable size. You gradually use larger ones until your vagina has stretched enough for you to have sex comfortably.

Your radiotherapy team can give you a set of dilators. Speak to them if you have any problems or questions, or if you don’t feel comfortable with using dilators for any reason.

It is normal not to feel like having sex for a while after treatment, so don't worry if you wait for a while. It is still important to keep your vagina open by using dilators.

Photograph of a dilator

Spotting

Over a period of time, the radiotherapy causes an overgrowth of small blood vessels in the vagina. As they are delicate and near the skin surface, they are more likely to bleed. Do tell your healthcare team so that they can check that the bleeding isn't caused by anything else.

Damage to the bones

Radiotherapy to the pelvis can damage the bones in the pelvic area. The bones can become weaker. This can cause pain and also increases the risk of breaks (fractures) of the pelvis or hip.

Tell your doctor if you have any hip or pelvic pain.

Bladder or bowel changes

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 pee more often. This doesn't happen to everyone.

Radiotherapy can irritate the lining of the bowel. As a result, you might have loose bowel motions and they may be more frequent. Tell your doctor if this happens. You can take medicine to help. 

Some people could have the opposite effect and find it more difficult to poo. Talk to your doctor if you become constipated. They might need to check your bowel for a possible blockage.

You can take medicine to relieve constipation if a blockage is not the cause. A diet higher in fibre and drinking plenty of fluids might also help.

Sometimes, radiotherapy to the pelvis can cause bleeding. This will show up in your poo or pee. This can be worrying, but it is not often serious.

Leg and groin swelling

One or both legs can swell (lymphoedema) if the radiotherapy affects the lymph nodes in the groin. It stops fluid from being able to drain out of the legs.

If you think you are developing swelling, tell your healthcare team straight away. They can refer you to a lymphoedema specialist for assessment. The sooner it is diagnosed, the easier lymphoedema is to treat.

Severe side effects

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

  • Cancer of the vagina: 2021 update
    FIGO cancer report
    TS Adams, LJ Rogers and MA Cuello
    International Journal of Gynaecology and Obstetrics, 2021. Volume 155. Pages 19-27

  • ESTRO/ESGO/SIOPe guidelines for the management of patients with vaginal cancer
    RA Nout and others
    International Journal of Gynecological Cancer, 2023. Volume 33. Pages 1185-1202

  • Updates in the treatment of vaginal cancer
    A Jhingran
    International Journal of Gynecological Cancer, 2022. Volume 32. Pages 344-351

Last reviewed: 
09 May 2024
Next review due: 
10 May 2027

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