Vaginal stenosis is an abnormal condition in which the vagina becomes narrower and shorter due to the formation of fibrous tissue. Vaginal stenosis can contribute to sexual dysfunction, dyspareunia and make pelvic exams difficult and painful. The lining of the vagina may also be thinner and drier and contain scar tissue. This condition can result in pain during sexual intercourse or a pelvic exam. Vaginal stenosis is often caused by radiation therapy to the pelvis, an episiotomy, or other forms of surgical procedures. Chemotherapy can also increase the likelihood of developing vaginal stenosis. Vaginal stenosis can also result from genital reconstructive surgery in people with congenital adrenal hyperplasia.
Signs and symptoms
Common indicators of vaginal stenosis include pain and bleeding during sexual intercourse along with other types of sexual dysfunction. This can lead to challenges such as difficulty engaging in intercourse and decreased sex drive. Severe forms of vaginal stenosis can be associated with a complete inability to participate in sexual intercourse.
Atrophy, scarring, and damage to the vaginal tissue due to vaginal stenosis can lead to dryness, inflammation, and decreased elasticity of the tissue.
Lasting effects of vaginal stenosis could include impacts on psychological well-being in addition to physical limitations. Symptoms can worsen from post treatment ovarian failure or menopausal status, leading to reduced lubrication and increased thinning of the vaginal tissue.
Causes
Radiation-induced
Uterine, vaginal, anal, rectal and cervical cancers are often treated with pelvic radiation therapy (RT), most commonly external beam radiation therapy (EBRT) or brachytherapy. Radiation-induced vaginal stenosis can be a side effect of treatment. It is one of the most prevalent side effects, affecting about one third of people undergoing pelvic radiation therapy. Radiation-induced stenosis can be a late reaction to treatment. Damage to the vaginal epithelium causes abnormal collagen production that leads to atrophy, loss of muscle, decreased blood flow, hypoxia, and fibrosis. Pallor, adhesions, and fragility can be observed along with loss of elasticity. These can all contribute to sexual dysfunction that affects more than half of gynecological cancer survivors. Some women who have reduced ovarian function and an estrogen shortage after RT can have an even thinner vaginal mucosal lining that worsens vaginal stenosis.
Risk factors
While the severity of vaginal stenosis depends largely on the type of radiation therapy received, several risk factors can contribute to the development of vaginal stenosis. Women over the age of 50 with cervical cancer tend to have a higher risk of vaginal stenosis from radiation therapy. Tobacco use is also associated with a higher risk of vaginal stenosis. There is also a high correlation between vaginal stenosis and vaginal pallor reactions, which is when the mucous membranes thin and dry out, leading to inflammation and fibrosis.
Surgical procedures
Several types of surgical procedure are hypothesized to cause vaginal stenosis. Episiotomies, which are surgical incisions sometimes used to assist childbirth, can lead to narrowing of the vaginal opening and long-term dyspareunia: there is approximately 13% chance of experiencing dyspareunia for at least 6 months after having undergone a routine episiotomy. When the tissue from the episiotomy does not heal properly, complications can include mucosal damage and scarring, which can contribute to the development of vaginal stenosis. Vaginal stenosis is the most common post-operative complication in people with congenital adrenal hyperplasia who have genital reconstructive surgery in infancy or childhood. Vaginal stenosis can be an immediate complication or may arise later in adolescence. Additionally, in people undergoing a male-to female gender-affirming surgical procedure, such as vaginoplasty, vaginal stenosis has been shown to be a common post-surgical complication.