Vaginal Stenosis

What is vaginal stenosis?

Vaginal stenosis is when your vagina becomes narrower and shorter due to scar tissue. Scar tissue forms as part of your body’s natural healing process. When your vagina is damaged or injured, your body will try to repair it with scar tissue. But scar tissue makes your vagina less flexible and unable to move or expand easily. This means you may feel pain and discomfort any time something enters your vagina. Most often, vaginal stenosis happens after childbirth, surgery or pelvic radiation therapy.

You don’t have to live with the pain and discomfort vaginal stenosis causes. Treatments are available to help improve your symptoms and overall quality of life.

How common is vaginal stenosis?

It’s common in people with risk factors like surgery or radiation therapy. The studies vary, so there isn’t just one reliable statistic. Vaginal stenosis is a sensitive topic, so it may be underdiagnosed because many people don’t seek treatment for their symptoms.

What are the symptoms of vaginal stenosis?

Some of the most common symptoms of vaginal stenosis are:

• Pain during sex (dyspareunia).
• Pain and difficulty when inserting tampons into your vagina.
• Bleeding during or after sex.
• Discomfort or pain during a pelvic exam.
• Vaginal dryness.

What causes vaginal stenosis?

Vaginal stenosis is when scar tissue makes your vaginal canal narrower and shorter. Scar tissue doesn’t move easily and isn’t flexible like normal vaginal tissue. When you place something inside your vagina, instead of pushing against soft, flexible tissue, it’s rubbing against stiff tissue.

There are several things that can cause scar tissue to form in your vagina:

• Radiation therapy: Radiation therapy to organs in your pelvic region can cause vaginal stenosis (radiation-induced vaginal stenosis). It’s one of the most common side effects of radiation treatment, especially if you’re over 50. Chemotherapy can also play a role in developing vaginal stenosis.
• Surgery: Any surgery to your uterus, vagina or cervix can potentially damage your vaginal tissue and lead to scar tissue formation. This includes gender affirmation procedures, procedures to treat pelvic organ prolapse and many more.
• Childbirth: Complications from a vaginal delivery like episiotomies or vaginal tears can cause scar tissue to form.
• Skin conditions: Certain skin conditions like lichen sclerosus and lichen planus can contribute to vaginal stenosis.
• Menopause: When you reach menopause, estrogen levels decline. This can affect your vaginal tissue and make it drier and thinner (vaginal atrophy). This can sometimes lead to a worsening of vaginal stenosis symptoms.

In rare cases, you can be born with vaginal stenosis due to a congenital (present at birth) disorder like adrenal hyperplasia.

Who is more likely to get vaginal stenosis?

Vaginal stenosis can affect anyone with a vagina, especially if you’ve had:

• Surgery to your pelvic area.
• An episiotomy or vaginal tears during childbirth.
• Pelvic radiation therapy or chemotherapy.

Some studies show people who use tobacco products are at higher risk for vaginal stenosis.

What are the complications of vaginal stenosis?

Vaginal stenosis can take a toll on not only your sex life but your overall quality of life. It can be highly frustrating not to be able to use tampons, have a comfortable pelvic exam or be intimate with your partner. Without treatment, vaginal stenosis can worsen, which only makes it harder to treat. That’s why it’s important to speak up about any pain you have.

How is vaginal stenosis diagnosed?

Healthcare providers can diagnose vaginal stenosis with a pelvic exam and a discussion about your symptoms. Let your provider know when the pain started and what activities cause you pain. You should tell them your full health history including any surgeries or procedures.

During a pelvic exam, they’ll insert gloved and lubricated fingers into your vagina to see how flexible or deep it is. You should let your healthcare provider know if this exam causes you pain.

How is vaginal stenosis treated?

The goal of treatment is to make the scar tissue flexible or easier to move. The treatment you and your provider choose is based on the cause and severity of the vaginal stenosis. It’s important to note that treatment may take several months or years. Since scar tissue can come back, you may need to work on a long-term plan to manage vaginal stenosis.

Vaginal stenosis treatments include:

• Vaginal dilators: Vaginal dilators work by slowly and gently stretching your vagina. You start with a thin dilator and work your way up to a thicker dilator over the course of weeks or months.
• Pelvic floor therapy: Pelvic floor therapy is helpful for strengthening the muscles around your vagina and improving blood flow. You may find learning how your pelvic muscles contract and relax make it easier to use a vaginal dilator.
• Hormone replacement therapy (HRT): If estrogen loss is causing vaginal stenosis, taking estrogen can be helpful. HRT comes in many forms like creams, tablets, patches or pills. It helps improve the moisture and flexibility of your vaginal tissue. Always talk to your provider about the risks and benefits of HRT before making your decision.
• Surgery: Your provider may recommend surgery to widen your vaginal opening. This is typically the last resort.

Some additional treatments can also bring you relief. These include:

• Using water-based lubricants (like KY® Jelly) during sex.
• Using a vaginal moisturizer (like Replens™). Unlike sexual lubricants, you can use vaginal moisturizers even when you’re not having sex. They help keep your vaginal tissue moist throughout the day.
• Trying laser therapy (depending on the cause of vaginal stenosis).

Can vaginal stenosis go away on its own?

No. Scar tissue doesn’t go away without treatment. It can get worse over time when it’s left untreated.

Can you prevent vaginal stenosis?

Sometimes, but that’s typically only the case if you’ve recently had radiation treatment. Some providers recommend using a vaginal dilator as soon as you finish cancer treatment to prevent vaginal stenosis.

But, in the case of surgery, vaginal stenosis isn’t always preventable. Using minimally invasive surgical methods can reduce the amount of scar tissue that forms, but it won’t eliminate it.

What can I expect if I have vaginal stenosis?

Vaginal stenosis can be painful and frustrating. While there’s no permanent cure for vaginal stenosis, your healthcare provider can help you find ways to manage it. Since there’s a chance vaginal stenosis can come back, you may need to use treatments like dilators or lubricants on a regular basis. Most people see a significant improvement in their sex lives and overall quality of life with the right treatment.

When should I see my healthcare provider?

Contact your healthcare provider if activities like sex, inserting a tampon or having a pelvic exam cause you pain. It may be a sensitive topic to discuss but know that your healthcare provider is there to help you. Vaginal stenosis is a common condition, and there’s relief available for your symptoms.

Is vaginal stenosis the same as vaginal atrophy?

No. They’re related, but they’re different conditions. Vaginal atrophy is when the lining of your vagina gets dry and thin due to lack of estrogen. It’s hormonal and mainly affects people transitioning to menopause. On the other hand, vaginal stenosis happens due to scar tissue from surgery, radiation therapy and childbirth. The reason the conditions are related is because vaginal atrophy can worsen vaginal stenosis.

A note from Cleveland Clinic

Vaginal stenosis isn’t just a condition that affects your vagina. It can affect your happiness and confidence and make intimacy with sexual partners difficult. While it may be an uncomfortable topic to discuss out loud, seeking help from a healthcare provider is the best thing you can do for yourself. There are several treatment options available to help with vaginal stenosis. You don’t have to live with or accept the pain that comes with vaginal stenosis. Many people find their quality of life is much better after they find the right treatment.