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Introduction
This information has been written for patients who are having internal vaginal radiotherapy treatment (brachytherapy) for a gynaecological cancer. It explains what the treatment involves, describes side-effects you may experience during and after treatment, and how best to cope with them.
We understand that this is a worrying time for patients and their families. We hope this leaflet answers your questions and eases some of the worries you may have. If you still have any questions or concerns after reading this, please ask your radiotherapy doctor (also called a clinical oncologist), specialist nurse or radiographer involved in your care. We are here to help.
We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with treatment, by law, we must ask for your consent and will ask you to sign a consent form. This confirms that you agree to having the procedure and understand what it involves.
Staff will explain all the risks, benefits and possible alternatives before they ask you to sign a consent form. If you are unsure about any aspect of your proposed treatment, please do not hesitate to speak to the team looking after you.
During your time with us we aim to provide the highest standards of care and support you in your decisions regarding your treatment. We will respect your dignity, individuality and personal preferences.
Your care will be managed and given by doctors, therapeutic radiographers and nurses. You will meet both male and female healthcare professionals during the course of your treatment. If you have any concerns about this, please talk to the radiographers about it. We try to be sensitive to your needs, so please do not hesitate to discuss things with the team caring for you.
All individuals with internal reproductive organs (a uterus) of child-bearing ability (12-55 years old) will need to sign a form to confirm there is no possibility that you could be pregnant. You must tell the staff immediately if there is any chance of you being pregnant at any time during your treatment. Individuals should not become pregnant for at least four months after radiotherapy treatment.
All patients should use reliable contraception throughout this period. If you have any further questions or concerns about this, please talk to your radiotherapy doctor, your specialist nurse or specialist radiographer involved in your care.
HDR brachytherapy is a form of radiotherapy given by directly introducing a radioactive source into the part of your body which requires treatment. It is placed within or near to your cancer, as the radiation does not travel very far.
The doctors can give a high dose of radiation direct to the treatment area, while minimising the dose to surrounding healthy tissue. Brachytherapy can be given on its own or following a course of external beam radiotherapy treatment. Patients normally have between two and four treatments. Your doctor will explain the treatment to you and together you will decide which treatment is best for you.
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You will have your treatment in the brachytherapy suite in the radiotherapy department. You are able to eat and drink normally on the day. We will ask you to empty your bladder before we start. You are not required to do any other bladder or bowel preparation. You should allow up to one and a half hours for your first appointment. This will include brachytherapy planning and treatment.
A radiographer will meet you, and escort you to the brachytherapy suite. They will talk to you about what will be happening and answer any questions or concerns you may have. When you are ready, you will be asked to change into a hospital gown and to remove all your clothing below the waist.
You will be taken in to the treatment room where the radiographers will assist you onto the treatment couch. You will lie on your back with your legs raised and supported. The doctor or radiographer will perform a gentle internal examination to determine the size of applicator to use. There are various applicator sizes available, so we will use one which is comfortable for you. The applicator is lubricated and gently inserted into your vagina to check how it fits and some measurements are taken. This should not be painful but may feel a little uncomfortable. Please tell the team if you are in any pain. The applicator is then removed, and you will be transferred to a trolley and taken to the radiotherapy CT scanner.
In the CT scanner room, you will be transferred to the CT couch. Once you are comfortable on the couch the applicator is re- inserted into your vagina. All staff will then leave the room and a CT scan of your pelvis will be acquired. Keeping the applicator carefully in position you will be transferred back to your trolley and returned to the brachytherapy treatment room. Whilst this is happening, the doctor or radiographer will check the CT images and confirm that treatment may go ahead.
In the brachytherapy treatment room, the radiographers will connect the applicator to a computer-controlled machine called a Flexitron. The Flexitron pushes a single radioactive iridium pellet into the applicator to give the treatment. When final checks have been done, the radiographers leave the room, and the treatment is started.
There is nothing to see or feel during the treatment. You will hear a beeping noise which tells you that your treatment is taking place. You will be alone during the treatment however, the radiographers will be watching you on a TV monitor at all times from the control area outside. The treatment will take between 10 and 15 minutes. After this time, the radiographers will remove the applicator and you may go straight home.
For your other treatments there will be no planning required. You will only need to allow thirty minutes for insertion of the applicator and treatment.
Your clinical oncologist will advise you of any side effects you may experience following brachytherapy treatment. The risk and severity of side effects occurring will depend on, the dose given, the exact area which receives the radiotherapy, whether you are having vaginal brachytherapy as your primary treatment, or whether you are also having external beam radiotherapy.
Vaginal bleeding/discharge
You should not feel unwell after treatment, but you may notice some slight vaginal bleeding. In most cases, this should clear up within forty-eight hours. You may also experience a slight vaginal discharge for a few days. Please let your team know if this is heavy and/or has an offensive odour. Do not use tampons, feminine deodorisers, douches or talc as they could cause further discomfort and soreness and possible increase the risk of infection.
Vaginal soreness
Vaginal brachytherapy may cause vaginal soreness and inflammation. It may also reduce the amount of natural lubrication produced by the vagina. If you feel like it, having sexual intercourse during treatment is ok, but it may little uncomfortable, and you may notice some spotting of blood. If appropriate, you will need to take adequate contraceptive precautions. Your doctor or specialist nurse will discuss this with you.
Painful or difficult urination
You may have some discomfort on passing urine and experience frequency and urgency. This is a short-term effect. Please tell the radiographers if you are experiencing any problems. You may be asked to have a urine test to rule out any infection.
Bowel changes
You may notice a change in bowel habits involving increased frequency and urgency. Diarrhoea may also occur. We advise that you drink plenty of fluids (two litres a day) and adjust your diet if necessary.
Vaginal dryness and narrowing (common)
Pelvic radiotherapy and brachytherapy can affect the internal lining of the vagina. The vagina can become dry and not stretch as well as it previously would have, so it may feel smaller and tighter. This is due to the formation of scar tissue after your treatment.
We recommend the use of dilators after treatment. This ensures that vaginal examinations can be done more easily and that any sexual relationships can continue without discomfort. The use of a vaginal dilator can help keep the vagina open (dilated), to prevent the formation of scar tissue in the vagina.
The dilator is a smooth plastic tube that will be given to you at the end of your radiotherapy treatment. It is recommended that you start dilating within six weeks of finishing treatment. It is recommended that you use your dilator three times a week for about three to five minutes. Advice on how to use it will be given to you by your specialist nurse. Sometimes, there are reasons for delaying the use of the dilator.
Your specialist nurse will discuss this if it is relevant to you.
In certain cultures, dilation may not be considered acceptable. If you feel uncomfortable about this, further advice and help can be offered by your specialist nurse.
Bowel changes (uncommon)
You may notice a need to open your bowels more urgently. The bowel motion may also be more frequent.
Urinary symptoms (uncommon)
You may notice you pass urine more frequently.
Sexual function and sexuality
Continuing to have an active sex life during and after pelvic radiotherapy can be difficult for both you and your partner. You may lose interest or feel nervous, or it may be that other things are going on in your life which you feel are more important. Talk to your partner, to help share your feelings and work through this time together. Your partner may be worried about hurting you, or that your cancer might be contagious. You can assure them that the cancer cannot be passed on through physical contact.
Remember, if you do continue to have a sexual relationship throughout your treatment, your vagina may become increasingly sore, and you might find it helpful to apply a water-soluble lubricant. The vagina will stretch to accommodate the dilator and a penis, but bleeding can and does occur sometimes after sex, even years later. This does not mean the cancer has returned but does need to be checked. For the majority of patients, bleeding will be from fragile superficial blood vessels within the vagina, which bleed with very little pressure.
This can be treated and should not prevent you and your partner continuing a satisfying and fulfilling sex life. It will mean however, you may need to wear external sanitary protection for 24 hours after sexual intercourse or using the dilator. Please don’t be embarrassed to tell your specialist nurse, clinical oncologist, gynaecologist or GP. We are here to help you.
There are female gynaecological nurse specialists and clinical psychologists available to discuss any concerns you may have.
This information deals with the physical aspects of your treatment, but your emotional wellbeing is just as important. Having treatment can be distressing for some patients. Within the radiotherapy department you can gain support from the brachytherapy radiographers, the radiotherapy review team and the Macmillan Information and Support team. However, if you feel you require further medical or emotional support, you can be referred to a variety of health professionals who can help with any worries or difficulties you may be having.
All staff are here to make sure your treatment goes as smoothly as possible and to support you through this difficult period. We will try to help you with any questions or problems you may have.
Once your radiotherapy treatment has finished you will be given a follow-up appointment to see your radiotherapy doctor in about six weeks’ time. You should also receive an appointment to see your specialist nurse to discuss dilation. Usually, any side effects you may be experiencing during treatment will carry on, and can become worse, for a short while, after you have finished treatment. However, they should settle down within four to six weeks. Please try not to worry.
Please feel free to contact the brachytherapy radiographers, the radiotherapy review team or your specialist nurse if you are worried about any side effects after treatment.
Brachytherapy Radiographers
Telephone: 020 3447 3782
Email: uclh.
Specialist Nurses Gynaecological Oncology
Telephone: 020 3447 8636
Email: Gocnsteam
Gynae-oncology Team Co-ordinator
Telephone: 020 3447 8636
Monday to Friday, 09:00 to 17:00 answer phone available outside these hours
Radiotherapy reception telephone: 020 3447 3700/3701
Radiotherapy review team telephone: 020 3447 3700/3701
Out of hours oncology advice number (available 24 hours) Mobile: 07947 959020
If you have any concerns that you would like to discuss in confidence, please contact our PALS (Patient Advice and Liaison Service) for information and advice.
Email: PALS
Telephone: 020 3447 3042
Website: www.
Jo’s Cervical Cancer Trust (Jo’s Trust)
Telephone: 0808 802 8000
Website: www.
The Eve Appeal
Telephone: 0808 802 0019
Email: nurse
Website: www.
Vulval Awareness Campaign Organisation (VACO)
Website: www.
GO Girls
Telephone: 01305 255719
Website: www.
Daisy Network: Premature menopause support group
Email: info
Website: www.
Maggie’s (Providing cancer information and support in centres across the UK and online)
Website: maggies.org
Live Though This (cancer support for LGBTIQ+ community)
Website: outpatients.org.uk
Life After Cancer
Website: www.
Macmillan Cancer Support
Telephone: 0808 808 0000 (Freephone)
Email: cancerline
Website: www.
Cancer Research UK
Telephone: 0808 800 4040
Website: www.
Carers UK
Telephone: 0808 808 7777
Email: adviceline@carersuk.org
Website: www.
NHS Choices website: www.
UCLH cannot accept responsibility for information provided by other organisations.
Page last updated: 18 July 2024
Review due: 01 September 2025