After pelvic irradiation, how often do you recommend that female patients use a vaginal dilator and for how long?

The need for a vaginal dilator is dependent on the degree of stenosis, and related to the total dose, dose per fraction for HDR brachy patients, and patients underlying tendency to form scar tissue. In general we suggest evaluation by the physician every 3 months. If it appears that scar tissue continues to form, dilator use should continue indefinitely. If it appears that after a low dose regimen of vaginal brachytherapy there is no scar tissue, the patient is put on a trial of no dilator for 3 months and reassessed 3 months later. Close follow up of these patients is critical for individualization of recommendations.