How do you counsel a cervical cancer patient s/p definitive chemoRT who is not sexually active and refuses to use vaginal dilators to improve compliance?

There isn't much you can do except talk with them about the reasons for non-compliance (has it been painful, embarrassing, discuss rationale and encourage them. Are they unsure how to use it?- having them insert it during their clinic exam may help. If the dilator is causing pain, lubricants or vaginal estrogen cream may help. It is also important to be sure the patient does not have a yeast infection or bacterial vaginitis - these tend to cause a burning pain during insertion.

However, frankly, the benefit of vaginal dilator use remains uncertain. A 2014 meta-analysis suggested that patients who use a dilator have better vaginal function, length, etc than those who don't. However, it is impossible to know whether this is a causative or corr...

An option is to follow the patient more closely than you might otherwise, probably monthly. Usually, thin adhesions begin to form that can easily be bluntly separated by the examining finger prior to inserting the speculum. Doing this at least monthly can usually prevent or at least forestall the more permanent adhesions that will ultimately obliterate the vagina and prevent good examination or cytologic testing.