Intimate Wellness Institute

What is Vaginal Stenosis?

Vaginal stenosis is a narrowing, closing, or loss of flexibility of the vagina and vaginal opening. It is the side effect of scarring, radiation treatment, surgery to vagina, and hormone changes over the lifespan. Many times, it is accompanied by dryness, scar tissue, and loss of mobility of the vaginal tissue. Radiation to the pelvis and vagina is often performed to treat various forms of cancer. Radiation may be directed at the pelvic organs, including the bladder, bowel, uterus, ovaries, cervix, or to the vaginal tissue itself. Radiation induced vaginal stenosis often leaves the skin and tissue around the vagina thinner, dry, less pliable, and oftentimes, painful. Surgery to the area can leave scar tissue that has a similar affect and can shorten the vagina.  Surgery can affect the skin, connective tissue, blood vessels, lymph nodes, and overall flexibility of the vaginal tissue. Vaginal stenosis makes it difficult to have vaginal penetration for medical examination and make sex very painful if not impossible.

What is vaginal shortening?

Vaginal shortening is a condition in which the vagina becomes shorter than its usual size. This condition typically gets worse with a decrease in the levels of estrogen, a hormone that helps maintain the health and elasticity of vaginal tissues. While vaginal shortening is commonly worse with menopause other factors cause severe shortening. Some of these are:

  • Hysterectomy: a hysterectomy, particularly a radical hysterectomy, involves removing a portion of the top of the vagina and can leave the vagina shortened, causing pain with intercourse.
  • Pelvic Surgery: Surgery for pelvic organ prolapse, incontinence or many other issues can constrict and shorten the vagina.  
  • Surgical removal of the ovaries: This procedure, called oophorectomy, can lead to a significant decrease in estrogen production, which may cause vaginal shortening.
  • Radiation therapy: Radiation treatment for certain cancers in the pelvic area can damage the vaginal tissues and lead to shortening.
  • Breast cancer treatments: Some treatments for breast cancer, such as hormonal therapies and chemotherapy, can cause a decrease in estrogen levels, potentially leading to vaginal atrophy and shortening of the tissue.

Symptoms of vaginal shortening can include pain during sexual intercourse (dyspareunia) and a sense of tightness or discomfort in the vaginal area. These symptoms can have a significant impact on a woman’s quality of life and sexual health.

What to Do About Vaginal Stenosis and Vaginal Shortening

The good news is that there are steps that can be taken to help improve the elasticity of the vagina. Vaginal stenosis and shortening can be addressed by taking the following steps:

Use Vaginal Dilators

Use Vaginal Dilators (also referred to as Vaginal trainers) to gently stretch and improve the elasticity of the vagina. When a person is educated that it is safe to do so by the IWI team, vaginal dilator training can begin. Choose a set that comes with progressive sizes to allow you to gently and progressively improve the depth and width of the vaginal opening after vaginal stenosis has occurred.

Training sessions include gently compressing the dilator into the opening of the vagina, holding for 30 seconds to a minute, moving around the vaginal opening like a clock. Then, the dilator can be gently inserted into the vagina, and used to stretch and train the surrounding pelvic floor muscles to relax for improved ability to tolerate penetration.

Use Plenty of Lubrication

This applies to daily hygiene, dilator use, and sexual use. Using a personal high-quality lubricant significantly improves comfort during dilator training and sex.  At lease 1-2 tablespoons can be helpful, and additionally, lubricant can be injected into the vaginal vault by using a suspension dropper. 

Do Daily Pelvic Floor Release Stretches

Do daily pelvic floor release stretches. Gentle stretching for pelvic floor muscle release compliments dilator training in helping to relax the muscles that share connection with the vaginal opening, which can help make penetration more comfortable.

Use Vibration Therapy To Improve Blood Flow

Use vibration therapy to improve blood flow to the area. Gentle vibration can stimulate circulation and help soften scarred and radiated tissue when the treatment finished. Vibrating wands can be used for vibration therapy. 

Pelvic floor therapy and biofeedback

Your IWI treatment team may include a physical therapist to help release and stretch the constricted pelvic floor muscles and connective tissue. They will also give you the skills to continue to help yourself in the future. 

EmsellaTM Advanced Pelvic Floor Therapy

Emsella is a FDA-approved revolutionary treatment for improving pelvic floor muscle function and blood flow to the pelvis.  The BTL EMSELLA treatment uses High Intensity Focused Electro Magnetic Energy (HIFEM) to stimulate and improve ALL the pelvic floor muscles, not just the subset that can be exercised with voluntary contractions (Kegel exercises). .  During each 28-minute session you sit comfortably on the Emsella chair while it generates thousands of supramaximal pelvic floor muscle contractions.  Each session is equivalent to doing 11000 pelvic floor exercises but without the hard work!  The procedure is non-invasive, and you remain fully clothed throughout. No drugs are required and the most you will feel is a slight tingling during the treatment. With no recovery time needed you can leave immediately after each session and resume normal daily activity.

The majority of people need a course of six sessions over a period of three weeks to see optimum results, with most people seeing and feeling results after just two or three treatment sessions.  For vaginal constriction emsella helps the muscles relax and improves blood flow to scarred, restricted tissue to help it improve.  It also improves sensation.  Dr. Guerette and the IWI team have been pioneers in the development of Emsella for the treatment of pelvic pain.  IWI had the second Emsella machine in North America and has the most experience with Emsella.  Dr. Guerette has been the lead investigator on the studies to evaluate Emsella.

Laser and Radiofrequency (RF) Vaginal Treatment

Dr. Guerette is one on the pioneers in using gentle lasers and radiofrequency devices to restore and rejuvenate vaginal tissue to improve many issues including vaginal stenosis. These treatments help restore the collagen, elastin, nerves and blood vessels in the vaginal tissue to regain motion, comfort and sexual sensation.  IWI has the most comprehensive laser and RF options available for vaginal constriction and stenosis. In appropriate candidates simple office treatments with no preparation or recovery can be used to improve the vaginal tissue.

Platelet Rich Plasma (PRP)

PRP is a simple, safe office procedure to isolate growth factors from your own blood and place them into the damaged area to restore the collagen, elastin, nerves and blood vessels in the vaginal tissue to regain motion, comfort and sexual sensation.  There is no recovery to this procedure.


Dr. Guerette has used decades of experience and expert techniques to use minimally invasive vaginal and robotic techniques to create vaginal length and width in patients with shortened and constricted vaginas. These techniques have minimal risks of complications and gives the greatest chance of vaginal lengthening success. These surgeries are successful in women who have failed conservative therapy and/or prior surgical repairs. With proper post-operative care Dr. Guerette can restore the vagina to a normal length and width and restore normal function. 

Combined Treatment Plan

Treatment plans for constriction and stenosis work best when the therapies are used together. Your IWI team will design a custom treatment plan to maximize you success.

Above all, remember that reversing vaginal stenosis and shortening is possible. Dr. Guerette and the IWI team can work with you to restore the natural elasticity and length of the vagina for pain free penetration.