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Radiation given this way mainly affects the tissue touching the cylinder. This means nearby structures, like the bladder and rectum, will get less radiation exposure than with EBRT.

There are 2 main types of intracavitary brachytherapy.

Low-dose rate (LDR) brachytherapy: The radioactive material is put in the vagina. It stays in place for a couple of days. Gauze packing helps hold the cylinder in place, but you must stay in bed in the hospital for a few days during the treatment.

High-dose rate (HDR) brachytherapy: The radiation is inside a cylinder and is given over hours instead of days. This means you can usually go home the same day as the treatment. Multiple treatments are usually given over a few weeks.

Interstitial radiation uses needles to put radioactive material into the tumor and nearby tissues. The needles are held in place by an applicator inserted into the vagina. The applicator and needles are placed while you are under anesthesia (sedated). It stays in place for a couple of days while you are in the hospital on bed rest.

This type of brachytherapy might be used if your tumor is large or is shaped such that intracavitary brachytherapy might not work well. It is also used more often for tumors of the lower vagina.

This type of radiation is less likely to expose healthy nearby tissues to radiation than EBRT.

For more information, see Getting Internal Radiation Therapy (Brachytherapy).

Short-term side effects happen during or shortly after treatment. EBRT and brachytherapy can cause similar side effects.

Short-term side effects might include:

• Fatigue
• Hair loss in the area receiving radiation
• Red, tender, or dry skin in the area receiving radiation, like a sunburn
• Low blood counts, which are more common when radiation is combined with chemo or other drugs
• Nausea, vomiting, cramps, and diarrhea
• Bladder irritation (radiation cystitis), bleeding, or damage, which might cause pain or problems when passing urine
• Blood, pain, or difficulty when passing stool (radiation proctitis)

Side effects tend to be worse when chemotherapy is given with radiation.

Long-term side effects can last for months or years after treatment. Late effects can take months or years to develop after treatment. Long-term and late effects of radiation therapy depend on where it was given. Some of these effects can last many years after treatment.

Altered sexual function: Radiation to the vaginal walls can cause scar tissue to form, which can cause the vaginal canal to narrow and become dry, making sex painful. Vaginal dilators (plastic or rubber tubes used to stretch the vagina), regular sex, certain creams, and lubricants can help with symptoms. However, pain with sex can be a long-term problem after radiation. See How Radiation Therapy Can Affect Sex for Women to learn more.

Early menopause: For younger people with vaginal cancer, pelvic radiation can damage the ovaries, leading to early menopause. The hormone changes in early menopause can also increase the risk of other health problems such as broken bones, heart disease, and changes in mood, memory, and thinking. Treating early menopause can help lower these risks.

Changes in bowel or bladder habits: Radiation scarring can cause problems such as narrowing of the bowel, irritation of the bladder (cystitis) or rectum (proctitis). This can cause symptoms such as frequent or painful urination or constipation. This can begin months or years after treatment.

Radiation can also cause abnormal connections (called fistulas) to form between the vagina and the bladder, rectum, or uterus.

Swelling (lymphedema): Radiation to the pelvis can block fluid drainage from the legs, leading to lymphedema (swelling) in the legs. It’s more common in people who have lymph nodes removed during surgery.

Bone health problems: Pelvic radiation can also weaken bones, leading to fractures of the hips or pelvic bones. Low estrogen levels after radiation to the ovaries can also increase the risk of fractures.

Risk of a second cancer: Because radiation works by breaking DNA, it can also increase the risk of a second cancer many years later.

Changes to the skin and hair: If the skin is irritated by radiation, when it heals it might be darker and not as soft. The hair might not grow back.