How would you manage a patient with profound dyspareunia after pelvic radiation for anal cancer?  

Thanks for bringing up this important topic that remains understudied, with historically widely underestimated incidences of post-radiotherapy dyspareunia. There is currently no standardized method or schedule for assessing post-treatment sexual dysfunction including vaginal stenosis and fibrosis (a...

Topical estrogen and dilatation

You might also consider a referral to a physical therapist who specializes in pelvic floor rehabilitation therapy. I have had one person tell me that it helped them. There have been some clinical trials demonstrating some signal of benefit for patients with dyspareunia (not necessarily RT/cancer-rel...

I agree with @Nina Sanford in all respects, and particularly the fact that we don't have much objective data. So possibly anecdotal experience can be useful, or maybe not. Here is my anecdotal experience.  Dyspareunia is more common in patients treated for cancers of the vulva, vagina, and IIIA...

Simulating and treating with the vaginal cylinder in place can help reduce the dose to vagina and stenosis. 

In addition to other comments, vaginal laser therapy may be an option and could be assessed by a Gyn offering this service.

I often encourage these women to join a local GYN support group, whose members often have similar survivorship struggles. Many of these are now held virtually so the often intimidating in-person attendance is not a requirement. Next week, Johns Hopkins is hosting a great GYN cancer survivorship summ...

You might consider referring the patient to a comprehensive cancer center that has a clinic/program specifically for women's sexual health after cancer treatment.

Does anybody have experience with hyperbaric oxygen as a treatment option for this side effect?