Side effects from radiation therapy to the female pelvis

During radiation therapy to the pelvis, you may experience different short-term side effects.

What are the possible short-term side effects?

Radiation therapy to the female pelvis may cause a number of short-term side effects. However, everyone is different and you’re unlikely to experience all of the same side effects as someone who is receiving the same treatment as you.

If you’re concerned about any side effects during your radiation therapy treatment to the pelvis, we encourage you to speak with your care team who can help you with strategies to manage your side effects.

Types of short-term side effects

Skin reaction

If you’re receiving treatment to your bladder, pelvic bones, pelvic nodes, uterus or ovaries, it’s uncommon for a skin irritation to occur. If you do experience any changes, tell your nurse who can help you manage these.

If you’re receiving treatment to your lower bowel/rectum, vagina or vulva, your skin may start to become red, itchy or irritated two to three weeks after treatment starts.

Towards the end of treatment, the skin reaction can become more intense. You may experience some minor skin loss in the genital and anal region (perineum) and groin. This can be managed with a simple dressing until the area heals.

Your nurses will show you how to care for your skin and manage any skin reactions. Tell your nurse if you’re worried about a skin reaction or are experiencing any skin changes.


You may feel tired or lack energy for daily activities during your treatment. You may feel increasingly tired as you reach the end of your treatment. This is a common reaction to radiation therapy and each person is usually affected to varying degrees. Fatigue usually eases a few weeks after treatment finishes. Finding a balance between rest and activity will help you manage daily life.

Nausea and vomiting

If a large area of the pelvis is being treated, you may experience nausea or vomiting. If required, your doctor will prescribe anti-nausea medication. You may need to take this before treatment for your comfort. If you experience any nausea or vomiting, please let us know as soon as possible so we can help you.

Bowel irritation (including diarrhoea)

Bowel irritation may occur two to three weeks after treatment starts. Symptoms may include:

  • An increase in the amount of times you use your bowels
  • Softer/looser bowel actions
  • Discomfort in passing a bowel motion
  • An urge to use your bowels without passing a motion (tenesmus)
  • Bleeding from the rectum (especially if you have haemorrhoids)
  • Mucus discharge

Bowel irritation can be more noticeable if you’re also receiving chemotherapy. It is usually temporary and returns to normal two to three weeks after finishing treatment. Let us know as soon as possible if you experience diarrhoea, or notice mucus or blood in your bowel movement. We will monitor the severity of the irritation and can also provide advice to help you manage. Dietary changes may be required, or a referral to a dietitian if needed.

Bladder irritation

There can be irritation to the bladder lining and urethra (the tube that you urinate through) if they are in your treatment area. Symptoms may include:

  • The need to urinate more often, including overnight
  • A sudden urge to empty your bladder
  • A burning sensation when you urinate
  • A change/reduction in your urine flow/stream and/or difficulty urinating
  • Blood or particles in your urine

Let us know as soon as possible if you experience any irritation as we can provide advice and treatment options to reduce your discomfort.

Pain and discomfort

We will provide you with information to help control any pain or discomfort you may be experiencing. If required your doctor will also prescribe pain relief to help control any pain. Pain relief may be required if your skin becomes red, irritated or tender in the region of the perineum (genital/anal regions) and groin.

Pain flare

Radiation therapy to bone areas in the pelvis can cause a temporary increase in pain in the area being treated. It can occur after one dose of radiation and usually lasts for 12 to 36 hours.

Let us know as soon as possible if you experience a pain flare, as we can control this with the use of additional pain medication.

Vaginal stenosis

Vaginal stenosis is the development of scar tissue which may lead to shortening and narrowing of the vagina. It is a possible side effect of radiation therapy to the pelvis, usually when treatment is to the uterus, vagina and rectum. You may also find that vaginal tissue is tender, dry and has lost elasticity.

Your doctor will let you know if this is a likely side effect of your treatment. If so, the use of a vaginal dilator will be recommended. Your nursing team will show you how to use it and give you more information.

How can I manage skin changes?

Moisturise twice a day

Your care team will recommend a cream to help manage any skin changes. At the start of your treatment, apply cream to the area being treated twice a day. As treatment progresses, you may need to apply the cream three to four times per day. Do not apply cream within the hour prior to your treatment, as cream needs to be well absorbed. Let your nursing team know if you continue to experience skin changes.

Wear loose fitting clothing

Avoid wearing tight fitting clothing that could potentially rub or irritate the skin. Loose cotton underwear is best.

Avoid excessive temperatures

Avoid exposing the treatment area to excessive temperature including direct sunlight, heat packs, ice packs, saunas or hot spas during the course of your radiation therapy. Do not use talcum powder or sunscreen in the treatment area.

Wash with warm water and pat dry

You may wash the skin that is being treated with warm water and a mild non-perfumed soap. Pat dry the skin – do not rub.

Let your nursing team know if the anal area becomes tender. The use of salt water washes or baby wipes may be recommended after each bowel movement.



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