71 A recent study has highlighted the inconsistencies in preventative care for vaginal stenosis among women undergoing pelvic brachytherapy in Brazil. Despite the condition being a well-documented complication of radiotherapy for gynaecological cancers, there remains no standardised national protocol for prevention. The findings were published in the journal Revista Brasileira de Cancerologia. Vaginal stenosis is a common side effect of pelvic radiotherapy, causing narrowing and shortening of the vaginal canal, often leading to pain, discomfort, and difficulties with medical examinations and sexual function. The study, which surveyed radiotherapy services across Brazil, found that while the majority of institutions provided some form of guidance, the recommendations varied significantly between centres. Out of the 43 radiotherapy centres that responded to the survey, 34 confirmed they performed pelvic brachytherapy, with 33 stating they provided guidance on vaginal stenosis prevention. The most commonly advised preventative measure was the use of vaginal dilators, with 97% of institutions recommending them to patients. However, the specifics of their usage – such as when to start, how frequently to use them, and for how long – differed greatly. Most centres advised starting dilator use two weeks after brachytherapy, recommending sessions three times a week, lasting between 10 to 15 minutes. Some institutions suggested continuing use for at least three years, while others provided no clear timeline. In addition to dilators, other recommended methods included encouraging sexual activity with penetration, pelvic physiotherapy, and topical treatments. Around 82% of radiotherapy centres advised patients to maintain sexual activity as a preventative measure, while 66% promoted physiotherapy, and 48% suggested the use of topical solutions. However, these additional measures were less consistently endorsed, with some centres offering no guidance on them at all. One of the key findings of the study was the lack of a unified approach across Brazil. The absence of national guidelines means that the quality of care depends heavily on the individual practices of each radiotherapy centre. While some institutions provided extensive in-person consultations, others relied on printed or digital materials, and a small number offered minimal or no guidance at all. Furthermore, only a handful of centres provided vaginal dilators free of charge, leaving many patients to source their own, which could be a barrier to adherence. The study’s authors emphasised the need for an evidence-based national protocol to standardise care and improve patient outcomes. They highlighted the importance of multidisciplinary support, particularly from physiotherapists and oncology specialists, in ensuring that patients receive adequate information and support to prevent complications. Without consistent guidelines, there is a risk that many women will experience unnecessary discomfort and reduced quality of life due to inadequate preventative care. The findings underscore the necessity for further research and policy development to establish uniform recommendations for vaginal stenosis prevention in Brazil. Until then, disparities in patient care are likely to persist, leaving some women without the essential guidance needed to manage this significant side effect of radiotherapy.