Women who have undergone a course of radiotherapy to the pelvis may experience late effects resulting in distress in the physiological, emotional, social and sexual domains. Health professionals more frequently focus on vaginal late effects for women who have completed treatments for gynaecological cancers. However radiotherapy may equally impact women who have completed treatment for cancers of the anus, rectum and bladder. Radiotherapy to the pelvis may result in vascular and nerve damage that can lead to fibrosis of mucosal tissues and narrowing of the vaginal canal and vaginal stenosis, resulting in a loss of elasticity and shortening of the vagina. Women who have undergone a course of radiation for pelvic malignancy often experience severe dyspareunia due to the atrophy of the vaginal walls and the susceptibility for trauma. These issues can result in up to 20% of women not resuming sexual intercourse, which can be devastating for the women involved, who may also have to deal with other adverse side effects of the radiotherapy. Health professionals need to address these issues early, as part of supportive care in the acute treatment phase before they become late and irreversible. Radiation oncology nurses are well-positioned to provide this care in a professional and person-centred manner. This paper will focus on the late effects of radiotherapy to the pelvis where there has been a significant radiation dose to the vagina, and review updated studies relating to the use of vaginal dilators in this female patient cohort.