"Is brachytherapy painful?" is one of the first questions people ask after hearing they need it. The honest answer has two parts, and keeping them separate makes the whole thing easier to understand.
The radiation does not hurt. Macmillan Cancer Support says the actual delivery of internal radiotherapy "will cause no pain or burns", and Cancer Research UK puts it simply: "You won't feel the radiotherapy, but the tube can feel uncomfortable."
The procedure can be uncomfortable, and sometimes painful. That part depends on where the applicator goes, whether needles are used, how long it stays in, and which anaesthetic or pain relief your centre uses. Brachytherapy for the skin or the vaginal cuff is usually done without any anaesthetic; prostate implants, many cervical treatments and eye plaques are done under general or spinal anaesthetic. This guide goes through each treatment type, what published data says about pain, what is normal afterwards and what to ask your team.
The short answer: radiation vs procedure
Brachytherapy places a radioactive source inside or right next to the tumour, through a catheter, applicator, needles or seeds. The National Cancer Institute (NCI) explains that most brachytherapy "is put in place through a catheter, which is a small, stretchy tube", and sometimes a larger applicator.
Discomfort, when it happens, comes from four moments, not from the radiation. The diagram shows where they fall in a typical treatment.
- Placement. Inserting an applicator into a body cavity, or needles into tissue. This is the step for which anaesthetic or sedation is used.
- Lying still. With some applicators you must stay flat until treatment ends. Cancer Research UK notes that for cervical treatment, "once the applicators are in place, you cannot leave the bed and must remain flat".
- Removal. NCI says "you will get medicine for pain before the catheter or applicator is removed".
- Recovery. NCI adds that "the area where the catheter or applicator was might be tender for a few months".
If you are wondering whether you will be radioactive afterwards, that is a separate question with a different answer for seeds and for temporary treatment, covered in our guide to radiation after you go home.
Is brachytherapy a surgery?
Not in the usual sense. Brachytherapy does not remove tissue: it is a radiotherapy procedure. But some types are carried out in an operating theatre under anaesthetic, which is why people often describe them as an operation.
- Theatre-type procedures: prostate seed or HDR implants (general or spinal anaesthetic, per Macmillan), applicators placed into the womb for cervical cancer (general or spinal/epidural anaesthetic), and eye plaques, where Cancer Research UK describes "another operation to remove the radioactive plaques" at the end of treatment.
- Outpatient procedures without anaesthetic: vaginal cuff brachytherapy after a hysterectomy and surface (skin) brachytherapy are usually done in a treatment room with no anaesthetic.
Brachytherapy may also be given after an operation to remove a tumour, as Cleveland Clinic notes, but that is a separate step.
Pain and anaesthesia by treatment type
Most patient pages answer the pain question for one site only. This table brings them together. It describes what official and hospital sources report as typical; your centre may do things differently.
| Treatment type | Typical anaesthesia or pain relief | What patients may feel | Source |
|---|---|---|---|
| Prostate (LDR seeds or HDR tubes) | General anaesthetic or spinal anaesthetic | HDR tubes "can be uncomfortable" while in place; afterwards the area "can feel bruised and swollen for a few days"; discomfort passing urine | Macmillan |
| Cervix (applicator in the womb, with or without needles) | General anaesthetic, spinal/epidural, or sedation, depending on centre and applicator | Applicator "can feel uncomfortable"; must lie flat; removal sometimes under light sedation; mild period-like cramps afterwards | Cancer Research UK; Macmillan |
| Vaginal cuff (cylinder after hysterectomy) | Usually none; pain medicine if needed | The cylinder "feels a lot like a snug tampon"; "should not be painful" | American Cancer Society; Cancer Research UK |
| Breast (balloon or multi-catheter, partial breast) | Varies; in one study, mostly local anaesthetic, with or without sedation, at device placement | In one 44-patient study of balloon placement, average procedural pain scores were low (about 1.5–2.1 on the study's six-point scale) | Dooley et al., 2011 |
| Skin (surface applicator) | None | Described by an NHS centre as "a painless procedure"; delivery lasts a couple of minutes per session | United Lincolnshire Hospitals NHS |
| Eye (plaque for eye melanoma) | Usually general anaesthetic; some centres use local | "Some discomfort or pain" afterwards, treated with painkillers; eye often red for a few weeks | Cancer Research UK |
Prostate brachytherapy
Seeds and HDR tubes are placed through needles, with you under a general anaesthetic or a spinal anaesthetic (an injection that numbs the lower body). Macmillan notes you will not be able to drive afterwards because of the anaesthetic. With HDR, the tubes stay in until treatment is complete and "can be uncomfortable, and you must stay lying down while they are in place". Afterwards, bruising, swelling and urinary symptoms are common for a while; see prostate brachytherapy recovery for the full timeline.
Cervical cancer brachytherapy
This is the treatment where pain management varies most between centres, and where good pain control matters most because several sessions are usually needed. Cancer Research UK describes having either an epidural ("an injection into your spine… so you are numb below the waist") or a general anaesthetic. The next section summarises what published data shows. For the full procedure, see our step-by-step guide to cervical brachytherapy.
Vaginal cuff brachytherapy (endometrial or uterine cancer)
After a hysterectomy, treatment uses a smooth cylinder placed in the vagina, usually as an outpatient without anaesthetic. The American Cancer Society says it "feels a lot like a snug tampon" and that "if needed, pain medicines can be used". Most people describe it as uncomfortable rather than painful. More detail is in our guide to vaginal cuff brachytherapy.
Breast, skin and eye
For partial-breast brachytherapy, a balloon or several catheters are placed in the lumpectomy cavity. In one multicentre study of 44 women, most had local anaesthetic, with or without sedation, when the balloon was placed. We found no official patient source that sets a standard, so ask your team what they use. Skin brachytherapy uses an applicator on the surface of the skin and needs no anaesthetic. Eye plaques are attached to the eye in an operation, usually under general anaesthetic, and stay in place for 2 to 7 days according to Cancer Research UK.
Cervical brachytherapy: what the data shows
Patient leaflets tend to say "it shouldn't hurt". Published studies give a more nuanced picture, and they explain why it is worth asking about pain control in advance.
| Study | Setting | Key finding |
|---|---|---|
| Rivera et al., 2024 (US national survey of academic radiation oncology programmes, 41 responses) | Intracavitary brachytherapy | General anaesthesia alone 34%; conscious sedation alone 20%; oral painkillers alone 10%; spinal or epidural alone 9%; combinations 27%. Only 32% gave analgesia or anaesthesia across placement, planning, treatment and removal; 22% only during placement. |
| Becerra-Bolaños et al., 2023 (Spain, 154 patients, 247 HDR treatments) | Spinal (74%) or general (26%) anaesthesia, then continuous intravenous pain relief for 24 hours | Average pain score in the first 24 hours 2.56 out of 10; 81.8% mild pain, 18.2% moderate, none severe. Extra "rescue" pain relief was needed in 43.3% of treatments. |
| Chatterjee et al., 2019 (India, survey of 59 centres) | Cervical brachytherapy | General anaesthesia and spinal anaesthesia were each used at 44% of centres; the authors describe the procedure as "a relatively painful procedure" without anaesthesia and analgesia. |
Read together, these studies show three things. First, with planned anaesthesia and pain relief, most patients report mild pain. Second, a meaningful minority still have moderate pain, and in the Spanish study extra pain relief was needed in more than four in ten treatments. Third, practice varies widely: some centres cover only the insertion, others cover every step through to removal. The US survey authors cite "lack of anesthesia resources and clinician preference" as the most common reasons for not using sedation or general anaesthesia.
After the procedure: what's normal
Common, expected effects reported by official sources include:
- Tenderness where the applicator or catheter was, which NCI says can last "for a few months".
- Prostate: the treated area can feel bruised and swollen for a few days; discomfort or pain when passing urine, needing to go urgently and more often. Macmillan advises avoiding heavy lifting or energetic activity for 2 to 3 days, and centres usually give tablets to help you pass urine.
- Cervix: Cancer Research UK says you should not feel unwell, but may notice slight bleeding and mild period-like cramps.
- Eye: redness for a few weeks and sometimes blurred vision in the treated eye.
- General: Cleveland Clinic says that, depending on the procedure, "you may feel better within a few days up to a week", and that fatigue is common.
Ordinary painkillers are often enough; your team will tell you which ones are suitable alongside your other medicines. Macmillan suggests your GP, cancer doctor or pharmacist can advise.
When to call your team
Your centre should give you written instructions with a phone number, including out of hours. Sources list these as reasons to contact the team promptly:
- Bleeding that gets worse, or large blood clots (Macmillan, after prostate brachytherapy: "contact the hospital straight away").
- Difficulty passing urine or stopping urine from leaking, or difficulty controlling your bowels (Cleveland Clinic).
- Trouble breathing or swallowing (Cleveland Clinic).
- Bowel problems that do not improve, or that start later on (Macmillan).
- Pain that is getting worse rather than better, or that your painkillers do not control.
The last point is our general advice rather than a quote: pain that keeps increasing is not something to sit out at home.
How to prepare and what to ask about pain control
Bring these questions to your pre-treatment appointment. They also appear, alongside other topics, in our printable list of questions to ask before brachytherapy.
- Will I have a general anaesthetic, a spinal or epidural, sedation, local anaesthetic, or none? Why that choice for me?
- Does the pain relief cover every step: insertion, waiting while the plan is made, treatment and removal?
- How long will the applicator be in, and will I need to lie flat?
- What will be done if I feel pain during the session? Can I ask for more pain relief?
- What should I expect to feel in the days and weeks afterwards, and which painkillers can I take?
- Who do I call if pain or bleeding gets worse, including at night and at weekends?
- If I have several sessions and the first is uncomfortable, can the plan be adjusted?
Practical tips: follow the fasting instructions if you are having an anaesthetic or sedation; arrange a lift home (Macmillan notes you cannot drive after a prostate implant anaesthetic); wear loose, comfortable clothes; and tell the team about any previous experience of pain or anxiety with medical examinations, so they can plan for it.
For the bigger picture of the two main techniques, which partly explains why some treatments need longer with an applicator in place, see HDR vs LDR brachytherapy.
FAQ
Can you feel the radiation during brachytherapy?
No. Macmillan says the delivery of internal radiotherapy causes no pain or burns, and Cancer Research UK says you won't feel the radiotherapy. What you may feel is the applicator, needles or tubes, not the radiation.
Is brachytherapy for cervical cancer painful?
Placing the applicator can be painful, so it is usually done under general, spinal or epidural anaesthetic or sedation. With planned anaesthesia and pain relief, most patients in a Spanish study of 154 women reported mild pain, but 18% had moderate pain and many needed extra pain relief. Ask what pain relief covers each step.
Is brachytherapy for uterine (endometrial) cancer painful?
After a hysterectomy, vaginal cuff brachytherapy is usually done without anaesthetic. The American Cancer Society compares the cylinder to a snug tampon, and Cancer Research UK says it should not be painful. Pain medicine can be given if needed.
Is prostate seed brachytherapy painful?
The implant is done under a general or spinal anaesthetic, so you should not feel it. Afterwards the area can feel bruised and swollen for a few days, and passing urine may be uncomfortable for a while.
Will I be awake during brachytherapy?
It depends on the treatment. You are usually asleep or numbed for prostate implants, many cervical treatments and eye plaques. You are awake for vaginal cuff and skin brachytherapy, which normally need no anaesthetic.
Does it hurt when the applicator is removed?
It can be briefly uncomfortable. NCI says you will get pain medicine before the catheter or applicator is removed, and Cancer Research UK says some people have light sedation for removal after cervical brachytherapy.
Sources
- National Cancer Institute — Brachytherapy to Treat Cancer (accessed 9 October 2026)
- Macmillan Cancer Support — Internal radiotherapy (brachytherapy) (accessed 9 October 2026)
- Macmillan Cancer Support — Brachytherapy for prostate cancer (accessed 9 October 2026)
- Cancer Research UK — Internal radiotherapy (brachytherapy) for cervical cancer (accessed 9 October 2026)
- Cancer Research UK — Internal radiotherapy for womb cancer (accessed 9 October 2026)
- Cancer Research UK — Internal radiotherapy for eye cancer (accessed 9 October 2026)
- American Cancer Society — Radiation therapy for endometrial cancer (accessed 9 October 2026)
- Cleveland Clinic — Brachytherapy (accessed 9 October 2026)
- RadiologyInfo.org (ACR/RSNA) — Brachytherapy (accessed 9 October 2026)
- United Lincolnshire Hospitals NHS Trust — Skin brachytherapy patient leaflet (PDF) (accessed 9 October 2026)
- Dooley WC, et al. Surgical perspectives from a prospective, nonrandomized, multicenter study of breast conserving surgery and adjuvant electronic brachytherapy. World J Surg Oncol. 2011;9:30 (accessed 9 October 2026)
- Rivera A, et al. Analgesia and Anesthesia Practice Patterns for Gynecologic Brachytherapy Procedures and Potential Impact on Women's Procedural Experience: A National Survey. Int J Radiat Oncol Biol Phys. 2024 (accessed 9 October 2026)
- Becerra-Bolaños Á, et al. Pain in High-Dose-Rate Brachytherapy for Cervical Cancer: A Retrospective Cohort Study. J Pers Med. 2023;13(8):1187 (accessed 9 October 2026)
- Chatterjee A, et al. Patterns of cervical cancer brachytherapy in India: results of an online survey supported by the Indian Brachytherapy Society. J Contemp Brachytherapy. 2019;11(6):527-533 (accessed 9 October 2026)
Educational content. It does not replace advice from qualified healthcare professionals. Your own treatment team is the right source for decisions about your care. Written by the brachytherapist.com editorial team from the sources listed above.