Cervical cancer is the most common malignancy treated with radiation in Botswana and post-treatment dyspareunia and relationship strain is common. To reduce vaginal morbidity following treatment, we introduced a program to offer vaginal dilators in 2017. We sought to assess initial acceptability of vaginal dilators, adherence with use, and barriers to successful use of dilators in a setting with high burden of cervical cancer. Beginning in July 2017, as part of standard clinical care at the sole radiation facility in Botswana, patients with a complete tumor response following curative-intent chemoradiation and brachytherapy, were offered education, a set of vaginal dilators, and lubricant. We analyzed consenting patients in the longitudinal Thabatse Cancer Cohort who received vaginal dilators through December 2019. Patients were reviewed at 6 weeks and thereafter every 3 to 6 months to assess compliance and quality of life. Successful completion of vaginal dilator use was considered as self-reported regular use for 2 years or return to regular sexual activity without dyspareunia. A total of 110 enrolled patients (median Figo stage IIIA) were given dilators. At scheduled 6-week follow-up, 101 (92%) had commenced dilator use. Reasons provided for not starting dilator use were return to regular sexual activity (4), fear of pain (1), fear of bleeding (1), not understanding instructions (1), and no offered reason (2). A successful outcome was observed for 98 (89%)— return to pain-free sexual activity (54, 49%), completed 2 years of use (16, 15%), and continued dilator use (24, 22%). Twelve (11%) women stopped dilator use prior to completion of 2 years. Offered reasons for discontinuing use included: running out of lubricant and pain, bleeding, discomfort with dilator use. Of 58 women returning to sex following treatment for cervical cancer, 50 (86%) were happy with their sex life and 4(7%) reported having pain on sexual intercourse. Reasons offered for not resuming sex were lack/departure of partner, fear of pain, low sexual desire, vaginal dryness, and feeling unwell. During follow up exams, 9 (8%) women provided dilators experienced pain or discomfort on clinical vaginal examination. No moderate or severe adverse effects of dilators were reported. Acceptance of vaginal dilators and self-reported use was high among women completing curative treatment for cervical cancer in Botswana. Further research is needed to optimize patient education and estimate impact of dilator use on function in our population. Retention to dilator use was considerably higher than reported in high-income country contexts and provision of dilators could be especially beneficial in settings like Botswana.