There are different reasons to use vaginal dilators. This particular post focuses on providing dilator information for women facing fear, anxiety, and/or pain with regard to vaginal touch, finger insertion, gynecology exams, use of tampons, and intercourse. My quest to find valuable, comprehensive resources for a guide for dilator use fell short. This is particularly true with regard to understanding that using dilators is NOT just to “stretch the vagina,” which is often told to patients. I created documents for patients to use and wanted to share (still a work in process, but isn’t it always?!).

Dilators provide an excellent way for women to transition from pain and/or avoidance behaviors to decreased anxiety and/or pain with any and all touch at and inside the vagina. Over the years, I witnessed patients bring in zip-loc bags of dilators and state comments such as “my doctor just handed these to me and told me to use them” or “I got this on the internet but once they started hurting me I stopped using them”. They felt lost, alone, and defeated. The most important thing I have found, and we can confirm with research, is that pain (and associated anxiety and fear) is not just happening at a local area of the body – i.e. the vagina. The brain is involved in this process! So, in order to have success with dilators, we should consider using them in a way that facilitates decreasing brain “danger” signals and allows for a positive experience.  I am in the process of developing a full guide to using dilators for various conditions. I prepared a handout guide for my patients and wanted to share it with you.

• If you are an individual dealing with pain or discomfort and are considering dilators, you can certainly try this guide on your own. However, I suggest working with a highly skilled pelvic physical therapist  (after you have made sure you don’t have any other underlying medical diagnoses that should be discussed with your physician) who can guide you through this process and evaluate and treat you with a complete program of care to meet your goals. Directory of pelvic health professionals. 
• There are also wonderful certified sex therapists, counselors, and educators who can support you through this process as well (best in conjunction with pelvic physical therapy.
• If you are a physical therapist, physician, physician assistant, sex therapist, sex educator or other medical professional, feel free to provide this handout to your patients as a guide.

This handout is most useful for women who are dealing with conditions such as:

• pelvic pain,
• vaginismus,
• pudendal neuralgia,
• vulvodynia/vestibulodynia
• history of sexual trauma. 

Click Here for the PDF You Can Print:

Vaginal Dilator Guide PDF Handout

Here’s a preview of the Vaginal Dilator Guide:

Tips for Success:

• This is a great step! The use of dilators provides the opportunity to transition away from fear and pain and toward your goals. This is for YOU.
• Be good to yourself through this process. It is a journey. I tell my patients that the journey may have times of frustration and peaks and valleys, but there’s a lot of hope! Remember that you are not “broken” or “less feminine”. Love yourself where you are.
• Dilators are primarily used in the privacy of your home, however, you can receive help from a qualified pelvic physical therapist trained in teaching you how to use them AND how to progress them.
• I usually suggest that you use the dilators by yourself and not with a partner initially. The goal is to make sure that YOU feel comfortable and can guide them without any outside pressure. Even a loving partner may mean well, but this may increase your fear or anxiety without you even realizing it.
• Prior to using dilators, it can be helpful to set the right environment – examples: taking a nice bath before; playing calm, soothing music; meditating or doing breathing exercises; playing guided imagery CDs.
• Graded Imagery (different than guided imagery): Imagine yourself using the dilator. Picture how you feel and pay attention to thoughts and how you can direct them in a positive way. Imagine yourself without stress, anxiety or pain with the dilator you plan to use
• You can even use a dilator on the outside of the vulva just to have some touch there and “connection” with the dilator prior to inserting – 1 min to 10 min.

Dilator Use: Ideal to use dilators every day (or night), but this can vary.

• • Position yourself reclined/lying on our back on your bed with your knees bent
  • Place a liberal amount of lubricant (water-soluble) all over the dilator starting with the smallest size (your pelvic physical therapist can also help you decide about the starting size). The recommended lubricant is one that is free of glycol (recommend Slippery Stuff or Sliquid Organics)
  • Slowly slide the tip of the smaller size dilator in – pay attention to how that feels. If you experience NO GREATER tan 3/10 discomfort (not necessarily pain), continue to slowly insert the dilator. You can pause at any time and either hold the dilator at that position or try to slide in further when you feel ready. 

• Allow the dilator to stay in place in a position that does not increase discomfort greater than 3-4/10 (0 is no discomfort or pain and 10 is severe ) fr 10 minutes. Whe you keep the discomfort level relatively low, this reinforces to your brain that the danger/threat level is low and fear/anxiety/pain levels may decrease as a result. This has a reinforcing effect that becomes cumulative during the time you use the dilators. 

• You can repeat the above step for several days and then, you can move on to the next size (or warm-up for a few minutes with the smaller size and then insert the next size). Repeat the process of slowly inserting the dilator, but the key is to make sure the discomfort does not stay increased greater than 3-4/10 (however, for example, a transient 6 that drops quickly to a 2/10 is okay)
• You can then progress to the following:
  • Use the second dilator your progressed to for 5-7 minutes and then insert the smaller dilator and do gentle movements in/out direction (with discomfort no greater than 3-4/10) Or use the smaller dilator first and do in/out movement for a few minutes, then progress to the next dilator size and hold static for 5-7 minutes for a total of 10 min. 
  • The ultimate goal is to progress dilator size at a comfortable pace (this could be weeks or month) so that you are using the largest dilator you choose without discomfort greater than 3-4/10 with movement (for your intended goal – GYN exam, tampon use, sexual activity, etc.)

Additional Options: 

• Some individuals may progress better after doing a gentle pelvic floor contraction or “Kegel” and then relaxing the muscles while inserting the dilator. This does not work for everyone, however.
• If you have tight pelvic floor muscles or want more stretching at the walls of the vagina, your pelvic physical therapist can teach you ways to angle the smaller dilators to them for pressure or stretching.
• You can experiment with different leg or trunk positions as well as angles of insertion for comfort.
• As you progress and feel comfortable, you can have a partner assist in using the dilators and/or use them as part of foreplay and transition to sexual intercourse if this is a goal.

 

Additionally, Dustienne Miller has a fantastic guided meditation for dilator use that can be a wonderful supplement to this guide. Click the button below for access! 

Please let me know if you use it and if it is helpful for you or your patients! ~ Tracy

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Tracy Sher, MPT, CSCS owns a private physical therapy practice in Orlando, Sher Pelvic Health and Healing. She is an international instructor and faculty member in the area of pelvic physical therapy and is the Founder of Pelvic Guru.  Consider following Pelvic Guru on Facebook too for regular “pelvic” discussions and very regular updates regarding research or articles (and fun stuff too).

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