Dilator Use and Tips for Success

If you’ve had the misfortune of experiencing pelvic pain you may be familiar with a common treatment tool in pelvic health therapy…..dilators.

What are Dilators?

Dilators are useful as a therapeutic treatment tools to combat pelvic pain, specifically pain on penetration of the vagina. Dilators aim to slowly and progressively increase the stretch of the vaginal opening, the introitus.

Common conditions that dilators are prescribed for include:

• dyspareunia (pain with intercourse)
• pain with insertion of tampon or speculum
• vaginismus
• fear of penetration
• vaginal atrophy (common during menopause)
• post-op surgeries including vaginoplasty
• post radiation treatment for cancer
• MRKH syndrome

What Kind of Dilators are on the Market?

Dilators range in composition from hard plastic to glass to silicone (more flexible). Deciding which type to get is mainly a personal preference. The main factors to consider are composition, ease of use, range of sizes available and cost. Some dilators have a loop, suction cup base or an extended handle which can be more user friendly. Dilators are approx 4 inches in size but have a wide variety of widths and lengths.

How do Dilators Work to Reduce Pain?

The purpose of dilators are to slowly stretch and open the vagina without causing pain. During treatment the dilator works to gently stretch vaginal tissues as your brain begins to reconnect with your body and develop positive emotional responses. As your body accommodates to each size the fear and anxiety often associated with penetration reduces. The goal is to desensitize the vagina and build confidence within the pelvic floor to allow for insertion (tampon, speculum, penis, sex toy, etc) without pain and negative psychological responses occurring.

Tips for Dilator Success

• Talk to your healthcare professional before hand. They can guide you on frequency and time depending on your specific condition.
• Clean dilators with soap and water before use. If it helps warm the dilator by placing in a warm glass of water beforehand. The same can be done for the lubricant.
• Use a liberal amount of water based lubricant.
• Always start small with dilator size. It’s easy to change for a larger size later.
• Place the dilator tip at the Introitus (vaginal opening). Get comfortable with the sensation of an object being there. Slowly slide the dilator tip into the introitus aiming it in a slightly downward direction. Continue to insert the dilator depending on your comfort level.
• If pain levels raise above 2/10 try some troubleshooting/relaxation tips below. If that doesn’t work remove the dilator. Take a break. Try again at a later time.

What Position Works Best for Dilator Use?

In the beginning, use the dilators while in a semi reclined position with your head propped up, knees are bent and can be resting on pillows/support. Sidelying positions can also be useful. You want to make sure you can reach the vaginal opening with the dilator without overstretching. Other positions to consider include a half kneeling position with one leg up or in standing with one foot on the side of a tub or chair. Keep in mind when changing positions start with a smaller size than you’re used to.

Troubleshooting When Pain Occurs During Treatment

• Use relaxation/breathing techniques to relax your body. Use that brain body connection letting go of tightness and stress within the body through gentle breathing.
• Imagery can be a powerful psychological tool to overcome challenges with dilators. Imagine your vagina as soft, smooth verse a thick impenetrable fortress.
• Have music on in the background or a TV show- try to distract yourself.
• Focus on belly breathing.
• Use contract relax methods to guide the pelvic floor into relaxing. Squeeze the pelvic floor for 1 second. Then relax the pelvic floor muscle squeeze and let go. You can repeat this techniques several times if you feel it helps.
• Some women like to use the power of sexual arousal before dilator use. This helps naturally relax the pelvic floor muscles, self lubricate the vagina and improve the psychological/emotional barriers.

Can Your Partner Help?

Absolutely. Just not from the get-go. You should be comfortable enough with dilators on your own before transitioning to help with a partner. You should be in full control of the experience, have full trust and excellent communication with your partner.

Should I Mix Dilators and Penetrative Sexual Activity?

Ideally no. There are many non-vaginal penetration sexual activities that you can engage in. When you have you have reached your goal with the dilators, you can transition to trying penetration from a partner. All sexual activity that involves penile penetration should involve you being in complete control to begin with. Your partner plays a passive role. Continue to try various positions or vary with insertion amount or speed. It’s important to establish a solid line of communication with your partner. It’s common for hiccups to occur, especially as you try different positions. It’s ok to try to work through these unless it continues to cause pain. Sometimes it’s necessary to stop and practice with dilators again.

Questions/Concerns?

We’re Here to Help! Our pelvic floor physical therapists are here to guide you. Body Harmony PT offers one-on-one treatment for up to one hour in private treatment rooms. This gives ample time to evaluate and begin treatment during the first session for the vast majority of patients.

We offer a quick call back option for individuals that would like to briefly speak to a pelvic health physical therapist.