Women who have undergone pelvic surgery or who suffer from vaginal shortening, vaginal narrowing, or scar tissue that may interfere or prevent penetration (and cause vaginal pain) have pelvic discomfort that makes them avoid sexual behavior. Vaginal dilators, or inserts, may be prescribed as part of their sexual rehabilitation regime. These dilators are size-graded vaginal inserts usually made of plastic or silicone; they are inserted into the vaginal canal. Dilators are often used to facilitate lengthening and widening of the vagina. They may also be used to help stretch the vaginal scar tissue that may contribute to pain and discomfort of vaginal intercourse.
Dilators can be used on a regular basis and with water- or hormone-based lubricants. The suggested schedules range from once daily for 10 to 15 minutes to at least three times weekly. Several studies report that ongoing supportive behavioral therapy is instrumental for continued compliance. Just getting a dilator is not enough — you need to see your sexual healthcare provider on a regular basis to ensure that you make slow but steady progress. Start of using the smallest size and gradually work up to the next larger size once you are comfortable.
To use a vaginal dilator, first begin by preparing yourself and your environment for dilator therapy. Make certain you will have privacy either by locking your door or working with your dilator when you will not be interrupted. At the Southern California Center for Sexual Health and Survivorship Medicine, we advocate using the dilators in the morning hours just before starting the day. This suggestion is for several reasons. Trying to do this at night often doesn’t work for the active, vibrant woman. At the end of a long, busy day with work, family, and social obligations, many women believe that it is too time consuming to do the dilator therapy. Too often fatigue and rest supersede sexual rehabilitation. Another reason to do dilator therapy in the morning is that after completion, you can shower and clean of and prepare for your day. Showering after therapy can be helpful if the lubricant is messy and/or results in any vaginal leakage. It only takes a few extra minutes.
The dilator should be inserted into the vagina with a generous amount of water-based lubricant. You should lie on your back, bend your knees, and spread your knees apart. With gentle pressure, the vaginal dilator should be inserted into the vagina as deeply as possible while still maintaining some comfort. Try to leave the dilator in place for about 10 to 15 minutes while remaining on your back. It is often helpful to be distracted by other activities while the dilator is in place, such as reading a book or watching television. After removing the dilator, it is important to wash it with warm water and soap, dry it with clean towel, and store it in a safe secure place.
Stay at one size for a least one week and ensure that there is no pain or discomfort, and then try the next size. Remember that it is a process and stepwise — Rome was not build in a day! Often it takes time to advance. If you feel that your muscles are tensing up, practice some self-talking exercises and focus on your conscious awareness that you are in control of the dilator and muscle relaxation. Try to relax tense muscles — take deep breaths in and out and focus on relaxation. Ease up on your pressure on the dilator and make certain that you have used enough lubricant.
Dilators can be very helpful in a variety of clinical situations. Be certain to discuss them and your progress with your sexual healthcare provider.
Selections from the book: Michael L. Krychman, “100 Questions and Answers about Women’s Sexual Wellness and Vitality: A Practical Guide for the Woman Seeking Sexual Fulfillment”, 2010.