How and When to Use a Dilator
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Welcome back, bestie! Last we talked, we got *deep* (no pun intended) into dilators. Today, let’s talk more about when and how to use a dilator. If you need a refresher on what a dilator is, check out our last chat here.
What are dilators used for?
Dilators are super versatile tools. Last chat, we compared dilators to foam rollers. If you have a foam roller at home or one at the gym you attend, you probably know they can be used to roll out many parts of the body. You might use it to loosen up your spine, roll out tight glute muscles, or decrease tension in your quad or hamstring muscles. Dilators, similarly, can be used to tackle many different muscles and symptoms. Let’s discuss some of the most common reasons someone might benefit from dilator use:
- Pain during vaginal penetrative intercourse: Pain during intercourse can have various origins. These could include tightness in the pelvic floor muscles (PFMs), irritation of the pelvic nerves, infection, trauma, and more. If the reason for the pain during intercourse is related to tightness in the PFMs, a dilator can help to stretch the tissues of the pelvic floor and can also help to desensitize the tissues of the vagina and pelvic floor (1). In cases where pain is present, but PFM tightness is not present, a dilator can still act as an important tool for desensitization of tissues.
- Rectal pain/constipation: Constipation and rectal pain can be the result of PFM tightness and difficulty relaxing the PFMs in order to allow stool to pass through the rectum and anus. If this is the case a rectal dilator can be helpful in stretching the muscles of the pelvis and desensitizing the area.
- Pain during anal penetrative intercourse: Similarly to above, a rectal dilator could be used to help stretch and desensitize tissues and muscles to reduce pain.
- Post-gender affirmation surgery (vaginoplasty): During a vaginoplasty, a surgeon constructs a vagina using the skin of the penis. After surgery and during the healing of the tissue, it is common for the tissue to constrict, resulting in a smaller vaginal canal. This is a normal part of wound healing, but is not ideal for maintaining the desired vaginal canal. Dilators are used post-vaginoplasty to maintain the width and length of the newly constructed vaginal canal. In many cases, dilators are used indefinitely after this surgery for maintenance.
- Post pelvic radiation: Radiation is an incredible tool for destroying cancerous cells. However, it has a less-than-optimal effect on the remaining healthy cells. It causes somewhat of a “shrinkwrap” phenomenon. This means the tissues constrict. In folks who have undergone pelvic radiation, the constriction or “shrinkwrapping” of the tissues could mean a vaginal canal that is stenosing, or getting smaller. Dilator therapy can be used to maintain the length and width of the vaginal canal following radiation treatment.
All of the above situations we have discussed work best in conjunction with other therapy treatments. These could include education, pelvic floor exercises, manual therapy techniques, pelvic floor lengthening techniques, hip and core exercises, biofeedback, and electrical stimulation. Dilator therapy is rarely used in isolation and should be a part of a broader treatment plan that addresses you as a whole person. This might touch on topics such as diet, exercise, mental health, medication, and more. This is important as it has been shown that people may not benefit from dilator training in isolation (2).
How to use a dilator?
Dilators are used in a variety of ways and each person’s progression will be unique to them. First, it is important to create an ideal environment for dilation. For some, this means an environment in which you will definitely not be interrupted, whether that be by children, animals, family members, or a partner. For others, this includes meditative or mood music, dimmed lights, and aromatherapy. An ideal environment could be created in a hot shower or bathtub, or in bed. Some folks dilate alone and others use the help of their partners in order to share the weight of chronic pelvic pain with someone they trust. What’s important is creating an environment that works for you, and this means you might have to play around with different settings to find the right fit.
I typically recommend starting in an environment in which your legs can be relaxed and supported. A bathtub is good for this because you can lay down and allow your legs to be held up by the sides of the tub. You can even have the hot water on to create an even more calming experience. I also like to recommend this because it provides a space in which you can have some peace and quiet. Folks typically shower or bathe alone and this built-in daily alone time lends well to regular use of the dilator. If you don’t like to use the dilator in the bath or shower, using it in bed is a great alternative, where pillows can support your relaxed legs. You can even start by sitting on a heat pack for a few minutes to relax the pelvic muscles and tissues before initiating dilation.
Some people like to use lidocaine jelly during dilation. This jelly is applied to the area around the vaginal opening and can numb some of the pain and sensitivity. Talk to your healthcare provider about whether they think you would benefit from lidocaine jelly. It can be purchased over the counter in mild forms and prescribed by your physician in heavier concentrations. If you use lidocaine jelly, apply it about 30 minutes before you start using the dilator to give it time to kick in.
While dilating, focus on deep, diaphragmatic breathing. This is breathing in which your stomach expands as you take a breath in and it falls as you breathe out. This type of breathing can calm the nervous system and decrease pain. You can also focus on pelvic floor muscle relaxation. This may include a gentle bearing down of the PFMs. Diaphragmatic breathing also helps with PFM relaxation. Your pelvic health specialist will talk with you about this prior to initiating dilation therapy.
Now, it’s time to actually use the dilator. In some cases of fear, anxiety, or traumatic history, just the thought of dilating can cause onset of symptoms. In these cases, someone might start by just sitting, fully clothed, near their dilator. They might progress toward holding the dilator in their hand and then toward moving the dilator near their vaginal opening. Where someone begins and how quickly they progress in their dilator journey will be specific to each person.
Dilators work best when used with lubrication. If you have a hard plastic or glass dilator, oil, silicone or water-based lubricants will work well. If you have a silicone dilator, do not use a silicone-based lubricant as it will cause the surface of the dilator to break down. I typically recommend the brands Slippery Stuff, Good Clean Love, and Coconu as lubricants that are not generally irritating to sensitive skin. Some folks just like to use plain coconut oil. Whatever works for you is great, but I would stay away from lubricants that have glycerin or parabens.
Once able to insert the dilator, if this causes pain, just leave the dilator inserted for a minute or two to let the pain subside. Focus on the relaxation techniques mentioned above. Once you are able to progress, start to press the dilator gently into the walls of the vagina. Imagine the opening of the vagina is a clock and press and hold the dilator to each of the numbers on the clock for about 90 seconds at each point. Focus on the areas that cause you to notice your typical symptoms, while keeping an eye on your pain levels. Your pain should not increase drastically during dilation. Pain that increases by a couple of points on the 0-10 scale (where 0 is no pain and 10 is emergency room-level pain) is okay, but more than that means you might be pushing yourself too much. When you are able to progress, you will start using a “sweeping” motion with your dilator. This is sort of a gentle “C” shaped motion along the walls of the vagina. Once you are ready to progress, you can move up to the next size of dilator. Each time you start a new dilating session, start with the smaller dilator to ease in before jumping to the larger dilator.
How long should I be dilating?
How long you spend using the dilator and how often you should dilate will depend on your specific scenario and conversations with your provider. Some may benefit from using the dilator for no more than 3-5 minutes 3 days per week. Others will need to dilate for 30 minutes daily. This is a conversation that will be had with your provider and it is important to note that more isn’t always better. If you’ve been dilating on your own for a while and haven’t noticed progress, this doesn’t necessarily mean you aren’t dilating enough. Maybe your technique could use some work, you would benefit from expanding your treatment protocol or you’re dilating too much (2).
Using a dilator can feel really overwhelming at first, but if you take it one step at a time, it is manageable and beneficial part of your treatment.
Happy Dilating!
XOXO,
Your Pelvic Bestie
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Other Dilators
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References:
1. Goetsch MF. Surgery combined with muscle therapy for dyspareunia from vulvar vestibulitis: an observational study. J Reprod Med 2007;52:597—603
2. Macey, K., Gregory, A., Nunns, D. et al. Women’s experiences of using vaginal trainers (dilators) to treat vaginal penetration difficulties diagnosed as vaginismus: a qualitative interview study. BMC Women's Health 15, 49 (2015). https://doi.org/10.1186/s12905-015-0201-6
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives.
