How to use a vaginal dilator for painful sex or penetration

Co-authored by Liz Miracle, MSPT, WCS

If you have a history of pain with vaginal penetration, whether during sex, OB/GYN exams, or even with tampon use, you may have a condition known as vaginismus. Your healthcare provider may have even instructed you to purchase a set of vaginal dilators (also known as vaginal trainers) as a way to help address your condition.

If you have already made this purchase, congratulations! You are one step closer to improving your function. It is very important to understand how to properly use dilators so that you can actually improve your tolerance to penetration.

Our goal is to provide a clear, basic step-by-step guide for how to use and care for your vaginal dilators.

Using your vaginal dilator for the first time

1. Recline on a bed with knees bent. Use pillows to support your head, upper body and knees. Feel free to use another position, such as the legs open in a diamond shape supported by pillows, if it allows more comfort and relaxation.
2. Begin by using the smallest size dilator you feel comfortable inserting. Use your preferred lubricant to generously cover the tips and sides of the dilator entirely. We recommend a water based, glycerin free lubricant.
3. Separate your labia with one hand to the side and use the other to slowly insert the dilator, try pointing it up slightly. Keep the pelvic floor muscles as relaxed as possible.
4. Pause if you feel significant discomfort or resistance, and allow the muscles to relax. Exhale and practice pelvic floor muscle lengthening/bulging as you insert, if it helps you.
5. Continue to insert the dilator until approximately 3⁄4 of its length is inside the vagina. Depending on the dilator's length, it may not fit completely inside.
6. Once you have it inserted, you can use a rolled towel to help keep the dilator in place so you don’t have to use your hands and can relax more completely.
7. If you are unable to insert the dilator to the desired depth, hold it at the depth you are able to tolerate with no more than moderate discomfort (4 on a scale of 1-10.)
8. Focus on keeping the pelvic floor muscles relaxed throughout this process. You can distract yourself by looking at non-threatening photos, like funny dogs or kittens on Instagram, or focus on relaxation and breath work.
9. Allow the dilator to stay in place for up to 15 minutes. Remove early if discomfort intensifies.

Progressing with your vaginal dilator to reduce pain

When you are able to comfortably insert the dilator fully for 10-15 minutes and move it in and out 25 times, you are ready to progress to the next larger size. The time needed to advance is different for every person, so be patient with yourself.

We recommend starting your session with a smaller size and progress to the next larger size within the same session, rather than beginning with a challenging size.

You can introduce movement by holding onto the end of the dilator and moving it slowly and gently in and out, side to side, or in circles. You may also try sustained pressure around the base of the vaginal opening based on your physical therapist’s instructions.

Cleaning your vaginal dilator

• Wash yourself and your dilator before and after each use. Use warm running water and mild, unscented soap.
• Dry the dilator with a paper towel and store in a clean plastic bag.

Points to remember

• Use adequate lubrication.
• Experiment with different leg and trunk positions, as well as angles of insertion to find the best combination.
• If discomfort progressively increases as you are using it, stop and come back to it another time. Be sure to inform your physical therapist.
• Never exceed more than 4 out of 10 in discomfort.
• You are in control of the dilator. Go at your own pace and progress when you are ready. Slow movement is usually best.

How pelvic floor physical therapy can help

While this is helpful information, it may not be enough to see results. Ideally, finding and working with a team of healthcare providers, including a physical therapist specializing in treating the pelvic floor, is the best way to begin treating your condition.

A pelvic floor physical therapist can work with you as a part of your healthcare team by assessing your muscle function, performing manual therapy to help reduce your symptoms, assigning exercises to help maintain your progress, and guiding you through the vaginal training process to help you achieve your goals!

Find a pelvic floor physical therapist near you or book a virtual consult with one of our trained pelvic floor specialists today.

References

1. Macey, Kat, 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, vol. 15, no. 1, 2015, doi:10.1186/s12905-015-0201-6.
2. Reissing, Elke D., et al. “Pelvic Floor Physical Therapy for Lifelong Vaginismus: A Retrospective Chart Review and Interview Study.” Journal of Sex & Marital Therapy, vol. 39, no. 4, 2013, pp. 306–320., doi:10.1080/0092623x.2012.697535.