How to Use Vaginal Dilators thumbnail image of Physiotherapist Michelle Kenway demonstrating how to use the smallest Velvi vaginal dilator

Vaginal dilators for pelvic pain are used to treat some women who suffer from pain, pelvic muscle spasm and anxiety with vaginal penetration.

Knowing how to safely and effectively use vaginal dilators at home helps women regularly follow up clinical treatment at home to self manage and improve pelvic pain therapy outcomes.

How to Use Vaginal Dilators for Pelvic Pain

Contents:

  • What are vaginal dilators
  • When are vaginal dilators used
  • Best starting position
  • How to insert vaginal dilators
  • Deep breathing exercises
  • Body scanning
  • How to progress vaginal dilator therapy
  • How often to use vaginal dilators
  • Precautions for vaginal dilator therapy
  • Bleeding after using dilator

What are Vaginal Dilators

Vaginal dilators are cylindrical shaped therapy devices (shown below).

Vaginal dilators Velvi COMPLETE

 

Velvi COMPLETE Vaginal Dilators

Dilators are used to treat a range of pelvic floor conditions including pelvic pain and pelvic floor muscle spasm (tightness) that prevent vaginal penetration e.g. gynecological examination, intimacy or inserting a tampon.

Individual dilators are usually manufactured from silicone or medical grade plastics.There is no standard size dilator and dilator sizes vary according to the manufacturer.

Vaginal dilator kits consist of a range of dilators usually varying in diameter (i.e. maximum width) and length (tip to base). This allows the user to progress vaginal dilator therapy gradually over time from very small dilators to  progressively larger size dilators. 

When are Vaginal Dilators Used 

Vaginal dilator therapy can be used for a range of outcomes. These include reducing anxiety with penetration, relaxing the pelvic floor muscles with penetration, decreasing hypersensitivity associated with touch and gently stretching vaginal tissues.

Vaginal dilators may be used to treat a range of pelvic conditions in women including:

  • Vaginismus (pelvic floor muscle spasm)
  • Tight vaginal tissues (after radiotherapy) 
  • Vaginal shortening or narrowing (after pelvic surgery)
  • Adhesions (with radiotherapy)
  • Vulvodynia (chronic pain at the vaginal entrance)

Vaginal dilator therapy is usually performed at home in conjunction with health professional treatment by a pelvic floor physiotherapist or oncology nurse. Always follow your health professional instructions for home therapy.

Starting Dilator Therapy for Pelvic Pain

  • Select an appropriate time and a warm comfortable place that allows uninterrupted relaxation for example the bedroom. Relaxing background music may promote general relaxation.
  • Position your body lying down with both legs bent. Place a pillow or cushions under your thighs to allow your legs to rotate outwards to promote muscle relaxation.
  • Start out using the smallest size dilator in the first session.
  • Warm the dilator before using it by wrapping it in a warm wet flannel cloth for 5-10 minutes. Avoid making the dilator too hot and always test the temperature on the inside of your wrist before insertion.

How to Use Vaginal Dilators Step-by-Step

Step 1 - Deep Breathing Exercises

The breathing technique to promote pelvic floor relaxation is called diaphragmatic breathing.

Draw your attention to your breath using a series of slow deep breaths. Try to breathe with slow, relaxed deep breaths so that your belly rises with the deep breath in and falls as you allow the breath to leave your body. Continue diaphragmatic breathing for 5 minutes at the start of home dilator therapy.

Step 2 -  Body Scanning

Scan your body to notice areas of muscle tension that you can feel, sensing from the top of your head progressively through different parts of the body down to your toes. Notice areas of muscular tension around your eyes, jaw, throat, shoulders, buttocks, pelvic floor, lower abdomen, thighs and legs. Mentally encourage each area to relax and soften with each successive breath out. Soften your pelvic floor around your three pelvic openings with each successive breath out. Visualize or imagine your pelvic floor in a state of softness and relaxing or letting go further with every breath out.

Step 3 - Lubrication

Place a small amount of water-based personal lubricant on the tip of the dilator before use. Avoid lubricants containing additives or petrochemicals which can irritate the pelvic floor tissues and exacerbate pelvic pain conditions.

Step 4 - Dilator Insertion and Progression

One of the most important aspects of vaginal dilator insertion for pelvic pain therapy is keeping this process physically and mentally comfortable at all times. If you experience physical or emotional discomfort, your pelvic floor muscles will be more likely to tense up rather than relax.

  • Gently rest the narrow end of the dilator against the vaginal opening continuing relaxed diaphragmatic breathing throughout.
  • When you feel ready to progress, move the tip of the dilator into the entrance of the vagina and allow yourself time to adjust to and feel comfortable with this sensation.
  • Gradually insert the dilator to a tolerable depth within the vagina. Keep the level of discomfort minimal. If you feel any discomfort, pause for as long as you need to while continuing to breathe and relax your pelvic floor muscles.
  • Insert the dilator slightly further as tolerated, stopping at regular intervals to allow your body to accommodate the sensation.

The duration of dilator insertion lasts as long as it feels comfortable. Aim to progress the duration of dilator insertion to 5-10 minutes over successive sessions.

Step 5 - Dilator Removal

When you have completed your home dilator therapy, gently withdraw the dilator and allow yourself to rest and relax before getting up.

Wash your hands and the dilator with warm soapy water, before drying thoroughly and storing.

How Often to Use Vaginal Dilators

Aim to use your vaginal dilator for approximately 5-10 minutes per session. When you’re starting out the time spent using the dilator may be much shorter according to your own personal level of comfort.

Most women can complete vaginal dilator therapy on at least 3 alternate days of the week. Research suggests that women who use vaginal dilator therapy longer than 3 months have a trend towards improved treatment outcomes¹.

Women often need to use dilator therapy for an indefinite time course. Long-term dilator use may be required for some women because vaginal changes can still occur for up to 5 years after pelvic radiotherapy treatment.

Precautions for Vaginal Dilator Therapy  

  • Start home vaginal dilator therapy with the smallest size dilator
  • Keep discomfort to a minimum when using a vaginal dilator for pelvic pain
  • Avoid using a vaginal dilator with an active pelvic infection
  • Don’t use a dilator immediately following pelvic surgery. Follow your specialists’ recommendations regarding all forms of postoperative vaginal penetration and dilator use.
  • Slight vaginal loss and blood staining is not uncommon following dilator use. In cases of pelvic pain or heavy vaginal loss stop using the dilator and seek medical advice before recommencing vaginal dilator therapy.

References

  1. Marisa Liu, Mark Juravic, Genevieve Mazza, Michael L. Krychman (2021). Vaginal Dilators: Issues and Answers,Sexual Medicine Reviews,Volume 9, Issue 2, Pages 212-220. https://www.sciencedirect.com/science/article/pii/S2050052119301258
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