Q: What size dilator should be my goal?

I wish there were an exact “science of measurement” that would answer your question definitively. The vagina is typically elastic--especially when we’re younger--and will stretch to accommodate any (or nearly any) size required, but there can be male/female matches that are outside of that range.

You asked. Dr. Barb answered.As we get older, our vaginas become less distensible and less elastic. The tissue itself becomes less elastic as we lose estrogen, and we lose the “pleating” we had when we were younger (I’ve used the analogy of going from a pleated skirt to a pencil skirt). Dilators work by gently and gradually stretching the vaginal walls, making them open enough (called patency) to allow for comfortable intercourse.

Because of the variations in tissue elasticity, atrophy, a woman’s anatomy, and her partner’s anatomy, the goals are comfort and pleasure, not a specific dimension. Dilators come in sets of graduated sizes, so a user can move from one to the next-larger as she gains comfort with each. Some women will progress through the entire range of sizes; others will be satisfied before that.

We offer a variety of dilators, because women’s preferences vary. Our most popular, the Amielle kit, includes five sizes and a removable handle that provides more length for maneuvering. For those who prefer a solid dilator, we offer a six-inch-long option in a set of five or a set of seven, again depending on need. And for some women, the texture of silicone and its ability to be warmed makes the Sinclair Institute set of five their preference.

I hope this is helpful! I’ve very happy to hear that you’re still tending to your sexual health.

 

 

Q: Can I enjoy intercourse again without expensive prescriptions?

You asked. Dr. Barb answered.You say you’re hoping to enjoy intercourse again after a five-year hiatus, but that you experienced some discomfort with your last gynecological exam. The prescriptions offered to you (which I assume were localized estrogen) are not in your budget, so you’re wondering about other options.

A vaginal moisturizer, used regularly, can help you regain some tissue elasticity. Any of the moisturizers we offer might be an option for you; they’re intended to be used regularly, from daily to several times a week.

Along with thinner and fragile tissues, in menopause, without estrogen and without sexual activity, the vagina will become more narrow and shortened. You may need the gentle stretching of dilators to help restore vaginal capacity.

I’m hopeful that, with some effort and regular attention, you can restore vaginal health to resume pleasurable intercourse!

Keeping Things Open

Maybe you’re divorced or widowed. Maybe you’ve been single and partnerless for a while. Maybe you found someone after a long dry spell. Or, maybe sex has just been darned painful lately.

Time was, you could count on your vagina to do its job. It just worked. You didn’t have to think about it. But with loss of estrogen you’ve been experiencing lately, that uncomplaining organ begins to act up. And if you haven’t used it lately, it actually begins to shrink and shorten.

Now, if you’ve been on the sidelines, sexually speaking, for a while, you won’t be able to jump back into the game without some preparation. At this point, sex can be surprising, and not in a good way.

After menopause, the name of the game is “use it or lose it.” Furthermore, it’s a lot easier to maintain vaginal health than to play catch-up after ignoring the situation downtown for a while.

As we explain in detail in our recipe for sexual health, when you lose estrogen, the vaginal walls become thin, dry, and fragile. They atrophy. Without regular stimulation, the vagina can become shorter and smaller. It can also begin to form adhesions and stick together. Some cancer treatments exacerbate this process.

We’ve talked about moisturizers, practicing your kegels, using a vibrator or other form of self-pleasuring as part of your sexual health maintenance program.

But another important tool, especially if you’re currently without a partner (or are trying to rehabilitate now that you’ve found someone) is the regular use of dilators.

Say what?

Dilators are sets of tubes, usually made of high-quality, cleanable plastic, that start small (half-inch) and gradually larger (up to an inch and a half). They’re inserted into the vagina in gradually increasing sizes to stretch the vaginal walls, making them open enough (which is called patency) and capacious enough to do their job.

It isn’t quick, but it is effective.

Occasionally, I run across suggestions for homemade dilators that make use of various round objects. Don’t try this. It’s important for all kinds of reasons to use only high-quality dilators that are smooth and easy to hold, that increase in size gradually and consistently, and that can be cleaned well.

You should only use the safest, highest quality product in this important place. If you don’t know where to look, we offer a selection of dilators on our website that we’ve carefully vetted. These will work much better for you than those candles you were eyeing.

Here’s how you use them:

Relax. Take a bath—it makes all those tissues soft and pliable. Lie comfortably on your back with your knees open.

Lubricate the smallest dilator well with a vaginal lubricant.

Gently insert it into the vagina. Keep all those pelvic floor muscles relaxed. Breathe. Push the dilator in as far as you comfortably can.

Hold it there for 20 to 30 minutes. Do this twice a day.

When you can comfortably insert the smallest dilator, graduate to the next largest size.

It can take three months or more to restore vaginal capacity.  Once you’re comfortable with the largest dilator, continue the regimen at least once a week if you aren’t having sex regularly. And don’t forget the moisturizers.

It takes patience and diligence to rehab your bottom, but you can do it. With a little TLC, everything will work as well as it ever did and sex can be every bit as luscious as it ever was.

Q: Can I use my electric toothbrush erotically?

I get occasional questions about erotic use of various household objects. I am, after all, long trained as a physician, so safety and hygiene are among my first concerns. And, since starting MiddlesexMD, I've seen some very well designed vibrators, dilators, and dildos that I know are safe, easy to clean, and designed specifically for older women's pleasure.

That said, I encourage women and their partners to be playful. These are the things I would look for to be safe: Are there sharp edges, seams that might pinch, protrusions that might surprise you? Can you clean the material thoroughly—before and after use? Is it compatible with any lubricants you might use? And, less clinical but just as important, will it make you feel like a valuable, sexually alive person?

With those cautions, have fun exploring.

Patience, patience!

So you arrive home from a hectic day at the office, and there's the box you've been waiting for, with your new lube, a vaginal moisturizer, and those dilators that have promised to return your sex life from painful to normal. "Oh boy!" you think. "Orgasm tonight!"

Please, please, please, slow down. I know it's hard to wait when you've been anxious to find an answer.

The conditions that cause painful intercourse in the first place can be comforted and in many cases reversed, but only with practice and time. Practice and time that are worth taking, when the result is the kind of sexual intimacy you want.

Picture a young athlete. She is powerful, flexible, supple, and graceful. She practices her sport every morning and night. Then she graduates, gets a desk job, has a couple of kids, spends nearly every waking hour sitting at her desk or in her mini-van, carpooling. Her fitness slowly drains away.

One day, she decides to get back into shape. If she tries to complete a workout at the level she did when she was in peak condition, she will get hurt. No doubt about it. She knows, or will soon realize, that she must start slowly. She'll get her fitness back, but only if she works within her comfort zone. When things start to hurt, she needs to back off. Keep moving, but slow down, decrease the intensity. Please approach your new sexual aids, your vibrator of course, your vaginal dilators, especially, with this same understanding. Pushing too hard, going too fast, will hurt you. You are trying to restore pleasure, and I recommend letting comfort and pleasure be your guide.

As always, if the pain just won't resolve, do discuss it with your doctors. Finding the real reason for the pain is the fastest way to resolve it.

Meantime, put the box down. Have a healthy dinner. Take a nice bath. Relax. Then begin, slowly.