Q: How frequently do I use dilators?

So glad you've been successful with the dilators you ordered from MiddlesexMD! Vaginal dilators can help to restore capacity and comfort for intercourse. Our website has instructions for how to use them to restore the vaginal opening.

Once you've been successful with that therapy, if you're not having regular intercourse, I recommend that you use dilators at least once a week to maintain the progress you've made. Stimulation is important to retaining vaginal health—which is what we mean when we say "use it or lose it." If you find that you're having more discomfort, increase the frequency of dilator use.

Post-menopausal women find that using a vaginal moisturizer (like Yes or Emerita) really helps to maintain elasticity.

Congratulations on following through with the dilators—and stay with it! You'll find it easier to maintain than to regain your comfort.

Q: What help is available for difficulty penetrating?

Tightening of the vaginal opening is one of the effects women can experience from the loss of estrogen. The type of lubricants that offers the most "slipperiness" and the least resistance is silicone; Pink and Uberlube are  the most popular at MiddlesexMD in that category.

It is possible to gradually, gently, and comfortably stretch the vaginal opening by using vaginal dilators. These are available in a set of graduated sizes; start with the smallest (and plenty of lubricant) in daily exercises and, when comfortable, progress to the next-larger size.

Only rarely is surgical modification appropriate for addressing this condition. With patience, women can typically achieve comfort with dilators and lubricants.

Q: Should I have my vaginal opening surgically enlarged?

If you can comfortably insert any size tampon, you don't need much more space to allow for intercourse. I use two fingertips as a rule of thumb; that is, if I can insert index and middle fingers during an exam, I can assume intercourse is likely to be comfortable. The only time I've done surgery to enlarge the vaginal opening was when only a Q-Tip could be inserted--a definitive intact hymen.

What you might find helpful is vaginal dilators to help to extend the elasticity that you already have. The graduated sizes of dilators, regularly used, can gently stretch the tissue to assure comfortable penetration. I'd certainly try that before opting for surgery!

Q: Is it possible that my vaginal dilators are too long?

Dilators are not intended to fit all the way inside your vagina. The extra length gives you some space to hold on to and to apply gentle upward pressure. The pressure gently stretches the tissues to achieve additional length or depth in your vagina.

The graduated diameters of the dilators in the set are intended to address narrowing of the vagina. Use the smallest one until it's comfortable, and then move to the next-larger size. We offer a more complete description of how to use dilators on our website.

I also encourage the consideration of vaginal moisturizers and localized estrogen to help keep the tissues healthier and more supple. That in combination with the dilators can give you more comfortable, faster, more lasting results.

Q: Will dilators help me prepare, in my 60s, for my first sexual encounter?

Yes, vaginal dilators will help gently and gradually to assure that your vaginal tissues are stretched. I recommend using them one or two times a day for 20- or 30-minute sessions. The more you use them, the more quickly you'll get the results you're looking for.

Dilators come in graduated sizes, starting as small as a half-inch diameter and stepping up to 1 3/8-inch diameter. Take your time, and I'm sure your first experience will be a comfortable one! Congratulations.

Q: Would vaginal dilators help me with painful penetration?

Vaginal dilators really do work to increase vaginal caliber--the size of the opening. If you're having your first sexual encounters, have an exam by your healthcare provider to rule out other causes: there may be an issue with the hymen, for example, that would have a different solution.

But for women who've been sexually active, dilators can make a world of difference. I had an e-mail a couple of weeks ago from a woman who hadn't been able to have intercourse for two years. After using vaginal dilators for a month, she was able to have pain-free sex!

Dilators come in graduated sizes; the smallest is only a half-inch in diameter. They are used with a lubricant daily. When you're comfortable with one size, you progress to the next-larger dilator until you've achieved the caliber--the opening size--that works for you and your partner.

Vaginal caliber is only one element of our sexuality, of course. I encourage women to think about the whole picture. But if a narrowing vagina is a problem for you, vaginal dilators really can help.