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Pelvic Health

Dilator Uses: How and Why They Work

Dilator Uses: How and Why They Work

by Dr. Barb DePree, MD

A vaginal dilator, sometimes referred to as a vaginal trainer or insert, is a tube-shaped medical device used to stretch the vaginal tissues to relieve tightness or dilate (open) the vaginal canal.

Effective in restoring the tissues and musculature of the vagina after atrophy, pelvic surgery, trauma, vaginismus, or cancer treatment, dilators are prescribed to help women return to sexual activity, or non-sexual penetration, without pain or anxiety. 

Read on to learn more about dilator uses, how they work, and why they work. 

Are All Vaginal Dilators the Same?

No. There are various types and brands of vaginal dilators available for purchase but just like any other product, different levels of quality exist, so it pays to do some research. Plastic dilators were the preferred option in the past and are still available for purchase online.

However, the resounding feedback from pelvic health specialists is that dilators made from FDA-approved medical-grade silicone provide more comfort and are more effective in obtaining dilation goals.

Plastic dilators are typically described as hard and too rigid for the extra-sensitive vaginal skin, especially when pain already exists, and many users mentioned bruising and extra irritation after use.

Silicone dilators, on the other hand, are described as soft and smooth, but still firm enough to exude the ideal amount of pressure against the vaginal walls to improve blood flow and slowly relax the vaginal tissues.  

That said, not all silicone dilators are made from medical-grade silicone that has been approved by the FDA, so it is certainly something to check before purchasing.

Another notable difference between dilator brands is the sizes. For the most relaxing and effective results, patients are encouraged to begin with the smallest dilator in a set and progress through the ascending sizes as soon as they feel comfortable using the previous.

The hike in measurements between each dilator should therefore be minimal, but also enough to encourage further dilation. When the difference is too large and patients feel pain rather than mild discomfort while dilating, they can become discouraged, frustrated, and stop dilating. 

What Are Dilators Used For?

The main purpose of dilation therapy is to help women reduce pain during intercourse or non-sexual penetration for an improved lifestyle. Although it can be embarrassing to speak about, even to a medical professional, many women feel pain during sex (dyspareunia) and many others suffer severe anxiety at the mere thought of penetration (vaginismus).

Both conditions are also often interrelated, in that a painful sexual experience can cause subsequent fear around any type of vaginal penetration in the future. 

Furthermore, dyspareunia and vaginismus, are typically linked to either an underlying condition, hormone fluctuations after childbirth and menopause, or anatomical changes to the vagina or pelvic area after surgery or cancer treatment.

The good news is, vaginal dilators are a safe and effective way to help women return to pleasurable sexual activity after a multitude of medical conditions. The most common of these are explained below. 


Women who are anxious about vaginal penetration and have been unable to insert a tampon, undergo a gynecological exam, or have intercourse despite several attempts, can experience a significant change after getting used to the slow and gradual insertion of dilators.

Medically referred to as vaginismus, this condition is treated by teaching women to understand the cyclical connection between what the mind fears and how the body reacts to protect itself. 

Underlying Conditions 

Women suffering from conditions that result in vaginal or vulvar pain to the point that sex is either painful or impossible, regularly find relief from using dilators. In these cases, dilator therapy can encourage the vaginal muscles to relax, and dilate the vaginal canal and the vaginal opening for more comfortable penetration and sexual activity.

These conditions include but are not limited to endometriosis, interstitial cystitis, lichens sclerosus, painful bladder syndrome, perineal tears or episiotomies during childbirth, vaginal atrophy, vaginal stenosis, and vulvodynia.  

Chronic Pelvic Pain

When chronic pelvic pain extends to the pubic region, lower back, hips, groin, thighs, or even the knees, dilators can help to stretch the pelvic floor muscles to relieve not only the pain but often additional bladder or bowel issues too. 

Surgery & Cancer Treatment Recovery

Assistance from vaginal dilators can also help women recover from vaginal or pelvic surgeries by keeping the vaginal tissues flexible and maintaining the width and length of the vaginal canal so that women can safely return to an active and enjoyable sex life.

For example, after a hysterectomy, pelvic organ prolapse repair, surgery for an imperforate hymen, or gender reassignment surgery. Women who have undergone breast cancer surgery, radiation treatment, or chemotherapy also find relief from vaginal dryness or shrinking of the vaginal canal by dilating. 

How Do Vaginal Dilators Work?

To achieve the goals of comfortable penetration and reduced pain during sex, vaginal dilators are designed to slowly relax and stretch the vaginal tissues and pelvic floor muscles over time. Essentially, dilation therapy provides women with the tools to get used to the feeling of pain-free penetration while moving at their own pace. 

To start, patients are always guided toward beginning with the smallest dilator in a set, which is ideally no larger than a small tampon or a pinkie finger. Aided by the plentiful use of lubricant, the insertion of dilators is performed in a relaxed supine position with the help of slow conscious breathing until it is fully inserted. 

While dilators remain in the vagina, patients are encouraged to relax by listening to meditation, soothing music, or watching TV for up to 15 minutes per dilation session.

To start with, some patients might succeed in keeping the dilator in place for just one minute, but with dilator therapy, every minute is considered a success in empowering women toward the end goal. It is therefore essential to stay patient and remain consistent throughout your vaginal dilator therapy. 

As dilator therapy progresses, patients are advised to use each dilator up to three times per week, for a couple of weeks, until inserting and holding the dilator in place for 15 minutes is comfortable and painless.

Once this is achieved with the smallest dilator, the patient moves to the next size dilator and repeats the process until a dilator similar to the size of their partner’s erect penis can comfortably penetrate the vagina.

Why Do Dilators Work?

According to studies, client feedback, and advice from pelvic health experts, there are several reasons why vaginal dilators work to relax vaginal tightness, anxious penetration, and reduce pain during sex.  

Material & Sizing

If you want your dilators to work, the most important factor is choosing the right dilators. Vaginal dilators should be comfortable, flexible, soft, and smooth, but firm enough to be felt pressing painlessly against the vaginal walls. Some mild discomfort is to be expected, but dilators should never be hard or rigid enough to create pain, bruising, or additional irritation. 

As discussed earlier, choosing a set of dilators in progressively increasing lengths & diameters is also imperative to allow for comfortable and pain-free advancement through the set of dilator sizes. 


Similar to any healing journey, knowledge and guidance are vitally important in the beginning and will ultimately determine how positive the recovery process will be. Patients looking to engage in dilator therapy have typically suffered for some time and inserting anything into the vagina can be nerve wracking.

Therefore, seeking the guidance of a pelvic health physical therapist or pelvic health rehabilitation specialist will always help to start and finish a dilation journey successfully. 

An initial consultation with a pelvic health specialist can help you to determine which dilators are best for your condition, what size you should start with, and for how long you should dilate.  


Due to the anxiety, discomfort, and pain that is associated with penetration and the many conditions that are treated with vaginal dilators, lubricant is not only essential but soothing too.

With the help of generous applications of lubricant, inserting dilators at a slow and gradual pace becomes bearable at first and then more and more comfortable as dilation therapy progresses. 

It is important to note that when using silicone dilators only water-based lubricant should be used to protect the outer layer.      


Even though it is best to seek guidance, instruction, and understanding from a pelvic health specialist before beginning dilator therapy, most subsequent dilation sessions will happen in the comfort of your own home.

Studies have shown that women who designate a private space for dilating at the same time every other day, report better consistency and ultimately more effective results. For instance, many women find it easier to dilate just before bedtime in the private and relaxing space of their bedroom where they will not be interrupted or get embarrassed.  


Relaxing during dilation is of the utmost importance to re-train the brain and body connection. Essentially, when the vaginal muscles first experience pain during penetration or intercourse, the mind signals the body (vaginal muscles) to tighten and protect itself when it happens again.

This cyclical reaction is often something that dilation patients must work to overcome and research has shown that listening to soothing background music, TV, or meditation while dilating can help patients to relax. 

The more patients relax, the better dilation works, and the more improvement they feel the more they are encouraged to continue to work toward the end goal.  


Another benefit of having a pelvic health specialist in your corner is that you can check in with them at different stages throughout your dilation journey. Although most patients experience success and significant relief from dilation therapy, healing such a sensitive part of the body takes time and patience.

However, having support from a healthcare practitioner can help you to find optimism and inspiration whenever you feel confused or discouraged. 


Vaginal dilators are used to relax tight vaginal tissues, restore pelvic floor muscles, and stretch the vaginal canal when it has narrowed or shortened. Proven to help women recover from a myriad of pelvic conditions that affect their sexual health and enjoyment, dilators are effective medical tools that can be used at home after initial guidance from a pelvic health physical therapist. 

Also recommended for treating atrophy during menopause, to help the recovery process after pelvic surgeries and cancer treatments, dilators help women return to pleasurable intercourse and pain-free penetration. 


Healthline - Vaginal Dilators 101: Everything You Want to Know -

Mayo Clinic – Dysapeurnia -

Web MD – Vaginismus -

The North American Menopause Society – Pain with Penetration -

National Library of Medicine - Internet-Based Guided Self-Help for Vaginal Penetration Difficulties: Results of a Randomized Controlled Pilot Trial -

Memorial Sloane Kettering Cancer Center – How to Use a Vaginal Dilator -