Vaginal dilator therapy is recommended by physical therapists and pelvic floor rehabilitation specialists to alleviate pain during vaginal penetration or intercourse and treat genital discomfort associated with several other female conditions.
In this guide for vaginal dilator therapy, we’ve explained what you’ll need to start, how to use dilators correctly, how often you should dilate, how to progress to the next dilator, and other frequently asked questions.
What is Vaginal Dilator Therapy?
Vaginal dilator therapy, also known as vaginal dilation, is a treatment approach used to help women who experience vaginal tightness, discomfort, or pain. It involves the use of graduated vaginal dilators, which are smooth, tapered devices made of medical-grade materials such as plastic or silicone.
The goal of vaginal dilator therapy is to gradually stretch and expand the vaginal muscles, tissues, and walls to reduce pain, increase flexibility, and improve overall comfort.
It is commonly recommended for women who have conditions such as vaginismus, dyspareunia (painful intercourse), vaginal stenosis (narrowing of the vaginal opening), or those who have undergone gynecological surgeries or radiation therapy that may cause vaginal scarring or adhesions.
What Are Vaginal Dilators?
Vaginal dilators are tube-shaped medical devices made from either plastic or silicone that are typically sold in sets of gradually ascending sizes resembling a small tampon to an erect penis.
The deliberate range of diameters & lengths, along and the incremental increase in size between each dilator, provides users with the tools to slowly relax and stretch vaginal tissues.
By slowly stretching the vaginal tissues and pelvic muscles with the regular use of dilators, blood flow is increased to the area, natural lubrication is improved, vaginal tightness is released, and vaginal penetration becomes not only more comfortable but also more pleasurable.
Recommended for Dilator Therapy: Plastic or Silicone?
While some vaginal dilator types are still made with hard, unbending plastic, pelvic health experts agree that the smooth and softer silicone versions are not only more comfortable but also more effective.
Given that the vagina is a particularly sensitive part of the female body, it makes perfect sense that easing pain, discomfort, or anxiety surrounding vaginal penetration or sex should be sensitive and gentle as opposed to rigid and agonizing.
That said, not all silicone dilators are produced with medical-grade silicone or incorporate the most effective design features for healing. For best results and easy-to-use dilators, women’s pelvic health experts advise choosing vaginal dilators made from smooth, body-safe, BPA-free, medical-grade silicone that has been registered with the FDA and sold in sets of increasing sizes.
Intimate Rose Vaginal Dilator sets, for example, possess all of the above attributes, in addition to a matte finish on the medical-grade silicone to provide an added layer of protection for delicate vaginal skin. In contrast to the “rubbery” or “sticky” finish from other dilator brands.
This smooth matte finish also means that Intimate Rose dilators are less sticky when lubrication is applied and offer a more life-like sensation inside the vagina. This is particularly important for people who have undergone chemotherapy, radiation, or surgery, to protect the delicate tissue.
As a consequence, Intimate Rose dilators are more comfortable and easier to use than their competitors, meaning patients are happy to use them regularly and enjoy the most effective results.
What Does Vaginal Dilator Therapy Treat?
Although vaginal dilators are primarily used to relieve the discomfort or fear of penetration (vaginismus) and/or painful sex (dyspareunia), vaginal dilator therapy is also recommended to treat vaginal dryness after childbirth, breastfeeding, and menopause.
Additionally, the regular use of dilators can improve muscle elasticity and reduce the growth of scar tissue after pelvic surgery, radiation treatment for cervical cancer, and transgender surgery.
Vaginal dilator therapy is also used to treat several additional female conditions, such as:
- Chronic pelvic floor pain
- Interstitial cystitis
- Lichen Sclerosis
- Vaginal Atrophy
- Vaginal Stenosis
Vaginal Dilator Therapy: What You Need
To start vaginal dilator therapy in the comfort of your own home, you’ll need the following:
- A set of dilators in progressively increasing sizes
- Water-based lubricant to ease insertion
- A towel
- 1-2 pillows
- 5-15 minutes in a quiet space where you will not be interrupted
How to Do Vaginal Dilator Therapy
While the following guide outlines clear instructions for performing vaginal dilator therapy at home, patients are advised to first seek guidance from a pelvic floor rehabilitation specialist or gynecologist to confirm which size dilator they should begin with and how long they should hold each dilator in place.
The majority of people are advised to start with the size that they can tolerate, and perform sessions daily or as close to daily as possible, progressing to the next size dilator only once the previous size can be inserted and held in the vagina pain-free.
Once you have received guidance from your healthcare practitioner, the following steps for vaginal dilator therapy will help to keep you on track.
- Always wash your vaginal dilator with warm water and soap before using it.
- Designate a private place in your home where you feel safe and will not be interrupted.
- Drizzle or rub a generous amount of water-based lubricant over the dilator as well as the entrance to your vaginal opening. (It is important to use a water-based lubricant to protect the medical-grade silicone of Intimate Rose Vaginal Dilators.)
- Select the size recommended to you by your pelvic floor physical therapist, or start with the smallest size.
- Lie down on your back, on your bed, on a yoga mat, or on some comfortable blankets with your knees bent and feet planted on the floor. Some patients prefer to lie on their sides with the knees bent and a cushion or pillow placed between the knees to support the upper leg.
- As you inhale, allow your belly to gently expand, and as you exhale, allow your belly to slowly drop. Continue to breathe gently like this for a few more breaths to relax the vaginal opening with each exhale.
- When you feel ready, bring the tip of the dilator to the vaginal opening, and during the next exhale, softly insert the tip. As you continue to breathe gently and slowly, ease the dilator into the vagina with each exhale until the lip at the end reaches the vaginal entrance.
- Breathe deeply and calmly, relax your shoulders, allow your body to sink into the support beneath you, and keep the vaginal dilator inserted in the vagina for 5-15 minutes, or however long your healthcare practitioner recommended.
- Once you become comfortable inserting each dilator, it's helpful to practice insertion in different positions to mobilize the organs around the vaginal canal and encourage gentle stretching of the tissues. As well as laying on your back or your side, recommended positions include a deep squat and a table-top position with your hands and knees on the floor.
- It is also helpful to gently press the dilators against the walls of the vagina by imagining the opening of the vagina as a clock and slowly moving the dilator in a circular position. Pause at each “hour” of the clock, gently compressing the dilator against the vaginal wall in each position.
How Often Should You Do Dilator Therapy?
How regularly you should use your vaginal dilator will be recommended by your pelvic health specialist and will typically depend on the condition you are treating. Practicing three times per week is typically advised, allowing the vaginal and pelvic muscles to relax for 24 hours between each session, however, this may vary depending on your diagnosis.
How to Progress to The Next Size Dilator?
Vaginal dilator therapy normally begins with the smallest dilator in a set (about the size of a mini tampon), allowing women to adjust to the feeling of vaginal penetration in a manageable way.
Once the first dilator can be inserted pain-free and held in place for the recommended time, patients are encouraged to progress to the next size dilator and repeat the process of becoming used to the feeling of insertion before progressing to the following size.
For instructions on how to insert the first dilator, see above.
How Long Should You Keep a Dilator In?
Ideally, this advice will be given to you by your pelvic floor rehabilitation specialist or gynecologist. The recommended time to keep a vaginal dilator in place is anywhere from 5-30 minutes, depending on the condition you are treating. When beginning vaginal dilator therapy, for instance, the extent of pain might only allow for a dilator to be inserted and held in place for one minute.
The goal would then be to work toward holding it in place for as long as fifteen minutes over the next few therapy sessions. For treatment of vaginal agenesis, after surgery, or cancer treatment, the goal may be to hold it in place for up to 30 minutes.
For best results, it is always best to follow the advice from your healthcare practitioner.
Do You Have to Use Vaginal Dilators Forever?
Although healing will vary from person to person according to their diagnosis, age, hormone levels, and commitment to regular dilation, women using vaginal dilators to treat conditions like vaginal dryness, vaginismus, or dyspareunia typically report feeling an improvement within a few weeks or a few months. For those recovering from pelvic surgery or radiation treatment, healing might take a little longer.
As a general rule, vaginal dilator therapy is no longer required once penetration and intercourse are no longer painful, however, it is always best to check with your healthcare provider before stopping.
Vaginal dilator therapy is described as a regular practice of gentle vaginal dilation to gradually ease vaginal pain during penetration or intercourse. Using a set of progressively increasing-sized dilators, ideally made from FDA-approved medical-grade silicone for a smoother, more life-like, and body-safe experience, vaginal dilator therapy helps to relieve tightness, anxiety, and pain so that sex can become pleasurable again.
Mayo Clinic – Dysapeurnia - https://www.mayoclinic.org/diseases-conditions/painful-intercourse/symptoms-causes/syc-20375967
Web MD – Vaginismus - https://www.webmd.com/women/guide/vaginismus-causes-symptoms-treatments
The North American Menopause Society – Pain with Penetration - https://www.menopause.org/for-women/sexual-health-menopause-online/sexual-problems-at-midlife/pain-with-penetration
Medicine Journal & Research Articles - Vaginal dilator use to promote sexual wellbeing after radiotherapy in gynecological cancer survivors- https://journals.lww.com/md-journal/Fulltext/2022/01280/Vaginal_dilator_use_to_promote_sexual_wellbeing.46.aspx
Science Direct – Vaginal Dilators - https://www.sciencedirect.com/topics/nursing-and-health-professions/vaginal-dilator
Intimate Rose – Dilator Training Guide - https://www.intimaterose.com/pages/dilator-training-guide
University of Iowa Health Care – Vaginal Dilator - https://uihc.org/educational-resources/vaginal-dilator
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.