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My Doctor Gave Me Dilators… Now What?!

So, somewhere in your journey through the healthcare system you’ve been given dilators. Maybe you reported that your underwear bothered you, or that tampons were irritating or difficult to insert, or that you had to use the smallest speculum at your gynecologist exam, or that you were having painful sex, or maybe avoiding sex because you can’t tolerate penetration of any kind.

You told your healthcare provider something along the lines of “touch and/or penetration hurts my vagina,” and you were given dilators.

Now, what?

Dilators can be a very helpful, therapeutic tool; however, they can also be very scary—especially when no one explains how (or why) to use them!

If you would rather watch than read on this topic, check out this video from my youtube channel!

If you were given dilators, chances are high you would benefit from seeing a pelvic physical therapist! Find one in your area, here!

Why Should I Use My Dilators?

The answer to this question is important to understand before we break down how to use dilators. It requires us to look through two lenses—a muscular lens, and a brain-related lens.

The muscular lens is more straightforward. Dilators are a slow, progressive stretch to the muscles that live in your pelvic floor, especially the first layer which lives near the vaginal opening. Just like stretching a short hamstring can be therapeutic, stretching a short pelvic floor muscle can be, too!

I would argue, however, that the brain-related lens is just as—if not more—important. When I use dilators with a patient, our intention is not only to stretch muscles, but also to retrain the brain. What does your brain have to do with pelvic pain? Everything.

Making sure someone understands the most up-to-date science surrounding pain is always a priority in my therapy. If you were given dilators, I highly recommend you read the book Why Pelvic Pain Hurts. It uses language meant for everyone, and outlines why retraining your brain is such an important part of overcoming pelvic pain.

A picture of Tori holding a copy of "Why Pelvic Pain Hurts"

Pain is not only normal, but also a vital part of being human. Without it, we wouldn’t survive. Here is the crazy part—pain is produced entirely by the brain. Much like an alarm system, it is our brain’s way of letting us know that there is a threat, or that we need to pay attention to something1. In order to use dilators to their fullest therapeutic ability, you should know that pain does not necessarily mean injury, and that your brain, or alarm system, can become too sensitive!

Hurt doesn’t always equal harm, and harm doesn’t always equal hurt.

Think about the following example. You are walking outside on some abandoned train tracks, and you stub your toe. Would it hurt? Sure, because your brain (or alarm system) wants you to pay attention to your toe and get the appropriate treatment for it to heal. Now, imagine this same scenario, but there is a train coming quickly down the tracks. Would your stubbed toe hurt? No! Your brain would decide that saving you from the oncoming train is more important for your survival than getting medical attention for your toe, and you’d be able to run away to safety. Once your brain has decided that you are safe and going to survive, it might alert you of your toe injury, but not while you are running away.

In that same vein, have you ever found a bruise on your body, but had no recollection of when or how you got it? Your brain (or alarm system) decided that bruise didn’t warrant your attention. Thus, it did not create pain to alert you.

Harm does not always equal hurt.

So, with these examples, we know that you can have injury without pain—that harm doesn’t always equal hurt. But can you have pain without injury?

Yes.

Remember the analogy of your brain as an alarm system? Imagine the alarm system you might have in your house. Ideally, you want your alarm system to be sensitive to “big” issues, such as someone breaking into your home. But, what if your alarm system becomes very sensitive, and you are alerted every time someone walks by the sidewalk in front of your house? Or every time a leaf blows by the front door2? The same thing can happen to your brain! At first, only truly harmful things are painful. Over time, the alarm system (your brain) can become very sensitive, and things like sex, tampons, and underwear, which originally did not set off an alarm and create a pain response, do! Not because of true injury, but because of a highly sensitive alarm system, or a highly sensitive brain. Thus, hurt doesn’t always equal harm.

Hurt does not always equal harm.

Now, this is not me saying your pain is all in your head. It’s not. Your pain is real and valid. Instead, this is me saying that we can use dilators to both stretch your muscles, and retrain your brain to understand that touch or penetration are not threatening, and do not warrant a pain response!

Let me also pause to remind you that you are not alone in this experience. I talk about pain science and dilator use daily in my clinical practice.

How Do I Use My Dilators?

I will now outline my instruction in dilator use when I am working with someone who has, for example, vaginismus, vulvodynia, painful oral or penetrative sex, or general pain near the vaginal opening. Again, if you were given dilators, you would likely benefit from seeing a pelvic physical therapist! Find one near you, here. Also, please remember our disclaimer.

Before diving into details, I want to say that language surrounding dilator use is powerful. I often find in my clinical experience that women will take the role of being penetrated by the dilator, which gives a lot of power to an inanimate object! Instead of the dilator penetrating you, I want you to give the power back to yourself—you are enveloping the dilator! You are the one doing, something is not being done to you.

A photo of a dilator.

Before you begin, it is important to create a calming environment for both you and your brain. Maybe this means taking a warm bath, playing soothing music, lighting a candle, or practicing some deep breathing beforehand.

1. Position yourself in a well supported, comfortable, position, where you can reach your vaginal opening without overly crunching your abs or holding your breath.

An example of a well supported position to use dilators.

Another example of a well supported position to use dilators.

2. Imagine yourself using the dilator. Pay attention to your thoughts and feelings surrounding its use, and try to direct that imagery positively. Imagine yourself using your dilators without stress, anxiety, fear, or pain.

3. Use a liberal amount of lubricant to cover the dilator. You may also apply lubricant to your vaginal opening. If your dilators are made of silicone, do not use a silicone-based lubricant! Read more about lubricant, here.

4. Allow your pelvic muscles to relax, and slowly slide your chosen dilator into your vaginal opening. Pay attention to how that feels. If you experience no greater than a 3/10 discomfort (the same discomfort you might feel stretching your hamstring, but not pain) continue to slowly insert the dilator. Remember that you can pause at any time and hold the dilator still, advancing it when you feel ready. Keeping your discomfort level low reinforces a low “danger,” or “threat” level to your brain, which we now know is equally as important as stretching your muscles.

5. Once the dilator is inserted to your comfort level, use a pillow or blanket to keep the dilator in place. Otherwise, it may slide out as you keep your pelvic floor relaxed around it. Implement deep breathing, and visualize your muscles relaxing around the dilator.

An example of me using a pillow to support the dilator once it is inserted.

If you are having trouble inserting or advancing your dilator, observe your breath. I will detail how your breath and pelvic floor are related in a future article, but trust that you can use your breath to directly relax your pelvic floor muscles. It may seem counterintuitive, but your pelvic floor elongates and relaxes on your inhale. Try belly breathing if you are having trouble relaxing!

6. Maintain this position for 5 minutes, then gently remove the dilator from your vaginal opening. Use warm water and soap to clean the dilator, and allow it to air dry.

7. Repeat this technique every day, adding 1 minute per day until you can tolerate your starter dilator for 10 minutes. If you find that using the dilators daily makes you too sore, try every other day, or every 2 days.

Not everyone will start at the same sized dilator. Assess with your provider to determine the right starting point!

8. When you can insert your starter dilator, use it for 10 minutes, and remove it with ease, you are ready to move up to the next size.

9. With the next size, repeat the process outlined above. Begin with 5 minutes, adding 1 minute per day, until you can tolerate insertion, 10 minutes of use, and removal with ease. Repeat this series until you reach the largest dilator size.

Now, if your goal is, for example, to use a junior tampon, you may not need to progress to the largest sized dilator. If you goal is, on the other hand, to experience pain-free (dare I say pleasurable) sex, and your partner is bigger than your largest dilator, that’s okay, too. If I were treating someone and that were the case, we would work to the largest dilator and, if sex was still painful, we would find another tool that best replicates your partner! Pelvic physical therapists want you to reach your goals, and we aren’t scared to get creative!

In Closing

It is important to note that each person’s goal with dilator use may be different, and that some may take longer than others to achieve their goal. Remember that you are in control, and that you can make a difference in your wellbeing. Take this new found empowerment, stay patient, and move forward at the pace that best suits you and your unique set of circumstances.

Dilators can be a very helpful, empowering tool when used correctly! I hope they are a little less scary, and make more sense. Don’t hesitate to ask a question or leave a comment, and I wish you the best in your journey to health!

If dilators were recommended to you, don’t forget to see a pelvic physical therapist in your area, as you would likely benefit from pelvic therapy!


Vaginismus: involuntary and/or persistent contraction (squeeze or spasm) of the pelvic floor muscles around the vagina when a woman attempts penetration—often associated with sexual abuse, this condition can make tampon insertion, gynecological exams, and penetrative sex painful, difficult, or impossible. (click to return to your reading!)

Vulvodynia: pain lasting more than 3 months in the skin around the vaginal opening (or vulvar skin) without an identifiable cause, typically associated with the feeling of burning or irritation. (click to return to your reading!)

Sources:

  1. Moseley GL. A pain neuromatrix approach to patients with chronic pain. Man Ther. Aug 2003;8(3):130-140.
  2. Louw, A., Hilton, S., & Vandyken, C. Why pelvic pain hurts: neuroscience education for patients with pelvic pain. International Spine and Pain Institute, 2014.  

10 Comments

  • Biba

    Hi,

    So I know you cant really diagnose my condition but i dont have access to Pelvic Therapists in my country and my Gyno isnt very knowledgeable in the art of pelvic therapy.

    So I feel pain at the entrance of vagina/Vulva at penetration stage and its a bit difficult for a guy to penetrate if i am not leading but after the intial penetration i no longer feel pain but my vagina walls are numb so i dont feel any sensations.

    Also when I am on top, i feel about of pain with further deep penetration but more like passing pain based on reach.

    So I am wondering if I should get a pelvic wand instead of the dilators to massage my vagina walls but would that also help with my tense vulva muscles?

    sorry for the this ignorant question but dilators permanetly stretch out your vagina beyond its normal size even when its not inserted?

    • pelvicempowerment

      Hi Biba!

      I am so sorry to hear that you don’t have access to a healthcare provider to help you in your country. Thank you for recognizing that I cannot give individualized medical advice, I appreciate that. I will still do my best to share knowledge with you!

      Your questions are not ignorant — I think they are perfectly reasonable and good questions. It can be really hard to find good educational sources when it comes to vaginal health!

      1. Hmm, given what you’ve shared it’s hard for me to tell if dilators or the wand would be best for you. Usually, when I am treating someone, we treat painful initial penetration before we treat painful deeper penetration. Which makes me want to encourage you using dilators first, but it’s hard for me to be sure. You could always try dilators for 4-6 weeks and see if you’ve improved! Then move to the wand if you are still having some pain with deeper penetration (you could also switch the order and try the wand for a period of time before trying the dilators).

      2. Dilators do NOT permanently stretch the vagina beyond it’s normal size — the vagina is a dynamic muscle, and is meant to have variation in its ability to shrink and expand!

      I truly wish I could be more helpful — please do not hesitate to ask other questions.

      Sincerely,

      Tori

      • Biba

        Thanks a lot for being so helpful and answering my questions!! You have really helped me put things into perspective. I will go ahead and purchase both tools.

        X

        Biba

  • Sara

    Hi, I just got married 2 months ago and found out that I’ve vaginismus. I wonder if you can recommend a specific dilator brand. I’ve been reading tons of reviews online for a few days now, but couldn’t decided which one I need to get. Also, I was thinking about getting an IUD in a month maybe, do you think I can still use dilator when I’ve IUD?

    • pelvicempowerment

      Congratulations on your marriage! I am so happy and excited for you!

      I am so sorry to hear that you’ve been diagnosed with vaginismus, but I hope you feel you’ve found a path to healing. Dilators are a great place to start, as is pelvic floor physical therapy. Remember that I cannot give individualized medical advice, but I can share my experiences and answer general questions. As far as a dilator brand goes, this is the brand that I use the most often in the clinic: https://vaginismus.com/products/vaginal-trainer-set/

      I love that set because its creator is a woman who also had and healed vaginismus. I also want you to know that I am not sponsored by that company.

      If you live in the US, you can use this directory to find a pelvic physical therapist in your area if therapy interests you: https://pelvicrehab.com

      Finally, in regards to getting an IUD — I have never told someone not to use dilators because of an IUD. That has never been a contraindication in my practice. That being said, the placement of an IUD does involve a speculum, which may be a challenging/painful experience given your diagnosis. I have seen IUD placement cause pelvic floor muscle tension/spasm, but that is not true always. It is usually the case that an IUD placement causes no longterm pelvic floor dysfunction. That decision is of course entirely yours. I simply want you to be as informed as you can be going into that decision.

      Wishing you only the best!

  • Jasmine

    Hi I’ve been using the dilators for a week now and I’m on the largest one, this one slightly hurts, everytime I try and put it in it takes at least half an hour. I can feel this tough wall at the entrance but after that it goes in smoothly with a slight discomfort. I don’t get why this wall next to my entrance is not stretching naturally making it a a mission to put the dilator in. It has been pretty easy putting the smaller ones in. Now that my brain knows the bigger ones going to hurt it naturally tightens me down there. What should I do ?

    Thank you

    • pelvicempowerment

      Hi Jasmine,

      Progressing to the largest dilator is a huge victory, I hope you’ve taken some time to celebrate! As far as this “tough wall at the entrance” that you are describing, that may be a pelvic floor muscle. If it is, there are a couple of options to try and help your brain and body not tighten up in anticipation of using the largest dilator and, therefore, help to melt the wall!

      Unfortunately, I cannot give individualized medical advice. But I can share what I’ve seen be helpful for past patients.

      Two options that come to mind are using a body scan before inserting the largest dilator, and/or pairing the insertion of the largest dilator with pelvic floor relaxation. I review a body scan in this pelvic floor relaxation video https://www.youtube.com/watch?v=JTcagOGZsLI at 2:23, and I review pelvic floor relaxation breaths at 6:21. Pairing insertion with the inhale of this type of breathing can be a really helpful technique!

      Let me know if you have any other general questions, and I wish you nothing but the best.

  • Vivian Pham

    Hi,

    I’ve been reading your article on dilators and it has been very helpful.

    I’m just wondering ad I get to the larger dilators how far do they need go in?

    Kindest regards
    Vivian Pham

    • pelvicempowerment

      Hi Vivian! I apologize for the delayed response on my end!

      I am so glad that the article was helpful for you! As far as advancing to the largest dilators, there are a few things to consider.
      1. When you are sexually excited, the vagina expands. It grows in both length and width, making it easier to accommodate a larger penis/toy/etc.
      2. Dilators are not sexual in nature, but therapeutic. So that added length and width is likely absent when using them.
      3. Ideally, you’d still be able to insert even the larger dilators fully; however, if you are a naturally small human, aiming for 75-80% insertion is likely a good goal 🙂

      Please do not hesitate to reach out with any further questions, and I wish you nothing but the best!

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