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