Dilators: helpful or harmful for recovering from pelvic pain?

In Vaginismus by Cambria Oetken

By Stephanie Prendergast, MPT, Cofounder, PHRC Pasadena and Cambria Oetken, DPT, PHRC Westlake Village

Spoiler alert: the answer is both. Let us explain.

Vaginal dilators are tools used to assist in the treatment of pelvic floor dysfunction, specifically when there are issues with penetration of any kind. Historically, patients have had to direct their own care and may have purchased dilators online or they were given dilators by a provider who gave little to no direction about how to effectively use them. Understandably, this has resulted in confusion,  frustration, and ultimately, individuals not using them. Under the care of a pelvic health professional, and when introduced at the right time and circumstances, dilators can be helpful. However, when introduced at the wrong time, or under the wrong circumstances, they can be emotionally and physically problematic. 

What Are Dilators?

Dilators are smooth, cylindrical devices that come in a range of sizes and materials, typically silicone or plastic. Most dilators can be used both rectally and vaginally, though there are specific brands that are meant specifically for these needs as well. Graduated dilators, meaning they start small and short and gradually increase in width and length, help to  gradually stretch and desensitize the pelvic tissues, including the vaginal walls, vulva, and surrounding pelvic floor muscles. Dilators can be used as part of a pelvic floor therapy program to help with:

  • Pelvic floor muscle tightness or ‘spasms’ (e.g., vaginismus, pelvic pain).
  • Post-surgical healing, such as after a hysterectomy, pelvic cancer treatments, or vaginal reconstructive surgery.
  • Scar tissue management after childbirth or injury.
  • Improving pelvic muscle control and awareness.
  • Sexual dysfunction, such as painful intercourse (dyspareunia).

Types of Dilators

They come in various shapes, sizes, and materials, but most follow a graduated set-up:

  1. Graduated Sizes: vaginal dilators typically come in a set with several sizes (small to large). The smallest size is generally used first, with the goal of gradually increasing to larger sizes over time as comfort and tolerance improve.
  2. Material: Most vaginal dilators are made of medical-grade, body-safe materials like (medical grade) silicone or soft plastic. They are designed to be smooth, non-porous, and easy to clean.
  3. Design: Some vaginal dilators are straight, while others may be slightly curved or come with a handle or flared base for easier removal.

Conditions That May Benefit from Dilators

Vaginismus

A condition where the pelvic floor muscles involuntarily contract, making vaginal penetration painful or impossible.

Pelvic Pain

Chronic pelvic pain, which can be due to a number of reasons such as muscle tension or scarring, may benefit from gradual dilation to help release tension.

Postpartum and Peripartum Care

After childbirth or prepping for a vaginal delivery, pelvic floor muscles and the surrounding tissues may need rehabilitation to regain flexibility, especially after tearing or episiotomy.

Post-Surgery

After surgeries like a hysterectomy, pelvic reconstruction, vestibulectomy and gender affirming surgeries, vaginal dilators can help restore normal vaginal tone and elasticity.

Comprehensive Cancer Care

Gynecological and colorectal cancer survivorship is improving with the use of medical therapies including surgery, medications, and radiation therapies, but can impact the elasticity of the tissues and surrounding muscles. Dilators are often recommended in this population to improve function and tissue health.

Menopause

Vaginal atrophy and dryness due to reduced estrogen can cause discomfort, and a vaginal dilator may help maintain vaginal health and comfort. Sexual health is not the only important factor, routine gynecological care may also be more difficult when these structures are affected and a vaginal dilator can be helpful here as well. 

How to Use (Vaginal) Dilators

PSA: every person’s dilator program should be individually tailored based on their findings (impairments), symptoms, and the overall goals for their plan of care. It is best to work with a pelvic floor physical or occupational therapist to determine an effective plan. Goals for dilator therapy can include:

  • Trying to expand or maintain the diameter of the vaginal canal
  • Desensitizing painful tissues
  • Reducing pelvic floor myalgia (muscle pain)
  • Reducing fear and anxiety around insertion and penetration
  • Improving sexual confidence
  • “Biofeedback” for pelvic floor motor control exercises

Depending on the patient’s goals, the type of vaginal dilators and instructions may vary. Earlier we cautioned that sometimes people may start dilators too early in their treatment plan; in general, dilator therapy should be postponed if:

  • Someone has active vaginal infections. 
  • Someone is experiencing severe burning with insertion as this could indicate a non-muscular issue that should be evaluated by a specialist. Conditions such as  neuroproliferative or hormonally mediated Vestibulodynia or genitourinary syndrome of menopause (GSM) or lactation (GSL) are common conditions where individuals start dilators per instruction of a care provider, or self-directed, and need a more thorough evaluation from a provider knowledgeable in sexual health to determine the best approach to care.  
  • Someone experiences increasing amounts of pain instead of decreasing discomfort as the session continues or lasting pain following dilation. 

Dilator prescription should be a dynamic process between the user and the provider. Every few weeks we should be able to make physiologic changes and revise the treatment plan if necessary to address plateaus in progress in order to  help people restore their pelvic health. 

Important Tips for Success

Patience is key

Progress may feel slow, but with goal setting and working with a  provider who can help address barriers,  people see functional improvement over time

Pain is not normal

If you experience pain or burning (beyond mild discomfort), stop using the dilator and consult with your pelvic health therapist or healthcare provider to reassess your approach.

Gradual Progression

Do not rush to the larger dilators. The goal is to gradually stretch and relax the tissues, not force them. 

Set the Environment

Try using calming music, meditation or white noise for optimal relaxation and avoid being on your phone or watching tv.

Use a mirror

A mirror can be helpful for you to connect more while using dilators and also help you become more familiar and comfortable with the anatomy. A mirror also allows you to track your progress and have a direct visual on the depth of your dilator being inserted.

Lubricants

Use lube! But use the proper type of lubricant. Most dilators will require a good water based lubricant. Silicone or oil based lubricants should not be used as they can break down the materials over time. All lubricants are not created equal and should be compatible with the vulvovaginal environment. Check out our blog on lubricants for more information on ideal pH, osmolality, and brands we recommend. 

Cleaning and Care

  • Clean after each use: Wash the dilator with mild soap and water. Some dilators are also dishwasher-safe (check manufacturer instructions).
  • Inspect for damage: Regularly check for signs of wear, cracks, or damage, and replace dilators as needed.
  • Storage: Store dilators in a clean, dry place, away from direct sunlight and extreme heat.

When to Consult a Professional

If you experience persistent discomfort, pain, or difficulty using the dilators, it’s important to consult a pelvic floor physical therapist or return to your medical provider. A pelvic floor therapist can help assess the condition of your pelvic floor muscles, address underlying causes, and tailor a treatment plan to your needs. Vaginal dilator therapy depends on multiple factors, which is why consulting with a healthcare provider is essential. Dilators alone are rarely the answers to pelvic pain, if you are struggling please come find one of us to help you! Your pelvic health deserves it!

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Check out our recently published e-book titled “Vulvodynia, Vestibulodynia, and Vaginismus,” designed to empower and inform individuals on their journey towards healing and understanding.

Did you know we opened our 11th location in Columbus, OH? Now scheduling new patients- call (510) 922-9836 to book! 

Are you unable to come see us in person in the Bay Area, Southern California or New England?  We offer virtual physical therapy appointments too!

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

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tags: vaginal dilator, physical therapy, dilator therapy, painful sex, pelvic exam, silicone dilator, medical condition, deep breaths,