Mend Physical Therapy Blog and Injury Information

How To Use A Vaginal Dilator For Painful Sex Or Penetration

July 17, 2023

Vaginal dilators are tools that help stretch and expand the vaginal introitus (or opening) and surrounding tissues. Dilators come in many shapes, sizes, and material types but all utilize the underlying strategy of desensitizing and stretching the tissue gradually and progressively.

Most often dilators are prescribed for conditions that cause pain with vaginal penetration. Common diagnoses seen in our Boulder Physical Therapy and Lafayette Physical Therapy clinics are vaginismus, dyspareunia, menopause, and persistent pelvic pain syndromes. Dilators are also prescribed following interventions that have affected the extensibility of vaginal tissue such as chemotherapy or radiation, surgery, or repair of tearing during childbirth. Pain is typically present with penetration during sex, tampon use, or pelvic examination. If you have been experiencing these symptoms, dilators are a great tool, but should be used in adjunct to pelvic floor physical therapy. A specialized therapist can help not only diagnose the cause of the symptoms, but will provide specific manual therapy interventions and individualized exercises to treat current symptoms as well as offer education on maintenance and prevention of recurrence. Your therapist will help determine the type of dilator and most appropriate size to start with, then you can these at home with these instructions:

  1. Clean the dilators in warm water with gentle soap or per the instructions.

  2. Get in a comfortable position with your head and legs supported – reclined on the bed with pillows behind the back and head and another one or two under your knees. Your knees should be bent and resting in the butterfly or bound angle position.

  3. Apply a generous amount of lubricant (we recommend water-based, free of glycerine or parabens) to the dilator and vaginal opening. Start with the smallest dilator you have been prescribed or feel comfortable using.

  4. Begin with a few deep diaphragmatic breaths and pelvic floor drops to help relax your pelvic floor and nervous system.

  5. Separate the labia to either side with one hand and use the other hand to slowly begin to insert the dilator. You can try pointing the dilator slightly up to make insertion easier.

  6. Slowly progress the dilator to a comfortable position, pausing if there is pain and allowing the pain to decrease or subside before progressing the dilator further. Pain should remain at or below 4/10.

  7. Once the dilator is inserted you can try some active movement (rolling the dilator, stretching from side to side or straight down) or leave the dilator in place by placing a rolled towel underneath so you can let go and fully relax.

  8. Allow the dilator to stretch the tissue up to 15 minutes, though if pain increases remove the dilator early.

How to progress to the next size:

When you are able to tolerate 3 sessions of 15 minutes and gentle movement of the dilator, you can progress to the next size. It may be helpful to begin the session with the current size dilator and then progress to the next size once the tissue has relaxed and is prepared for the stretch.

Schedule an appointment today with one of our pelvic health physical therapists in our Boulder or Lafayette clinic today!