Vaginal dilator therapy should take place after an assessment and discussion with your health care professional.
The dilator therapy will have been discussed with you alongside you receiving this leaflet.
If after reading this leaflet you have any further concerns or questions please contact the member of staff that recommended your dilator therapy.
What is a vaginal dilator?
A vaginal dilator is a smooth plastic device with a flat or rounded tip that usually comes in a set of various sizes. Dilators are usually made from plastic and they provide a comfortable treatment option for improving comfort and sensation around and within the vaginal tissues.
Why do I need to use a dilator?
Vaginal dilators may be used to encourage vaginal tissue sensation and action. This may include improving scar tissue following childbirth, vaginal surgery or radiotherapy. Using vaginal dilators will also help you feel more comfortable with any future internal examinations such as clinical follow ups or cervical screening test. It can also help with retraining the pelvic floor muscles to let go and lengthen. Sometimes the outside and the inside of the vagina can be over sensitive to touch and dilator therapy can help to teach the tissues that normal touch is ok and safe. This can help with normal touch (e.g washing and wiping) and can lead to reduced pain and improved confidence with intimacy.
If you have been advised to use vaginal dilators following radiotherapy treatment, please read the leaflet Vaginal care after pelvic radiotherapy available on the Leeds Teaching Hospitals NHS Trust website.
What are the dilators used for?
In order to have pain free penetration you need your pelvic floor muscles to be able to let go and go to their normal resting length. It is therefore important to work on strength, flexibility, control and awareness of your pelvic floor muscles. Dilators can provide a safe and comfortable way to practice achieving this through regular exercises. They allow you to start with the smallest size and hopefully progress at your own pace.
If you follow the steps in this leaflet you will hopefully see improved comfort and confidence with intimacy and penetration. You may find these strategies useful to try before penetration too.
The Dilator Programme
Before you start
Are you ready?
To make progress with your dilator therapy you will need to spend a little bit of time on a regular basis. You will need to start with 1-2 minutes and build up to 10-15 mins 5-6 times a week.
If you commit to working on this on a regular basis we would hope that you will see results in the long term. If you are not able to do this you may find that you struggle to make progress and find that you have more peaks and troughs in your progress. It may be worth waiting until you are able to make time on a regular basis.
Expect that it will take weeks to progress from one dilator to the next, but steady progress listening to your body and keeping focus will help. You may feel some discomfort during the process but try to avoid pain. If you try to progress too quickly or push through discomfort into pain you may encourage more muscle spasm and your body to fight more against the dilator entering the vagina.
Tips
- You need to be as relaxed as possible when setting up and using your vaginal dilators.
- Start in a comfortable position laid on your back or side, alternatively you may find it easier in the bath.
- Some patients find it helpful to play some calming background music.
- We suggest that you find a place where you can be away from interruption and focus on your therapy without distractions, (such as noise, children, and family walking into the room).
- It is recommended that you empty your bladder before starting a session with your dilators.
STEP 1: The exercises
Your health care professional will have recommended which dilator to start with. Most people will start with the smallest dilator. For each session start with the smallest dilator, or one size below the size that you have been working with.
STEP 2: Lubrication
It is useful to moisten the tip of the dilator with a lubricant to make it more comfortable to insert by reducing any friction. There are several different types of vaginal lubricant, many chemists and large supermarkets sell a variety. Lubricants may be available on prescription if necessary. It is important that you choose a plain, fragrance-free lubricant. Examples include: KY Jelly, Yes, Durex, Aqua gel, Hyalofemme and Sylk. You can use an oil based lubricant* on the tip of the dilator and water based lubricant on the entrance to the vagina to further help with comfort if required.
Caution
Please take care if using oil based lubricant and you use condoms for intercourse. Oil based lubricants can alter the effectiveness of condoms.
STEP 3: Insertion
- Find a position of comfort lying down. This may be lying down with your knees bent and feet flat on the floor. It could be laid flat on your back with pillows under your knees and feet, or you may wish to lie on your back with your knees relaxing out to the side on pillows or a wall. Allowing your leg muscles to relax helps your muscles in your vagina to relax too.
- When you have found a comfortable position, start with the smallest dilator first.
- Apply firm, gentle pressure – insert the dilator slowly into your vagina, pointing towards your lower back.
- At first, it may help to push the dilator as far as is COMFORTABLE, twist gently and pull back.
- You may find it beneficial to focus on a pelvic floor squeeze and then relax your pelvic floor muscle around the dilator. This helps to increase your awareness of muscle tension and help the muscles relax.
- Focus on breathing control whilst using dilators. Your physiotherapists will go over this with you. If you are unsure of breathing control techniques speak to your physiotherapists.
- Start with the smallest dilator or one that you find comfortable to insert.
- Place some lubricant onto the dilator (and the vagina if required).
- Allow yourself to breathe naturally in for a count of two and out for a count of two, keep this normal breathing going throughout.
- You may find it helpful to gently tighten your pelvic floor, then straight away try to relax the pelvic floor.
- Then place the tip of the dilator at the entrance to your vagina and let your vagina get used to normal touch by continuing to breathe.
- If you think your pelvic floor is relaxed slowly ease the smallest dilator into the vagina 1-2 cm, or as far as you are able to do without pain. If you feel the muscles tightening or you feel resistance, check your breathing and consider a squeeze and release of your muscles before you continue.
- Do not worry if the dilator is not fully inserted. Insert as far as you are able to do so. Then hold the dilator in the vagina and leave it there for 1-2 minutes.
- Gradually build up the time that you leave the dilator in the vagina. If you are not aware of the dilator or it is comfortable then your pelvic floor is relaxed.
- At the end of your time make sure you keep breathing and very slowly remove the dilator from the vagina.
- Repeat these steps daily until you find it comfortable.
- If you feel comfortable for 10 minutes you may be ready to try the next size! Remember to go slowly and start with 1-2 minutes. Always start your session with a small dilator and work up.
You may find it useful to record each session in a diary to chart your progress. Write down which dilator you used and how long you managed to keep it in without pain.
Cleaning the dilators
When you have finished using the dilator wash it in the same soap that you would use to wash your pelvis area, rinse and dry well (do not sterilise the dilator).
Things to look out for
If using the dilators causes any bleeding, increased soreness that lasts longer than an hour, or increased pain, stop using the dilator and speak to your physiotherapist, nurse or GP. You do not have to use the dilator during your period but resume it as soon as possible afterwards.
Further Support or information
If you require any further support or information, please contact:
