How to use dilators for painful sex or penetration
If you are a vulva owner and experience pain with penetration, such as with sex, OBGYN exams, or even with inserting a tampon, you have have a condition known as “vaginismus.” Did you that, according to American Family Physician, up to 20% of people may have pain with penetration or sexual activity. Unfortunately, there is often a stigma surrounding sex or genital related pain, as well as an overall lack of education on the parts of healthcare provdiders regarding the treatment option for pain with sex or penetration. It can sometimes take vulva owners years to receive and accurate diagnosis and optimal treatment options. The good news is that pain with sex or penetration is often very treatable!
If you are experience pain with sex or penetration, it is important to start by working with your medical provider. There are a variety of reasons why sex or penetration may hurt, and we want to rule out any underlying gynecological or urological conditions, or hormonal changes that may require the treatment from a physician. One common cause to pain with sexual activity and penetration is pelvic floor muscle tension. Pelvic floor physical therapy treatment and the use of dilators can be a very helpful tool for you.
As a disclaimer: We highly recommend an evaluation with a pelvic floor PT prior to using dilators. Dilators are just one tool of many, and proper + safe use is important for optimal outcomes. There are also other treatment options your pelvic PT may offer!
The following instructions can be helpful for the proper use of dilators:
USING YOUR VAGINAL DILATOR FOR THE FIRST TIME
Recline on a bed with your knees bent. Use as many pillows as needs to support your head, trunk, and knees. You can also use a butterfly position in your legs, with your knees bent, resting on pillows, if it is more comfortable and relaxing.
Start by using the smallest size dilator you feel comfortable inserting. First generously apply lubricant over the tips and side of dilator. We recommend a water based lubricant (if you are working a patient at Awake Pelvic Health, ask for free lubricant samples!)
With one hand, separate your labia, and use the other hand to slowly insert the dilator about half way. Keep your breathing relaxed and pelvic floor muscles relaxed as much as possible.
Pause if you feel a lot of resistance or discomfort. Breathe and allow your muscles to relax. You can even visualize your muscles “softening” or “melting like butter.”
Continue to insert the dilator until approximately 3⁄4 of its length is inside the vagina. Depending on the dilator's length, it may not fit completely inside.
Once you have the dilator inserted to the depth that feels best for you, you can use a book or rolled up towel to keep the dilator in place so you don’t have to use your hands. If are unable to insert the dilator to the desired depth, hold it at the depth you are able to tolerate with no more than moderate discomfort (4 on a scale of 1-10.)
Focus on keeping your breathing, body, and pelvic floor muscle relaxed. If it helps, you can play relaxing music; looking at non-threading pictures of photos like flowers, dogs, pets; dim lights and a candle, etc.
Allow the dilator to stay in place for up to 15 minutes. Remove early if discomfort intensifies.
PROGRESSING WITH YOU VAGINAL DILATOR/TRAINING TO REDUCE PAIN
When you are able to comfortable insert the dilator fully for 10-15 minutes, and move it in and out of your vaginal canal about 15-20 times, you are ready to progress to the next larger size. There is no right timeline to advance to the next size, so be kind and patient with yourself. We recommend starting with the smaller size at the beginning of a dilator session and going to the next size in the same session, to “warm up” the muscles.
You can introduce movement to the dilator by holding onto one end of the dilator and moving it slowly/gently in and out of the vaginal canal, side to side, or in circles. You can also provide sustained pressure around the base of the vaginal opening for 30-60 seconds.
CLEANING YOUR VAGINAL DILATOR
Wash yourself and your dilator before and after each use. Use warm running water and mild, unscented soap.
Dry the dilator with a paper towel and store in a clean plastic bag.
KEY POINTS TO REMEMBER
Use adequate lubrication
Experiment with different leg and trunk positions and different angles of insertion
If you are experiencing discomfort that progressively increases, even after pausing and breathing, stop for the day and come back to your dilator session at another time. Inform your PT
Keep discomfort to a 4/10 or less, our goals is to help the brain learn that insertion into the vaginal canal is safe and comfortable, not a painful activity.
You are in control! Go at your own pace and be patient and kind with yourself.
WHY DO PELVIC FLOOR PHYSICAL THERAPY IN ADDITION TO DILATORS?
A pelvic floor physical therapist can valuable part of your healthcare team. They can provide a thorough examination, treatment plan, manual therapy, exercise programming, and guidance to help you on your journey and help you meet your goals!
