Vaginal Dilators: What are they and when to use them
What are vaginal dilators?
Vaginal dilators are cylinder or tube-shaped medical devices in graded sizes, that can be inserted into the vagina to help gently stretch and retrain the soft tissues in and around the vagina to behave more normally.
Vaginal tissue may become damaged after childbirth, gynaecological surgery or radiotherapy following cancer. Menopausal vaginal atrophy is a condition where lack of oestrogen causes the vaginal tissue to be thinner and less elastic. Vaginismus, (the involuntary tensing or contracting of the muscles around the vagina) is another condition where vaginal dilator therapy is recommended by psychosexual therapists using a structured programme. All these conditions can cause penetration to be painful.
Exercising the pelvic floor is essential to help improve the strength, flexibility and control of the pelvic floor muscles but for penetration to be pain-free it is important to be able to relax the pelvic floor muscles, so using a dilator allows you to practice penetration, whilst being in control.
Specially designed dilators are also used after male-to-female gender confirmation surgery in order to prevent vaginal shrinkage or stenosis.
For some women, the thought of using a vaginal dilator can be daunting. This blog post will discuss the basics of vaginal dilators, how to use them, and some of the benefits they offer for a number of conditions.
How to choose the right vaginal dilator?
Dilators are usually made from either medical-grade plastic or silicone. Plastic dilators are available on prescription following surgery, but silicone vaginal dilators are a little softer and can offer a gentler, more flexible feel. Both types come in sets of varying sizes.
When starting out using these devices, it's important to begin with the smallest one and gradually transition to bigger sizes when they feel comfortable inserting without any pain or resistance. The sizes available on the market typically range from around 1 inch in circumference to 5 inches. Choosing the correct size will depend on which one does not cause any pain or resistance when inserted and sits comfortably within the vagina.
How to use vaginal dilators
- Wash your hands before inserting the dilator
- Apply a water-based or oil-based lubricant to the device. NB. Silicone lubricants are not compatible with silicone dilators.
- Begin inserting the dilator slowly into the vagina similarly to how you would if you use tampons, pointing towards your spine.
- Keep inserting the dilator until you feel a natural muscle resistance to stop
- Slowly begin moving the dilator inside the vagina from side to side or in circles for around 10-15 minutes and apply more of your chosen lubricant if required.
Once the pelvic floor feels relaxed and vaginal tissue less tight, slowly remove the dilator and wash the device after use.
This process can be done a few times a day, or as needed. Another way to use a vaginal dilator is to insert it and then remove after a few seconds. This can be done a few times in a row. This method may be helpful for women who have a lot of pain on initial penetration. Some women find it helpful to use vaginal dilators which have a small integral vibrator inside. The vibration can help relax the muscles and reduce pain and may provide some pleasurable sensations.
Conditions for which vaginal dilators may be helpful.
As mentioned at the beginning of this blog, vaginal dilators may be recommended for the following conditions:
Cancer Treatment & Menopause
Treatment for breast and gynaecological cancers can have a negative impact on intimate health. Chemotherapy and hormonal therapies, such as Tamoxifen for breast cancer in women who are pre-menopausal can lead to sudden menopause and the side effect of vaginal dryness and painful sex. Women undergoing hysterectomy for a gynaecological cancer will experience surgical menopause and if pelvic radiotherapy is also carried out, their symptoms may include shortening of the vagina and changes to the vaginal tissue including vaginal atrophy. Vaginal dilators can be very helpful for these women and should be offered by the cancer team before discharge.
Vaginismus is a condition that affects a woman's ability to have vaginal sex. It is an involuntary contraction of the muscles around the vagina. The condition can be mild, moderate, or severe. Treatment for vaginismus typically focuses on helping a woman relax the muscles around her vagina and help is available from a psychosexual therapist.
Dyspareunia is the medical term for pain during intercourse. The cause is often unknown and difficult to diagnose but may be caused by menopausal vaginal changes, surgery, endometriosis or other pelvic conditions. It can occur in both men and women, but it is more common in women. This pain can be felt throughout the pelvis, vagina or lower abdomen.
Vaginal atrophy is a common condition that affects women as they age and in post-menopause. It is caused by a lack of oestrogen which affects natural lubrication, elasticity and the quality of vaginal tissue, rendering it thinner and more inclined to vaginal tears. Itching, burning and painful sex are all symptoms of vaginal atrophy. Vaginal dilator use can help to restore sexual comfort and confidence, and vaginal moisturisers are often recommended. Local vaginal oestrogen can also be prescribed to help with restoring vaginal tissue and elasticity.
Vaginal stenosis is defined as a narrowing and shortening of the vagina. Vaginal stenosis can cause the vagina to become less flexible, drier and more fragile, which can result in dyspareunia and discomfort during pelvic exams. Vaginal stenosis can be the result of gynaecological surgery, chemotherapy or pelvic radiation therapy. Vaginal dilation therapy is an excellent option for preventing and treating vaginal stenosis, aiming to gently stretch the vaginal walls over an extended period of time, usually weeks or even months
Male to Female (MtF) Gender Confirmation Surgery (GCS)
After GCS surgery, it’s normal for the body to register the neo vagina as a wound, and the body will try to heal. Because of this, the neo vagina may start to shrink or develop scar tissue called granulation. Dilation therapy is an absolute must to keep the neo vagina functional, to minimize scars from forming in the vaginal lining, and to prevent the loss of vaginal depth and width. Usually, MtF transgender patients start using vaginal dilation a few days after surgery and continue to use vaginal dilators, to some degree, for the rest of their lives. A water-based lubricant is essential for use with the dilators for at least the first year following surgery to prevent tearing of the delicate skin inside the neo-vagina.
The GCS surgeon should inform patients how to safely use vaginal dilators, what size to use, and how often to employ post-operative vaginal dilation to maintain the neo- vagina.