female on bed with Milli

How to use a vaginal dilator

For too many women, vaginal penetration is a source of pain rather than pleasure. While you should always tell your healthcare provider about vaginal or pelvic pain, at the same time you can educate yourself about vaginal dilators. These products, also called vaginal trainers or vaginismus dilators, are often recommended by healthcare providers to help address a variety of conditions that can cause pain during vaginal penetration.

To get you started, here’s some information about dilators, dilator therapy, and how to use a vaginal dilator. 

What’s a Vaginal Dilator?

Dilators Come in Different Sizes, Shapes, and Types of Material

Vaginal dilators are carefully designed, semi-rigid, tube-shaped training tools. You insert them into your vagina to help gently stretch your vaginal tissues and retrain your vaginal and pelvic floor muscles (which wrap around the vagina) so that you can ultimately reduce pain and increase comfort during vaginal sexual activity.

Vaginal dilators are usually made of silicone or plastic and come in a variety of sizes. Additionally, there are kits selling up to eight different sizes, which consecutively progress in size from smallest to largest. There are adjustable, gradual expanding vaginal trainers, eliminating the need for buying or storing multiple sizes or kits. Few vaginal trainers come with a built-in vibration feature, but they do exist! Vibration helps relax your vaginal and pelvic floor muscles to allow for easier insertion and to enhance overall relaxation.  

What’s a Vaginal Dilator Used For?

Common Conditions and Causes

Vaginal dilators are often recommended as part of a treatment plan for a variety of pelvic pain conditions. It’s important to remember that a physical condition causing vaginal or pelvic pain can also trigger anticipatory, involuntary muscle clenching that can prevent vaginal penetration. Vaginal dilation therapy can help address both the physical and the psychological elements stopping you from having pain-free vaginal penetration.

Here are some terms and physical conditions you may hear from your healthcare provider or your pelvic floor rehabilitation specialist about what could be causing your pain during vaginal penetration:  

  • Vulvodynia – A feeling of burning and irritation around the vulva (the opening of the vagina). It’s generally not possible to isolate the specific cause of vulvodynia, but sometimes a previous infection or hormonal change can trigger it.
  • Vaginismus – An involuntary tightening of the vaginal and pelvic floor muscles in anticipation of or during penetration. Vaginismus can be caused by stress, anxiety, or other psychological triggers.
  • Dyspareunia – A general term for pain during vaginal penetration. Dyspareunia can be the result of physical issues (e.g., lack of lubrication or an injury) or psychological factors (e.g., stress or trauma related to past sexual abuse).
  • Vaginal Stenosis – A narrowing or shortening of the vagina often accompanied by thinning and drying of the vaginal tissue. Vaginal stenosis can result from episiotomies, reconstructive surgeries, and cancer treatments.
  • Genitourinary Syndrome of Menopause (GSM) – GSM refers the thinning of vaginal walls due to the loss of estrogen in menopausal women or women undergoing cancer treatment. You may see the term “vaginal atrophy” online but because this condition associates to vaginal and urinary symptoms, healthcare professionals often use the term “GSM”. GSM is accompanied by dryness, itching, and other irritation.  
  • Menopause – A drop in estrogen levels after menopause may lead to vaginal atrophy and related vaginal pain for women in this age group.
  • Post Hysterectomy – If the ovaries and fallopian tubes are removed during this procedure, menopause is induced in previously pre-menopausal women. Vaginal atrophy typically follows.
  • Post-Chemotherapy or Radiation – Cancer treatments (especially following breast, uterine and colorectal surgeries) can reduce estrogen levels, which can increase the likelihood of dyspareunia, atrophy, and stenosis.

Vaginal dilation therapy can help with any of these causes or conditions. Be sure to talk with your healthcare provider about how using a vaginal trainer can bring you back to the point where you can enjoy penetrative sexual activity once again.

What’s Vaginal Dilation Therapy?

Ways to Reduce or Overcome Pelvic Pain or Painful Sex

Vaginal dilation therapy is the process of using vaginal dilators or trainers over a period of time to reduce or eliminate pelvic pain due to vaginal penetration. The therapy can be very effective, but it doesn’t happen overnight – it can take weeks or even months before you achieve pain relief or vaginal expansion you want.

It’s important to choose the right vaginal dilator with the features that will help you achieve your goals. Your healthcare provider or pelvic floor rehabilitation specialist can help you with this choice. They’ll also suggest the best size to start with and help you design your own plan regarding the frequency and duration if your vaginal training sessions. If you ever have any questions, be sure to ask your healthcare provider about how to use a vaginal dilator. It also helps to have a coach or partner, in addition to your healthcare provider, who will hold you accountable to stick with the therapy.

Most dilator therapy plans suggest using your dilator three to four times each week for at least ten minutes each session. Try to avoid too many days of consecutive use if possible. Once you’ve settled on your dilation therapy plan, follow the steps below very carefully in each session.

What’s a Dilation Session Like?

How to Use Your Vaginal Dilator – at Home or Elsewhere

Whether using a vaginal dilator at home or at the office of your healthcare professional, it is always good to be relaxed during each vaginal dilation session. When it comes to being at home, find a private, comfortable dilation therapy “safe spot” in your home. Like many experiences that require you to relax and feel comfortable, try to create a relaxing atmosphere. Consider using music, aromatherapy, and other relaxing elements that can enhance mindfulness. Some women prefer to have a mild distraction, so they watch television during their sessions. In either case, you’ll want to keep your hands free, so set your smartphone and tablet aside during your sessions!

Here are some additional tips when using your vaginal dilator at home:

  1. Wash your vaginal dilator with warm water and non-scented soap.
  2. Apply a small amount of water-based lubricant to the tip (rounded edge) of the dilator.
  3. Lie on your back and take a few minutes to relax your body and mind. Be sure your dilator and water-based lubricant are in arm’s reach.
  4. With your feet flat, raise your knees slightly and spread your legs so that they’re shoulder-width apart, just like you would for a pelvic exam.
  5. Locate your vaginal opening with your finger (use a mirror if necessary) and apply some water-based lubricant to that area. Then touch the rounded end of the dilator to that spot.
  6. Take some relaxation and cleansing breaths and then gradually insert the dilator into your vagina. Use a slightly downward angle, just as you would when inserting a tampon.
  7. Continue to slowly push the vaginal dilator in as you breathe deep from your diaphragm.
  8. Stop pushing when you feel discomfort or muscle contraction. Pause and relax. If your dilator has a vibrator feature, you can engage it at this or any other time to help with muscle relaxation.
  9. After a minute, see if you can push past that spot without excessive pain or discomfort. Don’t worry if you can’t go any further initially.
  10. Once you’ve inserted your dilator as far as is comfortable, hold it in place since your vaginal muscles may try to push it out.
  11. Try to slowly twist the dilator or rock it gently in and out and against the walls of your vagina.
  12. Continue this random activity, pausing for short periods of rest and deep breathing, for the rest of the session.  
  13. Slowly remove the dilator and then remain on your back and continue your breathing exercises for another minute or two.

After Using Your Vaginal Dilator

Practice Clean and Helpful Habits After Each Vaginal Dilation Session

First of all, congratulate yourself for the steps you’ve taken and the progress you made! In general, always remember to thoroughly wash your vaginal dilator with non-scented soap and warm water. Dry it with a clean towel and store it in its intended packaging. As dilators are made of different materials, please be sure to consult your dilators’ operational or user manual for the most appropriate cleaning directions.

Like many things involving objects in or around your vagina, clean yourself to maintain general hygiene and urinate after your session. For women especially prone to urinary tract infections (UTI), urinating may reduce the already relatively low chance of developing a UTI. Of course, always consult your doctor or healthcare professional on what they advise.

It is not uncommon to see a small amount of blood, similar to the amount you might see during flossing your gums.  You may notice a little bit of blood on your dilator when you remove it and you may experience slight bleeding immediately afterward.  Watch this situation closely and be sure to contact your healthcare provider right away if the discharge amounts to more than short-term spotting.

On your vaginal dilator training off-days, try to consider other pelvic floor muscle exercises or training. There are many resources, like Pelvic Health Rehabilitation Center, who frequently publish free resources online, on their Facebook page, and on their Instagram about this. Consider using vaginal moisturizers to soothe and lubricate your vagina between sessions, especially if you’re experiencing dryness or cracking related to menopause or post-cancer treatments.

Support and Resources

Utilize Intimate and Pelvic Health Wellness Groups for Added Support

For more information on women’s sexual health issues, and for connections to organizations and forums for women who are dealing with sexual pain and sexual health issues, we encourage you to explore a wide variety of available resources.

Here are some sources of virtual and online access to healthcare:

Here are some professional organizations related to women’s health and pelvic health specialists:

You can also find online groups of women who have come together to share support and first-hand experiences related to sexual and pelvic health. Consider, for example, this Facebook group called The Happy Pelvis or this online support group called Pelvic Health Summit.

Commonly Asked Questions

What is a Dilator Used For?

Healthcare providers often recommend vaginal dilator therapy to help patients overcome anxiety and pain related to vaginal penetration. Post-menopausal women, cancer survivors, and women with certain pelvic floor disorders can use vaginal dilators to improve their sexual health and once again experience penetrative sex with less pain and more comfort.

Do Dilators Really Work?

Every case is different, but the best results from dilator therapy occur when the patient:

  • Commits to their dilator therapy in terms of frequency and duration over time.
  • Follows up regularly with their healthcare provider and rehabilitation specialist(s).
  • Conducts their dilation therapy with a positive mindset and in a comfortable physical environment.

How Long Should I Keep a Vaginal Dilator In?

The most productive dilator therapy sessions last around ten minutes. There are no definitive studies that indicate longer sessions achieve better results. Most vaginal trainers are not intended to be used while the patient is in any other position than lying on their back.

If I Start Using a Vaginal Dilator, Will I Need to Use One for the Rest of My Life?

Many patients reach their goals within six months to a year. According to a poster published at the North American Menopause Society in 2019 from a study conducted of 164 women, 45% of Milli users were able to return to intercourse within 3 months of use.  Some women who undergo dilator therapy develop a comfortable habit and continue to use their dilator to maintain or monitor their dilation progress. Some couples find that using dilators before intercourse is a helpful way to prepare for comfortable penetration.

For more helpful information from medical experts about vaginal dilators and painful intercourse, check out Milli’s YouTube channel or join Milli’s Instagram community.

Information in this blog is for educational purposes only and not intended to replace medical diagnosis or advice from a health care professional. Patients are encouraged to seek a medical appointment for their evaluation of pelvic pain.