How to Use a Vaginal Dilator

This information will teach you about vaginal dilators and how to use them for vaginal dilator therapy.

After menopause, your vagina becomes drier, less elastic (stretchy), narrower, and shorter. This process can happen sooner if you had cancer treatments or a surgery to lower your risk of cancer. Using a vaginal dilator and starting vaginal dilator therapy can help with these changes.

About vaginal dilators

A vaginal dilator is a tube-shaped device that’s used to stretch your vagina. Vaginal dilators come in kits with different size dilators ranging from small (about the size of a finger) to large. Some kits also come with a handle to make it easier to hold the dilator while you’re using it (see Figure 1).

You’ll start vaginal dilator therapy using the smallest dilator in your kit and slowly increase the dilator size over time as you feel more comfortable.

It’s often better to use firm dilators made of hard plastic, not softer dilators made of silicone. This is because firm plastic dilators move and stretch the muscles around your vagina (your pelvic floor muscles) better than silicone dilators. Your healthcare provider may give you a kit in clinic (such as the Amielle^® Comfort), or you can buy your own (such as Soul Source^™ Rigid Plastic Vaginal Dilators or VuVa^™ Smooth Vaginal Dilators).

About vaginal dilator therapy

Vaginal dilator therapy will help keep your vagina from becoming too narrow. It can also help keep your vagina elastic. These things will help:

• Your healthcare provider do a full pelvic exam (look at your vulva and internal reproductive organs).
• Make pelvic exams and vaginal penetration more comfortable.

The length of time you’ll need to do vaginal dilator therapy depends on many things. You can do it for as long as you need to. Talk with your healthcare provider about the length of time that’s right for you.

How to do vaginal dilator therapy

Find a time and a quiet place where you can be alone. Try to pick a comfortable space where you feel relaxed, such as your bedroom. Relax your pelvic floor muscles and take some deep breaths before you start. If you aren’t sure which muscles are your pelvic floor muscles, read Pelvic Floor Muscle (Kegel) Exercises for Females (www.mskcc.org/pe/kegels_females).

Start by getting into a comfortable position.

1. Lie on your back with your feet flat on the bed or couch and your knees slightly bent.
2. Spread your legs so they’re shoulder-width apart. If you have trouble doing this, you can place pillows under your knees for support.
3. Make sure you can easily touch the opening of your vagina with your hand. Use a hand mirror to see your vaginal opening if you need to.

Once you’re comfortable, take some slow, deep breaths into your belly. You can also practice Kegel exercises (squeezing and relaxing your pelvic floor muscles). These things can help relax your pelvic floor muscles and make it easier to insert the dilator. If you aren’t sure how to do Kegel exercises, read Pelvic Floor Muscle (Kegel) Exercises for Females (www.mskcc.org/pe/kegels_females).

Using your vaginal dilator

Using a vaginal dilator is simple. It shouldn’t cause any pain if you do it slowly and gently. It should take about 10 to 15 minutes.

Start with the smallest size dilator in your kit. The dilator should feel snug but not painful. If you don’t feel any pressure when you insert the dilator, you might need to use a larger size. Read the section “Increasing your dilator size” for more information.

1. Apply a water-based lubricant (such as Astroglide^® or K-Y^®) to the dilator and the opening of your vagina. This will help the dilator slide into your vagina more easily.
   • Don’t use petroleum jelly (Vaseline^®). It can cause irritation.
   • Avoid using oil and silicone-based lubricants. They don’t wash off the dilator easily.
2. Using gentle pressure, slowly insert the round end of the dilator into your vagina.
   • Always insert it straight toward your spine (backbone) or at a slightly downward angle, like you’d insert a tampon.
   • Keep inserting the dilator slowly until you feel slight discomfort or muscle tension, then stop. Never use force. Stop if you feel pain.
3. Do a set of Kegel exercises. This will help you relax your pelvic floor muscles and insert the dilator a little further.
   • Your vagina will narrow when you contract your pelvic floor muscles and open slightly when you relax them. It may be easier to insert the dilator further when you’re relaxing your muscles.
   • If it’s still hard to insert the dilator after doing Kegel exercises, try taking some deep breaths. Then, refocus on relaxing your pelvic floor muscles and try to insert the dilator a little further.
   • Don’t worry if you can’t insert the dilator completely. Over time, you may be able to get the dilator in a little further. If you still can’t insert the dilator, talk to your healthcare provider.
4. Gently move the dilator inside your vagina for 5 to 10 minutes. Add more lubricant if you need it during this process.
   • Gently push the dilator in and out. This helps stretch the length of your vagina.
   • Gently rotate the dilator in wide circles at the back, middle, and opening of your vagina. This helps stretch the width of your vagina.
   • It may be helpful to work with more than one size dilator. For example, you can use a larger dilator at the opening of your vagina and a smaller dilator deeper inside your vagina until you’re able to use the next size dilator fully.
5. Take the dilator out of your vagina.

After using your vaginal dilator

Wash your dilator with hot, soapy water. Dry it with a clean towel or paper towel. Store it as instructed in your kit.

You may have a small amount of vaginal bleeding while using the dilator or after you’re finished using it. This is normal. You may want to wear a panty liner after dilator therapy. If you have a lot of bleeding, such as bleeding that soaks a sanitary napkin (pad), or if the bleeding continues for longer than 1 day, call your healthcare provider.

If you get urinary tract infections (UTIs) often, you may want to urinate (pee) after using your dilator.

If you have any questions or problems, talk with your healthcare provider at your next appointment.

Increasing your dilator size

The goal of vaginal dilator therapy is to increase the size of your dilators slowly. When you can insert one size of a dilator completely into your vagina without any discomfort, you should start using the next size up. The goal is to insert the largest size dilator without any discomfort, if possible. Increasing the size over time will help you have more comfortable pelvic exams, vaginal sex, or both.

When to do vaginal dilator therapy

You should do dilator therapy 3 to 4 times per week, but don’t do it 2 or more days in a row. Doing dilator therapy many days in a row may cause pain or irritation. Try to do Kegel exercises on the days you don’t use your vaginal dilator. Kegel exercises shouldn’t be painful.

If you forget to do your dilator therapy or don’t have time to do it, don’t give up. Try to start again as soon as you can. Coming up with a plan or routine for yourself can help you be successful.

Vaginal moisturizers

Vaginal moisturizers (such as Replens^™, HYALO GYN^®, and Revaree^®) are products you can use regularly to increase the moisture in your vagina. This can make dilator therapy, sexual activity, and pelvic exams easier. Vaginal moisturizers are especially helpful if you’re in menopause or are taking medications that can lower your estrogen levels.

Use vaginal moisturizers at least 3 times per week, or more often if you need to. You can use them inside your vagina, at your vaginal opening, on your clitoris, and on your inner labia (the smaller folds of skin around your vaginal opening).

The best time to use a vaginal moisturizer is right before bedtime. This is because it absorbs best while you’re lying flat and sleeping. Don’t use a vaginal moisturizer right before dilator therapy because the moisturizer will not absorb into your skin properly.

To learn more about vaginal moisturizers, read Improving Your Vulvovaginal Health (www.mskcc.org/pe/improving_vulvovaginal_health).

Female Sexual Medicine & Women’s Health Program

If you’d like more support and information about sexual health and intimacy, talk with your healthcare provider about MSK’s Female Sexual Medicine & Women’s Health Program. For more information about the program or to make an appointment, call 646-888-5076.

The Female Sexual Medicine & Women’s Health Program provides services at the following locations:

• Rockefeller Outpatient Pavilion
  160 East 53^rd Street
  New York, NY 10022
• Evelyn H. Lauder Breast Center
  300 East 66^th Street
  New York, NY 10065