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Dilators: A Simple and Effective Stretch

Dilators: A Simple and Effective Stretch

By Barb Depree, MD

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Even though vaginal dilators have been around for decades, they still elicit lots of attention and a few quizzical looks even from health care professionals whenever we display our wares at medical conferences. My patients sometimes have questions, too, and we get phoned-in and emailed questions here at MiddlesexMD.

Dilators are one of the most straightforward medical devices you'll run across. They are a set of tubes that gradually increase in diameter from about a half-inch to about an inch and a half. They are usually made of high-quality plastic, but may also be made of silicone, which gives them a softer, more flesh-like quality. Both types are washable with soap and water.

Dilators are used to increase vaginal "patency," the capacity and ability of the vagina to accommodate the things that it is made to accommodate, like a speculum, a baby, a penis—some pretty important stuff, in other words.

Dilators are used to:

  • Prevent scar tissue from forming after some cancers or pelvic radiation therapy.

  • Increase vaginal capacity and length after certain procedures, such as a total hysterectomy.

  • Maintain vaginal capacity during times when sex isn't an option for whatever reason.

  • Improve vaginal capacity after a long time without sex (remember the old use it or lose it adage).

  • Help to address vaginal shortening and tightening due to hormonal changes of menopause.

  • Treat conditions, such as vaginismus, that make penetration difficult.

Since some vaginal conditions might require additional treatment, such as localized estrogen or muscle relaxants, you should always discuss any vaginal pain or change in your ability to have sex with your doctor, as well as how you might benefit from using dilators. From there, if it's simply a matter of conditioning or maintenance, our shop has a selection of high-quality plastic and silicone dilators.

I recommend any of these sets. Choose the features and sizes that appeal to you. The first set that we found and offered remains a favorite. It's available with five or seven dilators, depending on your starting point, and the straight, solid cylinders are easy to handle and clean.

The silicone kit is firm yet flexible with a softer touch. (Bright colors don't hurt, either.) Be aware that silicone lubes will degrade the surface of these dilators, so use them only with water-based lubricants.

The Amielle kit is our high-quality, good-value choice. This set of five dilators is made of medical-grade plastic and includes a detachable handle that might make insertion easier.

Increasing vaginal capacity takes patience—often several months. For maintenance, you may need to use dilators regularly until you're having sex regularly. The goal is to accommodate your partner's penis (or your doctor's speculum) comfortably and without pain. It's a worthy goal, so accept that you're in it for the long haul.

To use dilators:

  • Start with a warm bath to soften tissues and relax your pelvic floor muscles (along with everything else).

  • Find a comfortable and private place and lie down on your back, legs bent at a 45-degree angle and shoulder-width apart.

  • Consciously relax all your muscles, from head to toe. Do a mental scan for areas of tension around your eyes, brows or anywhere else. Focus on breathing in, breathing out.

  • Begin with the smallest dilator and slather it with high-quality, water-based lubricant (not petroleum jelly or any kind of oil). Generously lube your vaginal entrance as well.

  • Gently insert the dilator until you meet resistance. Pause. Breathe. Practice Kegel exercises. Insert it a little farther if you can do this without discomfort. The dilator should fit snugly but without pain.

  • Keep it in place for 20 or 30 minutes. Watch TV or listen to a podcast or your playlist. Practice Kegels.

  • You can try rotating it in place or moving it in a circular motion around the vaginal entrance or gently moving it in and out.

  • Clean with soap and water. Towel dry.

  • Move to the next size when you can comfortably insert the smaller one.

  • Do this three or four times per week or every other day.

You may bleed a little at first. This is normal. But if you soak a sanitary napkin or experience frequent bleeding, this is not normal. Stop using the dilator and call your doctor.

I like dilators because they're both simple and effective. Granted, taking a pill is easier, but there are no pills that treat vaginal patency as such. If you stick to the regimen, dilators are very effective in both reconditioning the vagina and in maintaining elasticity during fallow sexual periods.

Barb DePree, MD, has been a gynecologist for 30 years, specializing in menopause care for the past 10. Dr. DePree was named the Certified Menopause Practitioner of the Year in 2013 by the North American Menopause Society. The award particularly recognized the outreach, communication and education she does through MiddlesexMD, a website she founded and where this blog first appeared. She also is director of the Women's Midlife Services at Holland Hospital, Holland, Michigan.