What a Pelvic Floor Physical Therapist Wants You to Know About Vaginal Dilators
No, dilators aren't sex toys, but they are meant to make sex a more enjoyable, pain-free experience.
Compared to other items on the list of things you can safely stick up your vagina, dilators seem to be the most mysterious. They look similar to a colorful dildo but don't have quite the same realistic phallic appearance. And unlike the sex toys you use solo or with a partner, you might even see a few of them in your ob-gyn's office. So what's the deal with vaginal dilators?
Here, Krystyna Holland, D.P.T., a pelvic floor physical therapist and owner of Inclusive Care LLC, breaks down everything you should know about vaginal dilators, including what they're really designed to do. Surprise: It's not to give you an orgasm.
Dilators are primarily used for two reasons.
Vaginal dilators aren't used for the same sensual reasons as most sex toys and gadgets. Instead, they're designed to help individuals with vulvas get used to the feeling of stretching their vaginal canal, and they're available in a wide range of lengths and widths, says Holland.
1. Treating painful sex.
People who experience painful sex caused by vaginismus — a condition in which the muscles surrounding the vagina spasm, causing it to narrow — and individuals who have pain without a directly correlated gynecologic issue (i.e. ovarian cysts or endometriosis) are the most common dilator users, says Holland. Aside from physical medical conditions, your emotional state can make sex painful: If you're feeling anxious or afraid, for example, your brain can send signals to your pelvic floor muscles to tighten, leading to discomfort during sex, according to the Mayo Clinic. This initial pain could make you fearful that future sexual encounters will hurt, too, so your body may continue to tense up before and during penetration, continuing the cycle of pain, per the Clinic.
TL;DR: Any feeling of stretch or pressure (via P-in-V sex, for example) that might feel fine and dandy for one person can interpreted as painful in another, explains Holland. "Most often the dilator is controlled by the person who has the pain, so they can kind of tell themselves that they're familiar with this amount of stretch and pressure, they're totally in control, and it shouldn't be painful," she adds. "They're trying to recalibrate that connection between their brain and their pelvis to be able to accommodate the feeling of stretch or pressure and have it not be painful."
It's important to note, though, that having frequent or severe pain during intercourse could be a sign of another health condition that shouldn't go unchecked, according to the American College of Obstetricians and Gynecologists. So, sticking a dilator up there will do no good if you're not addressing the root cause of your pain. "You can try to retrain muscles all day, but if there's something going on with your organs or cervix, the muscles are going to continue to guard and be tight to protect them," says Holland. If you can't go one romp without pain, don't try to "work through" it on your own — talk to your doctor, stat.
2. Stretching the vagina.
Aside from helping to create pain-free sexual experiences, vaginal dilators are often used by people who have had radiation treatment for gynecologic cancer and transgender women who have had a vaginoplasty. In both situations, the dilator helps keep the vaginal tissues flexible and prevents the vagina from narrowing, says Holland.
Talk to your doc before using a dilator.
While trying out a vaginal dilator on your own seems simple enough, you want to take the time to chat it over with a professional before you do. Skipping this step could actually do more harm than good, particularly if you have a bad experience with it and develop a negative attitude toward dilators altogether. "[If that happens,] even just talking about the dilators or looking at the dilators can make people have very strong emotional reactions that are not helpful for down-training the nervous system," says Holland. "And that's really a bummer because then we have to do some investigating into whether we're ruling out dilators altogether or if it's just a specific set of dilators. It makes the [treatment] process a little bit harder to start."
After confirming with your ob-gyn that you're free of any medical conditions that could be causing your pain, Holland suggests meeting with a pelvic floor physical therapist to find out if vaginal dilators are the best tools for you and how to use them to fit your individual needs and goals. "Sex in itself is so personalized based on what you're bringing to the table, so it makes sense that your treatment for painful sex would also be individualized," she adds. (Related: What Every Woman Should Know About Pelvic Floor Dysfunction)
How to Use Vaginal Dilators
Go slow and steady — and expect some discomfort
You wouldn't jump into the pool's deep end your first time swimming, and you shouldn't stick a 7-inch dilator up your dry vagina on your first go-around, either. (Ouch.) During your first few trial runs, lube up the dilator and your nether regions, insert the smallest dilator in your set, and leave it in there for a few minutes, says Holland. Once you feel comfortable with the dilator hanging out inside you, try moving it around, using it for roughly seven to 15 minutes per session. If it feels only slightly unpleasant, move up to the next dilator size, then continue to increase sizes based on your tolerance level, suggests Holland. "With dilators, you want it to be uncomfortable, but not horribly painful," she explains.
If you experience no discomfort while using a dilator at all, your body won't learn to tolerate it IRL. And if you start with a dilator that's extremely painful, makes your entire body tense, or even causes you to tear up a bit, you'll only continue to associate that feeling of stretch with pain, says Holland.
Mindfulness is key.
If you want to get the most out of your vaginal dilator, you'll have to press pause on your Netflix show and put down your phone once you insert it. "For people who are having painful sex and are trying to [acclimate] to that feeling of stretch, if you put the dilator in and distract yourself, it's unlikely to do that recalibration between the brain and pelvis," says Holland. "It's better to stay mindful, do some deep breathing exercises, and basically try to down-regulate your sympathetic nervous system to help you accommodate that feeling."
On the flip side, people who are using a dilator after gender-affirming surgery or cancer treatments can feel free to zone out. In those instances, the dilator is working to change the way the vaginal tissue sits at baseline — not to get your mind comfortable with the stretch, she adds.
It takes time to see results.
If you're looking for a quick fix for painful sex, a vaginal dilator isn't it. A person who's been having agonizing sex since their first time might see a positive change within six to eight weeks — if they're using a dilator three to four times a week, says Holland. "Using dilators is not usually a short-term, 'If I just get through these dilators really fast I'll never have to think about them again' situation," she says. A new partner, a long break between penetrative endeavors, and acutely stressful situations can all lead to painful sex and, in some cases, the need to use a dilator again, says Holland. "Normally, most people who use dilators in order to have pain free, penetrative intercourse will need to use the dilators again in their life," she adds.
Those who have a vaginoplasty are looking at a lifetime of dilator use, amounting to three to five times a day every day for the first three months after surgery, then a couple of times a week after that, says Holland. And those who received gynecologic cancer treatment are generally advised to use a dilator two to three times a week for up to 12 months, according to a study published in the International Journal of Gynecological Cancer.
Dilators aren't your only option.
"The thing that comes up most often in my visits is that people feel like dilators are their only option if they're having painful sex," says Holland. "I think what happens is that people have been told by another provider or they read about it and they're like, 'This is how I treat this thing.'" Pelvic wands — hook-shaped tools that offer more leverage to stretch your pelvic floor — can also be beneficial, she says. While a dilator increases your tolerance to stretch overall, a pelvic wand helps to release specific tender points and targets hard-to-reach pelvic floor muscles — such as the obturator internus (a hip muscle that originates deep in the pelvis and connects to the thigh bone) and puborectalis (a U-shaped muscle that's attached to the pubic bone and wraps around the rectum) — in people with chronic pelvic pain, according to the American Society of Colon and Rectal Surgeons.
Some people can also use their vibrators as dual-functioning dilators, too. "If people have vibrators that they like and enjoy, have positive experiences with, and can use them internally, oftentimes I'll suggest people start with that," she says. (FTR, some vaginal dilators do vibrate, but in general, "dilators make really boring sex toys," says Holland.)
Still, there are some instances when a dilator could be the best option. People who have negative opinions about or had bad experiences with vibrators might feel more comfortable with a no-frills, medically recommended dilator, says Holland. Plus, most sex toys aren't available in sizes as small as a tampon or cotton swab. If that's your starting point, you'll probably need to turn to a dilator.
Know you're not the only one experiencing painful sex.
Based on social media, movies, and conversations with friends, you might feel as though you're the only one dealing with aches and pains during penetrative intercourse. But research shows approximately 5 to 17 percent of people have vaginismus (which often causes pain during penetrative intercourse), and a survey of 15,000 sexually active women found that 7.5 percent of respondents experienced painful sex. "It's something I see all the time, and it's also something that people can feel very isolated by," says Holland. "People feel like, 'It's my vulva that's broken, it's my vagina that's broken,' and I think people are having a lot of really unfulfilling, really painful sex that's damaging to their psyche because they feel like it's their only option."
That's why Holland says it's so important to normalize the use of vaginal dilators. "When we start talking about dilators and we start recognizing that there are treatment options for people who are having painful intercourse, [you realize] there are things you can do about it," she explains. "You can be in control of this and there are multiple options, which I think is really empowering for people."