Correct Use of Vaginal Dilators FOR VAGINISMUS:
Before one embarks on a dilation program it is important to assess the severity of vaginismus. Women who have severe vaginismus are often unable use dilators because of fear and anxiety and should first seek medical help. I have had far too many patients who ordered dilators but never even opened the box. This article is meant for women who have had some experience with penetration such as tampons but are unable to progress to pain free intercourse and need guidance using vaginal dilators.
Most women who have vaginismus tend to use their vaginal dilators incorrectly. The usual error is not enough dilation time. Women get tired of using vaginal dilators and this seems to be the primary reason for the lack of compliance and therefore the inability to make progress.
Step-by-step approach for the improved use of dilators FOR VAGINISMUS
Vaginal Dilator Techniques used in the treatment of Vaginismus:
- Apply lubrication to the entrance of the vagina, lube the dilator and start with a small dilator, one that is comfortable to use. If you are using silicone dilators do not use silicone lube or oils as this will alter the structure of the dilators. Just use a water based lube. Any lube can be used with Pacik Glass Dilators.
- Start with a series of 5 Kegels (squeezing the pelvic floor). First do a series of “flickers” (soft Kegels) and do this about 5 times. Then follow this with a strong pelvic squeeze for about 10 seconds, hold and completely release to let the pelvic floor fully relax. Each time advance the dilator a small amount. Use lots of lube. DO NOT BE IN A HURRY. This process can take 30 minutes or longer. Do not be impatient.
- During the first month continue progressing to larger dilators as comfortable. Try to leave the dilator in place for a MINIMUM of 30 minutes though even 5 minutes is helpful if you are new to this. If burning or pain results use the dilator for a shorter period of time or back down to a smaller dilator. Each woman is different. After a few days try advancing to the next larger dilator after a comfortable dilator has been in place for about 5-15 minutes. The goal is to advance to the #5 or 6 dilator as this size is needed for comfortable intercourse in most women. It is effective if you dilate for about 2 hours a day, preferably divided between the morning and evening. For those who need to get to work just dilate in the evening and dilate in the AM and PM on weekends. Record your dilation progress in a log. This is important so that you can see your progress.
- Avoid using a large dilator as the first dilator because the vagina needs to be prepared for penetration by using a finger or small dilator first.
- During the first month sleep with a medium #4 dilator every 2 days. Wear a tight pair of panties, boy shorts or bicycle shorts to help keep the dilator in place. Most patients are more comfortable sleeping with the # 4 of 6 dilator even if you have advanced to the # 5 dilator during the day. If the dilator falls out during the night this is no major problem. The dilator will have been doing its work for several hours which is beneficial. The # 5 dilator is somewhat large for sleeping and may be uncomfortable though some women use this size with no adverse effects.
Shown: Pacik glass dilators sizes 4-6. The Pacik glass dilators are available in sizes 3-8, all are 3 1/2 inches in length and have a comfortable fit against the vulva. (see ordering information below). CAUTION: When washing glass dilators always place a towel in the sink in case the dilator drops. When the borosilicate glass hits the ceramic sink it can break. There appear to have been no instances of breakage in the vagina.
The Pure Romance dilators are made of silicone. Sizes 5 and 6 are made too long and usually protrude beyond the vaginal opening which restricts mobility. The Pacik borosilicate glass dilators are all 3.5 inches in length and can be ordered in Sizes 3 through 8 or a set of sizes 4, 5 and 6.
- Remember: GOOD HYGIENE. If you wash your hands and the dilators each time they will be clean enough for insertion. Toxic shock syndrome is not a problem because the dilators are nonporous. Women who have had problems (toxic shock syndrome) are those that have left high absorbency blood soaked tampons in for days. An overnight clean dilator is not a problem because it is nonporous.
- Use a comfortable dilator for about one week and then advance to the next larger size using the same instructions noted above. Again use lots of lube. Alternate between the medium #4 and the next size up until the larger dilator becomes comfortable and can be retrained for a longer period of time. If this causes mild burning or discomfort return to a smaller size and use Tylenol or ibuprofen 20-30 minutes before dilating. Continue sleeping with the dilator as noted above for about 1-2 months. If the vagina or vulva get irritated use over the counter 1% hydrocortisone cream or ointment 2-3 times a day.
- Each time you can expect to spend a few days to a week working between the sizes until the larger size becomes comfortable and can be used for a longer period of time. Always start with a smaller dilator or finger to start the natural vaginal dilation process. Avoid starting the dilation process with one of the larger dilators as the vagina needs to be prepared to accommodate a larger object. Think of the dilation process as physical therapy for the vagina. This takes time and effort. It is similar to physical therapy for an arm that has been casted. The arm is stiff when the cast is first removed and takes months before you have comfortable range of motion. You must do the work and devote the time if you want to get better. It is easy to fall off and postpone the dilation to another day. By being conscientious you will move more quickly to satisfactory dilation and achieving intercourse. You should try to advance to the next larger size every week. Intercourse is not an adequate substitute for dilation, and you must continue dilating until you achieve pain free intercourse on a regular basis which usually takes about a year. (I noted a higher rate of regression when my patients stopped dilating at the 6-month interval after treatment.)
- After dilating for about one month you will be approaching the use of the largest dilator for a longer period of time.
- By the second month you will be able to reduce the amount of dilation time to about one hour a day. By this time, you should no longer need to sleep with the #4 medium dilator.
- After about 3-6 months it is possible to reduce dilation to 15-30 minutes. As noted, it is important to do some dilation for about one year even if only 15-30 minutes a few times a week. For those who have become comfortable with intercourse some dilation is still needed to prevent regression because intercourse is not a substitute for dilation. If regression is noted simply get on an increased dilation schedule. The dilators are your road to freedom and pain free penetration.
- The transition from dilation to intercourse is a concern for many women because of the fear of intercourse. Once you are able to dilate comfortably to the larger sizes this becomes less of a problem.
Resuming Dilation after Menses:
- Resuming dilation is actually easy if one starts with a smaller dilator than the one used before the menses started. Use Kegel exercises as described above before beginning. Start the dilation process using a finger or two. Find a dilator that is comfortable to insert, leave this in for 30-60 minutes, and once again do this 2 times a day. Sleep with a comfortable dilator, and over the next 2-3 days begin advancing to the larger size as you did before your period started. This will allow you to resume the dilation that you accomplished before starting your period.
- It is safe to continue dilating during menses. Even 5 minutes is better than 0 minutes during times when the flow slows.