Vaginismus Treatment: Moving from dilators to intercourse

It is common for women to advance well with their dilators yet have considerable fear advancing to intercourse. Arousal and reduced anxiety are needed to help make this transition successful. 

  • Women and men often have reduced libido because of vaginismus. Therefore, it is important to set the stage. It could be candles, wine, soft lighting, music, hugging, kissing, taking a shower or bath together. Plan a date night. Have fun. Go out for a bite to eat, have a glass of wine. Enjoy one of your favorite activities together. Women with vaginismus are afraid because of their past fears that intercourse will cause pain resulting in another failure.  The difference is that now you have successfully dilated which in of itself is monumental.
  • Dilate for about one hour with the largest dilator (#6 ) or the next smaller one (#5) before attempting intercourse depending on the size of your partner. One day you will no longer need to do this.
  • Have your husband or mate use the dilator as a “toy”. Spend time with clitoral and nipple stimulation and become acquainted with your erogenous zones. Only 30 % of women achieve orgasm with vaginal penetration, so the other areas should not be neglected. Finger play is very helpful to start the natural vaginal dilation process.
  • A first time failed attempt should not discourage you, just try again at a later time.
  • Use a vibrating dildo as foreplay. It is completely normal not to be too turned on during the initial attempts, this will come later. For now, you will be happy to be functional. The fun will arrive later as you learn to enjoy and relax with this new experience.
  • “MINIMAL PENETRATION INTERCOURSE, NO THRUSTING” is essential with the first few attempts of intercourse to avoid regressing into major fear and withdrawal. This means TIP ONLY, NO MOVEMENT so that the vagina can slowly stretch around the tip of the penis. After a few times experiment with slightly more penetration and do this slowly until you become comfortable. If you would like to practice with thrusting, try this gently by "thrusting" the dilator. Having your partner help with the dilation is a good way to give up some of the control that women with vaginismus have to avoid being hurt.
  • For women who want to maintain control, the woman on top position is effective. In this way you will be able to have control over the amount of penetration. The missionary position is favored by some of my patients again starting with minimal penetration. Pillows under the buttocks help raise the pelvis. Relaxation of the pelvic floor can be achieved using the spooning position or face down with 2-3 pillows under the pelvis and vaginal entry from behind. This also helps overcome "leg lock" in which the thighs close involuntarily. 
  • If you are using a topical anesthetic have your partner wear a condom. Otherwise he may have difficulty because of delayed ejaculation.
  • Progress according to your comfort. The woman needs to control and communicate her level of comfort, and your partner needs to agree to this ahead of time. Some of my patients “fail” the first time. Don’t worry about this.

By now you have made major gains with the dilators and it is only a matter of time until you become comfortable. By being systematic with the dilation process and then transitioning to intercourse, you will be able to overcome the long struggles of vaginismus. Keeping a daily dilation log will allow you to understand your progress and keep you accountable with the dilation program.