Vaginal dilators and dilation

A vaginal dilator is a device used to stretch the vaginal mucosa in cases whereby the vagina is small or constricted, either due to the impacts of cancer treatments, surgery, or an anatomical abnormality.

Vaginal dilators are also sometimes used as part of sex therapy, vaginismus^​1​ and lichen sclerosus.

What is a vaginal dilator?

A vaginal dilator is a cylindrical device made of plastic, latex or other medical-grade material used vaginally to open the vaginal canal. Dilators tend to come in sets (but can be bought individually), with the process typically starting from very small to as large as a big erect penis. The size is increased over time.

Some dilators can vibrate, warm up or be cooled before use.

Why are vaginal dilators used?

The main goal for patients is to allow penetrative intercourse and reduce pain during sex. During dilation, you can watch TV, listen to a podcast, read a book, meditate or listen to music.

Studies show that those who listen to soothing music or meditate tended to having better results when dilation was used for more than three months^​2​.

Evidence for using a vaginal dilator

Vaginal dilators have been used for several decades now; however, research that definitively proves their effectiveness is scant. A Cochrane review stated there is no reliable high-level evidence to show that regular vaginal dilating practices prevent radiation-induced vaginal stenosis. 

There is, however, plenty of observational evidence to suggest that use of dilators is associated with lower rates of self-reported vaginal stenosis. Using dilators during radiation is not recommended, since it could be harmful. More clinical trials are needed.

Clinical advice for using your vaginal dilator

Vaginal dilators are used in many ways, and there is no set, uniform approach used clinically. Advice for when and how to use dilators is highly variable. There is no one method for size, insertion technique, and usefulness in sexually active people. Treatment modality may also change the recommendation.

A Delphi consensus recently concluded that the oncologist should give information about vaginal dilators before cancer treatment starts. A nurse provides instructions at the relevant time, offering psychological and practical care ongoing.

The panel suggested that the dilator should start four weeks post-treatment, 2-3 times per week for 1-3 minutes, continuing for 9-12 months. Plastic dilator sets were deemed the most appropriate devices.

The dilator probably works by increasing blood flow to the vaginal tissue, which in turn keeps the cells more functional, and more blood vessels developing. The more blood in your tissue, the better off your vagina is.

Why use a vaginal dilator?

The vagina needs to stay open, even if you don’t intend on having penetrative sex or masturbating, because it is the only access to your cervix.

You need to be at least examined by a medical professional without undue pain or discomfort, but being able to have (or at least have the option of) penetrative sex is a meaningful idea for most people.

Using a vaginal dilator after radiation therapy

Radiation therapy is either external beam or brachytherapy inside the vagina. Most of the time, a dilator will be provided near the end of the treatment, though when the best time to use dilators is variable depending on your doctor. ^​3​

In the first instance, the dilator stops the damaged vaginal walls from sticking together and scarring the vagina closed while the vaginal tissue heals.

The radiation treatment itself causes damage to the vaginal walls, and scars are formed during healing. Vaginal dilators or penetrative sex 2-3 times per week can help the vagina stay as big as it used to be, though most people don’t properly use dilators or have sex after these cancer treatments.^​4​

Using a vaginal dilator after vaginal reconstructions

‘New’ vaginas are vaginas that have been reconstructed or altered out of remaining vaginal tissue or other tissue like intestine. A vaginal dilator will likely need to be used to stretch the tissue out so the neovagina is as normal as possible in function and feel, which means it should be able to fit an erect penis.

These vaginal dilators may be used during the night and a few hours in the day as the neovagina heals, particularly if skin grafts are used. Usually, neovaginas built from the intestine or skin and muscle flaps do not require dilators. Neovaginas have their own type of microbiome.

These types of vaginal reconstructions may be necessary in several circumstances, for example, if a child is born without a vagina or a full vagina, if there is disease where surgery to remove part or all of the vagina was necessary, and where a trans woman or non-binary person with a neovagina wishes to have penetrative sex.

Using a vaginal dilator for vaginal size maintenance

A vaginal dilator may be used postmenopause as required for keeping the vagina open in cases of severe atrophic vaginitis and in cases where oestrogen-blocking drugs are being taken for breast cancer.

Using a vaginal dilator for treating penetration anxiety

Some people are deeply afraid of vaginal penetration of any kind. This can result in the vaginal muscles being too tight to let anything in (vaginismus) or pelvic floor muscle tension pain (myalgia) and spasm. A vaginal dilator is used in conjunction with muscle-relaxing practices.

Using a vaginal dilator for vaginal graft versus host disease

A vaginal dilator is used to keep the vagina from shrinking, but the jury is out on whether it keeps the vaginal walls elastic.

Using a vaginal dilator for lichenoid conditions of the vulva and vagina

Lichenoid conditions may cause the vulva to close over, so treatments using a vaginal dilator may be appropriate.

Vibrator or dilator?

There has been some discussion regarding which is better: a vibrator or a dilator. Vibrators may have added benefits, including promoting arousal, which brings far more blood to the area than a mere dilator could ever hope to do. This means the benefits are more significant.

Some of the pitfalls of using a vibrator include not becoming as aware of anatomy (pelvic floor relaxation and tension on command), and the expensive of buying multiple sizes of vibrators as you graduate.

Vibrations are not necessarily going to be pleasurable for everyone, either. The important thing is that your treatments are comfortable and – dare we say – enjoyable, otherwise compliance is a massive issue.

Use what you feel comfortable with that gets the job done.

Using a vaginal dilator correctly

A large number of those who are given vaginal dilators don’t use them or don’t use them correctly or enough. This is a significant problem since scarring waits for no one.

The lack of use of a vaginal dilator appears to be multifactorial: some people aren’t used to putting things in their vaginas, it can cause anxiety, and it might be seen as unhygienic or gross.^​5,6​ The other uncomfortable truth is that using a vaginal dilator can be painful.

To start using a vaginal dilator, familiarising yourself with your vulva and vagina will be an important step. Looking at what you’re doing while you’re doing it can help – tensing and relaxing the vagina, and seeing what your body looks like. The use of a good-quality lubricant is also extremely important.

First, insert the smallest dilator and hold it in for a few seconds, then hold it in for a few minutes. Once that’s achieved, you can move the dilator around a little. Once those actions are comfortable, you are ready to move on to the next vaginal dilator size.

Tips on using your vaginal dilator

• Start small
• Use plenty of lubricant – water-based, a vaginal moisturiser, or coconut oil
• Be gentle – your vaginal tissue needs tender loving care
• Practice pelvic floor exercises – tense and relax, tense and hold, then relax, and repeat (or follow instructions from your pelvic physiotherapist)
• Masturbating or sex is way more effective than a dilator in terms of blood flow
• Scar tissue may need special consideration, so ask for help from your pelvic physiotherapist to avoid injury
• Make sure you have a good pelvic physiotherapist
• Listen to relaxing music or meditate
• Stick to your dilation schedule – it can’t work if you don’t do it!

If you have any of these symptoms while using a vaginal dilator, seek immediate medical help:

• Heavy vaginal bleeding
• Abdominal pain
• Pain on urination
• Frequent urination
• Blood in the urine
• Blood in stools

References^​7​

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