Vaginal Dilator Exercises for Psychosexual Therapy

Although these plastic sets are called “vaginal dilators” the name is not ideal, as nothing is being dilated (expanded) when you use them.

Often dilators are recommended for a combination of reasons. They can help retrain the soft tissues in and around the vagina to behave more normally. This may include improving scar tissue after childbirth/surgery/radiotherapy, or to help train the pelvic floor muscles to relax and lengthen as part of a structured program. Dilator use can also help to reduce vulval and vaginal hypersensitivity to touch.

Exercising the pelvic floor is essential to help to improve the strength, flexibility and control of the pelvic floor muscles. For penetration to be pain free, the pelvic floor muscles need to be able to relax fully and lengthen around something in the vagina. Dilators can help you to practice this.

Plastic dilators provide a pathway, allowing you to practice relaxing your pelvic floor muscles around something, increasing in size gradually, under your control.

If the smallest dilator is too big to slip into your vagina, you may need to start with something smaller, such as a cotton bud.

Dilators come in a set of various sizes. The smallest is the size of a slim finger, or a medium to large tampon. The largest is the size of a large erection. It is worth noting that an average erection is about the size of the 4th dilator in a set of 5. Dilators with a tapered end are often easier to use than those with a blunt end.

A plain lubricant is provided with most dilator sets. You will need to use lubricant for all these exercises. You can use any lubricant that you know suits you. Advice on lubricants that don’t contain many of the ingredients that irritate genital skin is available from your doctor, physiotherapist, nurse or psychosexual counsellor.

Sometimes they are available on prescription, or they are easy to order online or from your local chemist.  Dilators are available on prescription from your GP.

The exercises

It is best to practice little and often. 1 minute (building up to 5-10 minutes), 5-6 days per week is best.

Each step is likely to take weeks. The aim is to progress slowly and steadily, being comfortable with each step before moving on. If you go too fast and provoke lots of pain then you are likely to trigger muscle spasm, vaginal tightness and therefore more pain.

If you are unable to progress up the steps after weeks of trying, see your doctor, nurse, physiotherapist or psychosexual therapist. They may refer you on to someone for a more detailed examination and advice.

You will need to set aside some time each day to be relaxed and take your time with this process. Our minds and bodies are linked and if your muscles are to relax you need to feel relaxed and not rushed. How you think and feel about using dilators can affect your experience. Try to approach it with positive, optimistic attitude (even if this doesn’t come automatically). Last thing at night is not ideal,  as it is easy to put it off when you are tired at the very end of the day.

Please remember: the idea is to do what you can without causing pain. You may feel a little discomfort when first starting the exercises.

  • Start with the smallest
  • Prop yourself up semi-reclined on a bed/chair/sofa. Bending your hips and knees a little may
  • To prepare, you could try actively relaxing your pelvic floor muscles using your breathing (see our separate information leaflet – Pelvic Floor Exercises for Psychosexual Therapy).
  • A helpful first step can be to practice resting the tip of the smallest dilator at your vaginal entrance and using your breathing to keep your pelvic floor This will help you to overcome the reflex you may have developed, where your pelvic floor tenses up at the prospect of something entering your vagina.
  • When you think your pelvic floor is relaxed, take your time to gently slip the smallest dilator (covered in lubricant) into your vagina. Most vaginas slope up and backwards towards your tailbone. It may help to focus on your breathing, to reduce any physical and mental tension. The dilator doesn’t necessarily have to be fully
  • Leave the dilator in place for 1 to 10 minutes, keeping your pelvic floor You will be able to increase the length of time gradually with practice. If you stop noticing that the dilator is in there this is great– you are really relaxed! Repeat daily until comfortable.
  • When using the dilators, try not to get too caught up with thoughts or focused on emotions. Instead, bring your attention to your physical sensations as you use the dilators, or to the sensations of your breath in your body.
  • When ready, try the next size up from the one you are using. You may find it helpful to try 1 minute of the size that you are comfortable with before using the larger size immediately after. Continue in this way until it is possible to insert the larger size straight into your vagina.
  • Gradually increase the size of dilator you are using, remembering you should be comfortable with a given size for up to 10 minutes, feeling the muscles are fully relaxed around it, before you move on to the next.  If these exercises cause bleeding, or if you have difficult thoughts or feelings about using the dilators, which you feel are getting in the way, please discuss this with your doctor, physiotherapist, nurse or psychosexual counsellor.

Cleaning the dilators

Dilators should be washed in hot soapy water and rinsed thoroughly after each use. They do not need to be sterilized. They can be stored in the case provided.

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