Any women who enters my exam room can’t help but notice the colorful box of penis shaped articles that sit on my counter next to my lubricant warmer and mirror. It is the first clue that this visit is going to be different than their usual gynecologic exam.
Graduated vaginal dilators are used to evaluate vaginal size and elasticity and also as a therapeutic tool for women who are unable to have intercourse because of tight, tense pelvic floor muscles, vaginal shrinkage due to menopause, radiation therapy, chemotherapy and/or surgery. Often, vaginal dilator therapy is a part of pelvic floor physical therapy.
Vaginal dilators have two purposes. One is to get the vagina used to having something inside of it. Even if the size of your vagina is normal, painful sex initiates a cycle of pain–fear–muscle spasm–more pain that results in the vagina constricting at any attempt to have intercourse. Dilators are often needed after the initial cause of the pain has been eliminated to erase muscle memory that has kept your pelvic floor in protective mode. By starting small and then increasing gradually to whatever penis size is in your life, the vaginal tissues and pelvic floor muscles “learn” to accommodate having something inside without a pain response being triggered. That way, when you have sex with an actual penis, your pelvis won’t panic.
A vaginal dilator is also a way to gently and gradually stretch tissues that are tight and have lost their elasticity, which is often the case if a woman has vaginal dryness and thinning from hormonal changes, skin conditions (such as lichen sclerosis) or her vagina has been altered by radiation or surgery. Scarring and shrinkage of the vaginal opening is almost always reversible! The other important advantage to using a dilator is that you will know when you are ready for intercourse.
Where Do You Get Vaginal Dilators?
Medical dilators in graduated sizes can be ordered through a number of sources. My go to for medical grade, consumer friendly, color coded vaginal dilators is Soul Source. Graduated dilators can be purchased individually, but generally come in sets ranging from 1/2 inch to 1-5/8 inches in diameter. I know what you are thinking.
Just what is the diameter of an “average” erect penis?
The average diameter of an erect penis is 1.5 inches (3.8 centimeters), so if you can get the 1-5/8 inch dilator in comfortably, you are good to go. If you want to know the diameter of your partner’s penis, use a piece of string or ribbon to take a measurement. (I will leave you to come up with the creative reason as to why you are putting a ribbon around his erect penis.)
Tell him his result in centimeters, not inches, since that always sounds much bigger.
No matter what the measurement, look impressed. Never use the word “average” when announcing a man’s penis diameter.
“Alternative” Dilators
While it’s tempting to use phallic-shaped items from your kitchen (celery, zucchini, banana, cucumber) or candles (birthday, Hanukkah, tapers, pillars), I don’t recommend it. Ask any ER doc who has removed one of those objects from a mortifed patient or treated bleeding from vaginal scratches. If you must, put a condom over it in case of breakage!
Once you own a dilator, what do you do with it?
Once you get the go-ahead, here’s what to do:
Step 1: Start with a warm bath (to relax you and your pelvic floor muscles) and make sure you have at least 15 minutes of privacy. Putting a dildo in your vagina if your teenage son is about to burst into your room is not going to work.
Step 2: Lie in bed on your back with your knees bent and slightly apart. Be comfortable! Use pillows to support your head and back.
Step 3: Apply a generous amount of lubrication to the opening of your vagina and to the tip of the smallest dilator. If your dilator is silicone, be sure to use a water-based lubricant.
Step 4: Bear down slightly and gently slide the dilator in as far as it will comfortably go.
Step 5: If there is no pain or resistance, continue to sequentially insert larger dilators. The dilator that should be used to initiate your therapy is the dilator that does not cause pain with insertion but does create some resistance or slight discomfort when you insert it. Don’t push it. This is not the gym, and you don’t need to use the heaviest weight. You will get there eventually.
Step 6: Once you get to the size that causes some resistance, leave it in place for 5 to 15 minutes. Concentrate on letting your vaginal tissues relax around it. Your buttocks and thighs should be relaxed as well. Don’t forget to breathe. A little Mozart is not a bad idea.
Step 7: Repeat steps 1 through 6 on a daily basis, if possible. Don’t panic, however, if you miss a day.
Step 8: When you are at the point where the dilator you’re using slides in without resistance or discomfort, it is time to go up to the next size. This can takes days...or weeks.
Step 9: When you are ready to go up to the next size, always use the smaller dilator to start your session for at least a few days before you insert the next size.
Wash your dilators with antibacterial soap and water and dry them well before you put them away.
Store your dilators in a box labeled 2012 tax returns so your teenage daughter will not find them when she is raiding your drawers to borrow some tights.
When first using a dilator, a little spotting is not unusual, but you should never experience severe pain or heavy bleeding. If you do, or if you are unable to comfortably insert a dilator, see your doctor before proceeding.
Sometimes it is necessary to coat the dilator with local anesthetic jelly (you will need a prescription for this). In other cases, a muscle relaxant is useful. (Valium for your vagina!)
In general, once you can comfortably put something in your vagina that is slightly larger than your partner’s penis, you are ready for the real thing.
About Lauren Streicher, MD: Dr. Streicher is Clinical Professor of Obstetrics and Gynecology at Northwestern University’s Feinberg School of Medicine. Dr. Streicher is also Founder and Medical Director of the Northwestern Medicine Center for Sexual Medicine and Menopause, which include programs for menopause, sexual medicine, women’s bone health, and vulvar and vaginal Health. For more information, visit DrStreicher.com.