A vaginal dilator — also known as a spacer, trainer or accommodator — is a medical rehabilitation tool. It is designed to improve or maintain vaginal tissue pliability (how well the skin inside your vagina moves when pressure is applied) and space within the vaginal canal. There are a few different reasons the vaginal canal might need some help with tissue pliability and/or spacing.

Sometimes, the issues are with the actual skin cells that line the vaginal walls. Certain conditions can cause that skin to be dry, sensitive, or tight.

Other times, the problem isn’t with the skin, but the muscles beneath the skin. These muscles are called your pelvic floor muscles. The pelvic floor muscles can become tense, or “tight”, in response to different things like a history of trauma, injury, or other conditions such as vaginismus.

Using a dilator helps some people learn to relax the pelvic floor muscles more easily. These muscles can tense up with vaginal medical exams, procedures or sexual activity, and require help to release.

Dilators are also useful in mobilizing scar tissue created after surgeries, and maintaining new space in situations such as a vaginoplasty.

As we will see in today’s blog, dilators are an important tool used for many different people as both a medical and therapeutic intervention. Dilators can be helpful for conditions of several types. Keep reading to learn more about the different types of people who vaginal dilators are appropriate for, and to find out if you’re one of them.

Who are Vaginal Dilators Appropriate For?

There are four main types of people who respond to vaginal dilator therapy. They include those with:

Anatomical differences
Pain and/or restricted sexual activity
Chronic pelvic pain
Vaginismus

Let’s learn more about each category and how people in each may respond to dilator therapy.

Vaginal Dilators for Anatomical Differences

Vaginal dilators are commonly prescribed by healthcare professionals for people with medical conditions or treatments that have created anatomical differences within the pelvis. This includes:

Congenital conditions such as Mullerian Agenesis or Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome
The post-surgical pelvis (hysterectomy, prolapse repair, or gender affirmation surgery)
Changes caused by medical treatments such as pelvic radiation and Graft-versus-Host Disease (GvHD)
Breast cancer patients after cancer treatments and surgically induced menopause
Genitourinary Syndrome of Menopause (GSM) is also called vulvovaginal atrophy (VVA) which occurs with estrogen deficiency.

If you’re someone in this group, dilators may be helpful for you because they can assist in maintaining or restoring vaginal elasticity and function. They are often recommended to help prevent or alleviate issues like vaginal stenosis, scarring, discomfort, or pain that can arise from these medical conditions or treatments. While some people are born with anatomical changes, others are affected by conditions which make the vagina painful or even impossible to have vaginal sexual activity..

Vaginal Dilators for Painful or Restricted Sexual Activity

As many as 75% of women may experience pain during sex in their life. Vaginal dilators are also used for people who have pain with sexual intercourse, or who are unable to have sex due to vaginal restrictions. This category includes, but is not limited to:

Vulvodynia
Vestibulodynia
Lichens sclerosis
Interstitial cystitis
Perineal tears/episiotomy
Painful bladder syndrome
Pelvic pain after childbirth

If you’re someone in this group, dilators may be helpful for you because they can aid in gradually stretching and relaxing the pelvic floor muscles and tissues, reducing discomfort and improving sexual function. By gently expanding the vaginal canal and modifying your nervous system’s response to penetration, dilators can assist in desensitizing sensitive areas and promoting healing. Pelvic pain can be short term and limited to sex, but for some people, dilators come into play after years of dealing with chronic pelvic pain.

Vaginal Dilators for Chronic Pelvic Pain

Some individuals suffer with the persistent burden of chronic pelvic pain, a condition that can significantly impact their daily lives. For these individuals, the use of vaginal dilators can bring about profound and life-altering changes.

Chronic pelvic pain often manifests with a variety of symptoms, including discomfort in the pelvic girdle, encompassing areas like the sacroiliac joint, coccyx, and/or the pubic region. These symptoms may also coincide with bladder and bowel issues, such as urinary incontinence or the inability to control the passing of gas. In such cases, vaginal dilators can serve as a valuable component of a holistic approach to address the underlying causes of pelvic pain.

A couple of the primary objectives of incorporating vaginal dilators into the treatment plan for chronic pelvic pain are to enhance the function of the pelvic floor muscles and to down-regulate input from the nervous system. This therapeutic process aims to alleviate the pain and discomfort experienced in the pelvic region, ultimately enabling individuals to regain control over their daily lives and improve their overall well-being. Another group of people with chronic issues that may greatly benefit from dilator treatment include those with vaginismus.

Vaginal Dilators for Vaginismus

A fourth group includes those who have not been able to have a pelvic gynecological exam or procedure, wear a tampon during their menses, or be sexually active with vaginal penetration despite desire and multiple attempts. This condition is often called vaginismus.

With vaginismus you need to learn to control muscle and thought responses while focusing on insertion techniques. Mindfulness and breathing strategies have been shown to be extremely helpful for individuals struggling to regain control of their pain. It is also important to understand the neuroscience of pain, fear and anxiety. To read more about mindfulness and dilator therapy, check out this article about Dilator Use and Mindfulness.

So, Are Vaginal Dilators For You?

In conclusion, vaginal dilators are versatile tools that offer hope and relief to a diverse range of individuals facing various challenges related to their pelvic health. Whether you fall into the category of those with anatomical changes, experience pain or restricted sexual activity, battle chronic pelvic pain, or confront the complex condition of vaginismus, dilators can play a pivotal role in your journey toward improved well-being and comfort.

It’s important to remember that finding the right approach to address these concerns often involves a holistic strategy that may include the use of vaginal dilators. If you resonate with any of the groups mentioned in this blog, exploring dilator therapy under the guidance of a healthcare professional can be a promising step toward regaining control over your pelvic health.

Knowing which dilator to use and having clear directions on how to use it supports the process of recovery. With the support of a pelvic health therapist, you can move from being embarrassed, confused and discouraged to confident, inspired and empowered. While timelines for treatment vary, many reach their goal of pain-free vaginal sexual activity (or whatever your personal goal may be, even if it’s not sex).

Pelvic health therapists trained in sexuality concerns are ideal health care providers to work with during dilator introduction and progression. They have the expertise and time to evaluate and treat the pelvic girdle and vulvar regions, as well as the pelvic floor muscles. For directories of practitioners, see my free resource, Find a Pelvic Health Therapist.

For those eager to delve deeper into the world of vaginal dilators and their therapeutic potential, I invite you to explore my recently updated free educational handout, Types of Vaginal Dilators. This comprehensive list will give you several different types, sizes, and features of dilators and I break the types down into easy-to-digest groups. The chart helps you know exactly what to look for when searching through the sea of dilators online.

With the right support and resources, you can transition from uncertainty to confidence, and from discomfort to a more fulfilling, pain-free life.

For Clinicians:

If you’re a clinician looking for more information for your patients and clients, check out my Vaginal Dilator Kit: The Clinician’s Four-Part Guide. This comprehensive guide is designed to provide clinicians valuable insights and strategies for harnessing the power of dilator therapy in promoting pelvic health with specific vaginal dilator techniques.