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Sex Matters: Vaginal Dilators

By on September 3rd, 2014 Categories: Sex Matters

Let’s continue to build on what we’ve already discussed in previous columns with vaginal dryness, moisturizers, and lubricants. As we discussed, vaginal atrophy (thinning and dryness of the vaginal tissues) happens when estrogen levels drop during and after menopause, or as a result of cancer treatment that interferes with estrogen levels.

For some women, vaginal dryness and pain go hand in hand. Some women experience burning at the vaginal opening and pain on penetration. Some feel that the tissues have gotten tight (vaginal shortening or narrowing) and less elastic. Vaginal dilators maybe helpful for women who have vaginal dryness and sexual pain during intercourse.

But what is a vaginal dilator?

Vaginal dilators are graded-sized vaginal inserts usually made of plastic or silicone. Dilators are often used to help lengthen and widen the vagina and its opening. They can also be used to help stretch any vaginal scar tissue that may have contributed to pain and discomfort during vaginal intercourse. Scarring may be caused by pelvic surgery, radiation, or even trauma and injury. Dilators may be prescribed as part of a sexual health rehabilitation program. If you’re having trouble with pain, tightness, or other atrophy symptoms after treatment, ask your cancer team if they offer a sexuality program, or call the American Cancer Society (1-800-227-2345) to find specialists in your area.

Dilators can be used on a regular basis, and they can be used with water- and silicone-based lubricants. Your practitioner will suggest a schedule for you, such as once daily for 10 to 15 minutes or at least 3 times weekly. Several studies report that ongoing supportive behavioral therapy with a specialist in the sexuality field is helpful for being able to stay with the dilator schedule and keep moving towards pain-free sex.

You can buy dilators through a sexuality specialist or from online companies. Dilators come in a variety of colors, shapes, sizes, and brands. Soul Source Dilators is a brand featuring a variety of soft dilators in different colors. Berman Dilators is another, less expensive brand of dilators made of pink hard plastic. These feature a vibrate option; some health care professionals believe that vibration helps blood flow and lubrication, although as of now, there’s no scientific data to prove this.

Dilators maybe useful for a variety of women:

  • women who have vaginal dryness and painful intercourse
  • women who’ve undergone pelvic surgery
  • women who have vaginal shortening or vaginal narrowing
  • women who have scar tissue that interferes with or prevents penetration and causes vaginal pain

How do you use a vaginal dilator?

Using a vaginal dilator can help expand the vagina and help stretch any hardened tissue of the vaginal wall that may have been caused by cancer treatment or menopause.

Many clinicians advise women to use their dilators in the morning hours just before starting of their day for several reasons. At the end of a long, busy day with work, family, and social obligations, many women feel that it’s too time-consuming to do dilator therapy. Too often, fatigue and rest supersede and prevent sexual rehabilitation. Another good reason I prefer to recommend to women that they do dilator therapy in the morning is that after completion, they can jump in the shower to wash off any lubricant.

First, prepare yourself and your environment:

  • Be sure you have privacy by either locking your door or working with your dilator when you will not be interrupted.
  • Turn off your cell phone and computer and prepare a safe, comfortable space where you will be relaxed.
  • Get a favorite book or turn on a TV show you like for the 10 to 15 minutes you’ll be lying down with the dilator in place.

Now you’re ready to use your dilator:

  • Apply a generous amount of lubricant applied to the tip of your dilator.
  • Lie on your back, bend your knees, and spread your knees apart.
  • With gentle pressure, insert the vaginal dilator into the vagina as deeply as possible while still maintaining some comfort.
  • Leave the dilator in place for 10 to 15 minutes while continuing to lie on your back.
  • While the dilator is in place, it’s often helpful to be distracted by other activities, such as reading a book or watching television.
  • Once the dilator is inside the vagina and is comfortable and pain-free, gently move the dilator in and out, simulating the motion of intercourse.
  • After removing the dilator, it’s important to wash it with soap and warm water, dry it with a clean towel, and store it in a safe, secure place.

It’s best to stick with one size for awhile, and know that progress is often slow and steady. Only move to the next size of dilator once the smaller size is pain-free and comfortable. Of course, frequent visits to your healthcare professional are always encouraged and important.

Next month, we’ll discuss some special considerations including genital pelvic floor physical therapy and the use of special medications within the vagina when muscle spasms maybe present. Stay tuned for some more exciting topics, including vaginally administered, minimally absorbed local estrogen products and a comprehensive discussion about sexual desire.

Michael L. Krychman, M.D.C.M., is the executive director of the Southern California Center for Sexual Health and Survivorship Medicine in Newport Beach, California. He is the former co-director of the Sexual Medicine and Rehabilitation Program at Memorial Sloan-Kettering Cancer. Dr. Krychman is also an American Association of Sexuality Educators, Counselors and Therapists (AASECT) certified sexual counselor. He is an associate clinical professor at the University of California, Irvine, Division of Gynecological Oncology, and the medical director of Ann’s Clinic, a high-risk program for breast and ovarian cancer survivors. His special interests include menopausal health, hormone therapy, sexual pain disorders, loss of libido, and chronic medical illness and its impact on female sexual function as well as breast cancer sexuality. Dr. Krychman is also a member of the Breastcancer.org Professional Advisory Board.

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