Let us shed some light on a topic that some people may find uncomfortable when first given the opportunity to begin a dilator program. Do not be intimidated. It is not meant to be a sex toy. Beginning a dilator program is one of the most effective tools pelvic floor physical therapist use to address pelvic floor muscle tension. What is a dilator program? The purpose of the dilator program is to stretch pelvic floor muscles that are tight as well as to train an individual to not associate pain with penetration. It can help women tolerate gynecological exams, tampons, and intercourse. Dilators are cylindrical devices that are tapered off at the end. They come in varying sizes, with the smallest size similar to an index finger. A patient typically goes up to the size similar to their partner’s girth. Some pelvic floor physical therapists may advise patients to go up to a dilator slightly bigger than their partner’s girth. Reason being if a woman can tolerate a dilator bigger than her partner’s girth and length, then intercourse should be a piece of cake, especially since she will ideally be aroused and lubricated during intercourse.
There are cases where women tell their physicians that they are experiencing pain with intercourse and unfortunately, sometimes patients are easily dismissed. They are told it is in their head, they just need more lubrication, or go buy a sex toy. Some women purchase a dilator program but are not given proper instructions on how to use it or how to progress. If used improperly, these women will have a negative experience using it and they will think it does not work.
The key to a dilator program is to go slow and at one’s own pace. Again, a dilator program is used to allow one to disassociate pain with penetration. Thus, if a woman goes too aggressively, pushes too hard, and gets frustrated, her body will reject it. Patients are recommended to use their dilators without pushing it beyond mild pain. A dilator is meant to be used daily for about 10-30 minutes. There are 3 components. The first step is to be able to insert the dilator into the vagina until there is about 2 inches of the dilator outside of the body. If only the very tip of the dilator can be inserted without experiencing more than mild pain, then just stop right there. Hang tight and wait for the pain to dissipate or pain to reduce to mild pain. If the full 10 minutes passes and the pain does not reduce, then that is ok. Try again next time. The next component is to be able to rotate the dilator along the sides of the vaginal muscles to stretch tight and sensitive areas that need to be worked out. If a sensitive area is found, apply some gentle pressure until the pain dissipates or if more than 90 seconds have lapsed. Applying pressure for more than 90 seconds should be avoided due to restricting blood flow. Finally, the last step is to be able to move the dilator in and out to simulate the friction involved in intercourse. Once all 3 steps have been completed and the patient feels mild to no pain while using the dilator, she is ready to move up to the next dilator size. The transition to the next dilator size can range from 1 day to several weeks for some individuals. It does not matter how long it takes to progress, as long as it is within the pace of that individual. DON’T be intimidated. DO ask questions.