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Using pelvic dilators without a passive approach

Pelvic dilators are often recommended for individuals who experience vaginismus, where the muscles of the pelvic floor reflexively contract in anticipation of penetration. They can be helpful to prepare for using a tampon, an OBGYN exam, and for sexual pleasure. Traditionally dilator use was passive and involved inserting a dilator for 15-20minutes daily and reading a book. However, making the use of dilators more active can help to better prepare for future goals.

Rather than thinking about the dilators stretching tissue, they’re really decreasing the sensitivity to stretch and help to promote lengthening of the pelvic floor muscles. They also help to train the brain to not perceive penetration as dangerous since they are a non-painful stimulus.

Here are three ways to make dilator use more active.

  1. Focus on breathing – use a relaxed breath, where the lower belly moves, gently without over pushing out or forcing it, and passively let the air leave the lungs. This breathing helps to lengthen the pelvic floor muscles.
  2. Provide a gentle stretch – use the dilators to apply a gentle stretch in different directions, you can think about the opening of the vagina as a clock and applying a gentle, pain free, stretch at each number on the clock while using a relaxed breathing technique.
  3. Move into different positions – try moving to a standing position, squatting, or on hands and knees and see what if there is a change in sensation. Continue with stretching techniques in this position as tolerated.

Dilators should not provoke pain, if discomfort exceeds a 3/10 pause and try to use breathing techniques to lengthen your pelvic floor muscles. Frequency of dilator use depends on each individual, some find it helpful to use them daily, while others prefer to have a day between. The key to success is finding what works for you, at a time where you can fully relax in your environment.

If you’re having pain with tampons, OBGYN exams, or penetrative vaginal intercourse, coming in to Rose Physical Therapy for pelvic floor PT in order to help your get started with pelvic floor lengthening and dilator use.