Several tools can be used in perineal and pelvic rehabilitation to help rehabilitate the pelvic floor in sexual health. Among others, there is the use of a dilator, which has proven effective for certain issues.
What is a dilator?
A vaginal dilator is a tubular device made of plastic or medical-grade silicone that stretches vaginal tissue when inserted into the vaginal cavity. It is a treatment option, in conjunction with physical therapy, when it is necessary to stretch and relax vaginal tissues and muscles.
Dilators help increase the suppleness and flexibility of the vaginal cavity to normalize pelvic floor tone and function. These devices can be used alone, in the comfort of your own home, without the assistance of a physical therapist. Several types of dilators exist and vary in size and thickness, depending on the properties of your vaginal cavity and the goals you want to achieve.
What problems is it used for?
Dilators can be used for several issues or following certain surgeries such as:
· Pain on penetration or dyspareunia
· Vaginismus
· Menopause
· Pelvic surgery or radiotherapy
· Vaginal stenosis
· Gender Affirmation Surgery
How to use it?
Recommendations will vary depending on the current issue and the physiotherapist's assessment. Typically, the dilator is recommended to be used every other day.
To date, there is no consensus regarding recommendations for dilator use. Here is an example of a routine that can be used to begin use:
· Lying on your back, hips and knees bent
· Take a few breaths to relax the body and pelvic floor muscles
· Apply lubricant to the entrance of the vaginal cavity and to the dilator
· Begin inserting the dilator slowly, respecting the pain: do not exceed 4-5/10
· Hold for several minutes, as tolerated, without exceeding 10 to 15 minutes in total.
Later, it is possible to progress with clockwork and oscillation movements and add contractions alternating with relaxation. The physiotherapist determines the characteristics of the dilator (size, thickness, etc.) and the exercise prescription (time, repetition, etc.). The use of the dilator is often done in combination with other stretching and muscle relaxation exercises as well as physiotherapy follow-up. It is recommended to use a suitable water-based lubricant when using the dilator. Additionally, a vaginal moisturizer is also recommended, depending on the issue being encountered.
What are the benefits and risks associated with it?
Vaginal dilators can help:
· Reducing pain in cases of dyspareunia
· Increase and/or maintain tissue flexibility and elasticity
· Decrease muscle tone
· Prevent or reduce the tissue effects of genitourinary syndrome of menopause or certain treatments such as radiotherapy or following surgery
Please note that slight light pink bleeding and/or pain may occur for up to 24 hours after use. If symptoms persist for more than 24 hours or become more severe, it is recommended to consult a healthcare professional.
Finally, it is recommended to consult a health professional such as a physiotherapist expert in perineal and pelvic rehabilitation to help you flourish in your sex life!
Anne-Marie Violette
Physiotherapist in perineal and pelvic rehabilitation
Vice-presidency of the Quebec Physiotherapy Association
Owner – Anne-Marie Violette Physiotherapy
annemarieviolette.com
References
· Idama, T. O., & Pring, D. W. (2000). Vaginal dilator therapy-an outpatient gynaecological option in the management of dyspareunia. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, 20(3), 303–305.
· Morin, M., Dumoulin, C., Bergeron, S., Mayrand, M. H., Khalifé, S., Waddell, G., Dubois, M. F., & Provoked vestibulodynia (PVD) Study Group (2016). Randomized clinical trial of multimodal physiotherapy treatment compared to overnight lidocaine ointment in women with provoked vestibulodynia: Design and methods. Contemporary clinical trials, 46, 52–59.
· Miles, K., & Miles, S. (2021). Low Dose, High Frequency Movement Based Dilator Therapy for Dyspareunia: Retrospective Analysis of 26 Cases. Sexual medicine, 9(3), 100344.
· Murina, F., Bernorio, R., & Palmiotto, R. (2008). The use of amielle vaginal trainers as adjuvant in the treatment of vestibulodynia: an observational multicentric study. Medscape journal of medicine, 10(1), 23.
https://www.mskcc.org/cancer-care/patient-education/how-use-vaginal-dilator
https://my.clevelandclinic.org/health/treatments/24971-vaginal-dilators