Vaginal Dilators - An Overview

Introduction

Vaginal dilators are frequently prescribed to promote an adaptive brain-body connection to reduce anxiety and pain encountered in anticipation of sexual intercourse among women with sexual pain syndromes. Postmenopausal women, cancer survivors, and women with pelvic floor disorders who experience genito-pelvic pain or penetration disorder are often advised to include vaginal dilators in their pelvic floor rehabilitation program and treatment regimens to facilitate penetrative intercourse with less pain.

What Is Vaginal Dilator Therapy?

The concept of vaginal dilator therapy lies in behavior modification and a gradual exposure technique. Vaginal dilator therapy uses non-threatening or painless exposures for women who classically experience pain with vaginal penetration using neurophysiology principles. Such programs often required the affected women to attend therapy for an average of one to two weekly visits for eight to twelve weeks.

What Is the Function of Vaginal Dilators?

Vaginal dilator therapy is used to raise vaginal length for vaginal agenesis (a congenital malformation where the vagina is short, obstructed, or underdeveloped), to increase vaginal width for vaginal narrowing, and to prevent or treat vaginal stenosis after vaginal surgery.

Its functions include minimizing vaginal stenosis and scarring, preventing adhesions, promoting improved vaginal healing, relaxing pelvic floor muscles, and preventing pain. Vaginal dilator therapy also has psychological benefits for women, such as regaining the confidence to insert an object into their vagina, improved control, and increased relaxation when experiencing pain.

What Are the Indications for Using Vaginal Dilators?

• Dyspareunia (painful sex).

• Local neurogenesis surrounding endometriosis lesions.

• Deep dyspareunia is highly correlated with painful bladder and myofascial pain syndromes.

• Painful sex related to central nervous system sensitization.

• History of pelvic radiation.

• Vaginal agenesis.

• Comorbid conditions that contribute to dyspareunia include mental health disorders, chronic pain history, sexual trauma, endometriosis, and vulvar lichens sclerosis.

• Brachytherapy treatment of uterine cancer.

• Vaginal dilator therapy can preserve sexual function in women with anal cancer who undergo chemoradiation therapy by separating the lower vagina from the primary tumor area.

• Following vaginal or pelvic radiotherapy for patients with endometrial carcinoma to prevent vaginal stenosis.

How Is Vaginal Dilator Therapy Done?

Common practice prescriptions given to patients are highly variable, requiring 5 to 120 minutes of self-dilator therapy three to seven times weekly. The initial dilator caliber is determined by the resting length of the vaginal opening during the perineal and pelvic therapy examination. Sexual therapy trainers may advise progressive dilators if and when women approve reduced pain symptoms associated with partner penile girth after a minimum of four weeks of self-reported compliance with consistent vaginal dilator therapy.

The sexual therapy trainer may also teach movement-based dilator therapy during the pelvic floor therapy sessions after a complete external perineal and intravaginal pelvic floor muscle examination. It is an intravaginal dilator technique in which the patient performs a pelvic floor muscle contraction and then applies compressive force during the muscular relaxation phase.

A 1:2 ratio of contraction to relaxation enhances women's proprioception of dilator-assisted pelvic floor relaxation for twice as long as voluntary isolated pelvic floor muscle recruitment. Exercise dose between two to five minutes and five to ten minutes. It is instructed to engage in vaginal dilator therapy every day or every other day as long as it can be pain-free.

What Are the Steps to Use Vaginal Dilators?

• Before inserting it in the vagina, ensure the dilator is clean. Clean it with warm water and antibacterial soap, rinse well, and dry with a clean paper towel or cloth.

• Apply a water-based lubricant to the dilator and the opening of the vagina to help the dilator slide into the vagina more easily.

• Start with the smallest size dilator from a kit. Inserting a dilator should not be painful. If pressure is not felt while inserting the dilator, one might need to use a larger size.

Using gentle pressure, slowly insert the round end of the dilator into the vagina. Always insert it straight toward your spine or at a slightly downward angle, like inserting a tampon.

• Keep inserting the dilator slowly until feeling slight muscle tension, then stop. Never use force. Stop if you feel pain.

• Do Kegel exercises as instructed by the trainer. This will help relax pelvic floor muscles and further insert the dilator.

• Gently move the dilator inside the vagina for 5 to 10 minutes. Add more lubricant if need it during this process.

• Gently push the dilator in and out. This helps stretch the length of the vagina.

• Gently rotate the dilator in wide circles at the back, middle, and opening of the vagina. This helps stretch the width of the vagina.

• Take the dilator out of the vagina.

What Are the Advantages of Using Vaginal Dilator Therapy?

Vaginal dilator therapy promotes affected women's autonomy, empowerment, and self-efficacy and correlates with a subjective reduction in pain consistently within the first four to six weeks of use. In addition, it has the following advantages;

• Women can do it at home with the advantage of privacy.

• Cost-effective.

• Easier to learn.

• It does not require the application of estrogen, so in women for whom estrogen is contraindicated, vaginal therapy improves sexual dysfunctions.

• It does not interfere with other medication's efficiency, so women can use it with other treatment modalities.

What Are the Drawbacks of Vaginal Dilator Therapy?

• Using the dilator, women may experience undesirable emotions, such as embarrassment, anxiety, and fear.

• They may anticipate pain and loss of humility and experience a remembrance of bad memories such as painful cancer treatments to sexual violence.

• Other reasons women hesitate to undergo vaginal dilator therapy include pain levels, lack of proper information about how to use it, and misunderstanding of its potential benefits.

• Forceful insertion may cause bleeding in the vagina.

Conclusion

Everyone needs to understand the concept of sexuality in light of each individual’s background, including cultural and societal aspects. Women may not be able to achieve a sense of sexual normality only through anatomical correction. Thus, the vaginal dilator is not only to correct the anatomical structure of female genitalia; rather, it affects the individual as a whole. In this sense, regular follow-ups for assessing psychosocial well-being and adequate support are beneficial. In addition, psychoeducational interventions, including counseling, motivation, and guidance on vaginal dilator use, are vital to improving women’s compliance.