Leslie R. Schover, PhD
Vaginal dilators have been around in one form or another for at least 50 years. When I first worked as a psychologist/sex therapist in a major cancer center in the early 1980s, women getting pelvic radiation therapy got a dilator that looked like a hard plastic candle. The nurses told them to put surgical jelly on the dilator, and to put it in their vagina several times a week to prevent damage from scar tissue. Before that, I’d worked with dilators in sex therapy for women who had severe anxiety about vaginal penetration, helping them begin with putting in a very small dilator and work up to one as big as an erect penis. The dilators we used looked like something from a sadistic porn film—ominous black, penis-shaped cylinders. We did not have pastel-colored, soft silicone, nonthreatening dilators in many sizes, like the ones made by Soul Source. In fact, in those years I wrote a letter to one of the stores selling sex toys and videos, asking them please to make dilators just like these. I don’t know if it had any influence in getting them started.
WHY USE A DILATOR?
Vaginal dilators are used for several different purposes:
- After radiation therapy:If a woman has radiation therapy aimed at or near her vagina, she is usually given a dilator towards the end of treatment. At first, using the dilator helps prevent the vaginal walls from sticking to each other and scarring shut during healing. As healing goes on, the radiation causes fibrosis (a scarring process) in the vaginal walls. Using a dilator or having intercourse for a total frequency of 2-3 times a week may help the vagina stay as deep and wide as possible. Repeatedly, studies have shown that most women do not follow the usual advice to use a dilator or to have sexual intercourse for a total of 3 times a week, even for a few months after radiation, much less for years afterwards, although scarring continues to occur.
- After vaginal reconstruction:If a woman has surgery to rebuild her vagina because of a birth defect, later health problem, or after cancer treatment, she may be given a custom-made vaginal dilator to wear while she sleeps as well as for some hours during the day. The dilator helps the new vagina stay as deep and wide as possible during healing. Dilators are most likely to be used if the vagina is created using skin grafts. They may not be needed for vaginas built from intestines or skin and muscle flaps.
- To maintain vaginal size in the long term after menopause or cancer treatment:
Vaginal dilators may help women keep enough vaginal size and stretch to have pain-free intercourse or pelvic examinations after menopause, Dilators are also helpful during periods when a patient needs to take anti-estrogen hormone therapies for breast cancer. In addition, vaginal dilators are used to prevent scarring during graft versus host syndrome after a stem cell or bone marrow transplant from a donor.
- To create a vagina for young women born without one: Some women are born without a vagina. Instead, they have a small “dimple” that is a dead end. As they become teenagers they have the option of surgery to create a vaginal canal or they can use dilation. They press a dilator into the vaginal opening for about half an hour, twice a day. Over a few weeks, they can deepen the opening enough to have sexual intercourse with a male partner. However, they have to keep using a dilator or having regular sexual activity to maintain the vaginal canal. If their condition involves abnormally low hormone levels, they also use estrogen creams to improve the stretchiness of the vaginal area.
- To treat fear of vaginal penetration: Some women have an intense fear of something entering the vagina. This problem is called Vaginismus or Pelvic Floor Myalgia. Sex therapists used to think women with vaginismus clenched their vaginal muscles, making penetration impossible. More recently, the problem has been recognized as a kind of phobia triggered when a partner tries to put a finger or penis in the vaginal entrance. Muscle tension may occur along with the fear, but not always. Women can usually overcome vaginismus by practicing muscle relaxation while using a set of vaginal dilators that varies in size. The crucial ingredient is that the woman is in control over what goes into her vagina.
HOW TO GET COMFORTABLE USING A DILATOR
We know that women rarely use their dilators as often as recommended. Years ago, I looked at the dilators we had and knew that 90% of them were going to be put on a closet shelf or buried deep in a drawer, never to be seen again. Even nowadays, many women have not looked at their vulva in a mirror and have little idea of how a vagina works. They may never have put their own finger inside their vagina. Although almost all boys try masturbation, only about 60% of adult women admit they have ever tried to give themselves sexual pleasure. Putting a dilator into the vagina may make some women feel anxious, or even immoral, even though it has a medical purpose. Using a dilator may also be physically uncomfortable, although it should not be really painful. When I work with a woman, I want the dilator to be part of a process of getting her as familiar and comfortable as possible with her own body. I usually suggest that she learns about her vulva and vagina and looks at the area in the mirror. Starting with a small dilator, she can learn to tense and relax muscles surrounding the vaginal entrance, gradually slipping in the well-lubricated dilator while relaxed. Then a woman can progress to holding the dilator inside for a few minutes, and finally, to moving it around. When all of that is comfortable, she can move to a larger size. In this way, using a dilator is a part of empowering women to know and control their own vulva and vagina.
WHY A DILATOR VERSUS A VIBRATOR OR DILDO?
After radiation therapy or during graft versus host disease, using a dilator does seem to keep the vagina from shrinking. We do not know if it also helps the vaginal walls stay stretchy. Using a dilator probably helps direct blood flow into the vaginal walls and vulva, even if a woman does not feel sexually excited. The extra blood flow brings oxygen to the tiny blood vessels in the region, which may also help keep the tissue healthy. The emotional benefits are clearer—reducing anxiety and helping a woman avoid involuntary muscle tension that just adds to pain when the vagina has some tightness or scarring related to menopause or health problems.
Some sex educators advise women that they will get more positive results from using vibrators of different sizes rather than using dilators. They believe that vibrators will cause sexual excitement, promoting more blood flow or making the process more pleasurable. Other counselors tell women to just buy dildos (sex toys shaped like a penis that may or may not vibrate) of different sizes (or of one size that the woman prefers). I have nothing against adding vibration into the mix if a woman enjoys it, but I worry that using vibrators without the other parts of the program will not help women understand their own anatomy, including how to control the pelvic floor muscles. Even vibrators that come with several tips of different sizes to fit in the vagina do not have the range of sizes of commercially available dilators, allowing a woman to customize her dilation. Furthermore, some women may find the vibration unpleasant or even painful. If using the vibrator produces an orgasm, that may or may not be welcome. Women who can get comfortable using a dilator if they view it as a medical treatment may resist the idea of using a vibrator or dildo, which clearly were made to produce sexual enjoyment. I also worry that some of the counselors sell the recommended sex toys on their own online sites or stores.
MAKING DILATOR USE EASIER
- Start with a size that you can slip into your vagina with little or no discomfort
- Slather your dilator with lubricant and repeat as needed
- Make sure you know how to tense and relax the muscles at the vaginal entrance. Relax them as you put the dilator in.
- Remember that your vagina slants somewhat downwards if you are lying on your back and do not push the dilator in at a right angle
- If you are going to keep the dilator in for a few minutes, try reading or watching TV to distract yourself
- If you enjoy sexual sensations from the dilator, you can move it to produce good feelings, but that is an option, not a necessity
- If you have scar tissue from radiation therapy, surgery, or graft versus host disease, ask your medical team to show you how to use your dilator safely. It is occasionally possible to injure yourself by pushing or moving the dilator too roughly against fragile, scarred areas
Leslie R. Schover, PhD, is a clinical psychologist internationally recognized as an expert on sexual problems and infertility related to cancer treatment and other chronic illnesses. In 2016 she received the Holland Distinguished Leadership Award from the American Psychosocial Oncology Society recognizing her outstanding contributions to the field. She retired in early 2016 from her position as Professor of Behavioral Science at the University of Texas MD Anderson Cancer Center. Dr. Schover is the founder of Will2Love.com, the first comprehensive, online help for cancer-related problems with sexuality and fertility.
This educational material is intended for informational purposes only and is not intended to replace, or substitute for, professional advice, counseling, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a condition. Never disregard professional advice or delay in seeking treatment because of something you have read in this educational material.