For the longest time, women who complained of pain during sex were given one solution: lube. “That was when ‘vagina’ was a bad word,” says L.A.-based Sheryl A. Ross, MD, an OBGYN and author of She-ology: The Definitive Guide to Women’s Health. Period. “Thankfully, now the narrative has changed—and the vagina, recognized by activists as a marginalized topic, is poised to come out of the closet.”
Dilation therapy is part of this shift.
OK, so what is vaginal dilation therapy?
Penetration can be painful for a number of reasons, from atrophy to cancer to newly constructed vaginas for trans-women. When the vagina becomes too dry, micro lacerations and tears of the labia and vulva become more common. “Vaginal dilators increase the elasticity of the vagina at the opening, where it can become narrow,” says Dr. Sherry. In other words, if nothing is going into the vagina, it will close up—kind of like a body piercing without the jewelry. “The narrow opening can create problems with penetration, whether it’s a penis, a dildo, a vibrator, or even a tampon,” adds Dr. Sherry.
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Luckily, the atrophy is almost entirely reversible, and vaginismus (involuntary muscle spasms of the pelvic floor) treatment has an almost 100 percent success rate. Enter vaginal dilators, also called inserts, which are phallic-shaped plastic medical devices that come in a range of a sizes and widths. Inserting a dilator into your vagina keeps the tissue pliable, open, and elastic. The sole purpose of the therapy? To make the experience of penetration more pleasurable.
Who is it for, exactly?
Some women discover the involuntary tightening of their pelvic floor muscles—and the ensuing pain—from the first time they attempt vaginal sex. It could also be a tampon, or a gynecologist’s speculum, that triggers the pain. Burning spasms or impenetrability, as if a wall blocked the vagina, can result.
While it’s a physical problem, psychological issues often accompany vaginismus. Sexual trauma has a huge impact on vaginal pain, proving the adage, “we store our issues in our tissues.” The experience of painful penetration can occur any time in a woman’s life. The need for dilation therapy can also be late onset—after a sexless marriage, post radiation treatments (which can narrow and shorten the vagina), or during and after menopause, when waning estrogen can wreak havoc with vaginal elasticity, Sherry says.
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How does dilation therapy work?
The only time vaginal dilation carries a frisson of excitement is when a woman is about to give birth. Otherwise, dilation sounds somewhat onerous but dutiful, like wearing a mouthguard or a colonoscopy. But dilation therapy is an extremely important technique for women to be able to reclaim the full range of their anatomy. By gently stretching the vagina and training the surrounding pelvic floor muscles to relax, the vagina learns to make room—and derive pleasure from—penetration. “Vaginal dilators come in different sizes, the smallest being the width of a pinky and the largest the width of a cucumber,” Dr. Sherry says.
To use vaginal dilators, you’ll start with a small dilator that can fit inside your vagina without difficulty. You’ll then carefully insert dilators of gradually increasing size into the vagina, one at a time, which in turn slowly increases vaginal capacity.
Although dilators may look vaguely like a sex toy, they’ve suffered an image problem. “Old school dilators were hard, rigid, and sterile looking, says Dr. Sherry. “And there was horrible compliance, because you would have to stay lying down while the dilator was inserted. Now there are wearable versions of dilators you can wear while moving, walking, or sitting.”
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Doctors typically suggest starting with the smallest dilator (they tend to come in kits), using a lot of lube, and then working your way up incrementally. Dr. Sherry recommends 30 minutes a day, three to five times a week, until the issue is resolved. While the process can’t be rushed, if practiced diligently, you can see progress within months, she says.
Keep in mind it’s difficult to practice dilation therapy when you’re stressed. Sherry suggests finding creative ways to set the mood for dilation therapy, such as trying it in conjunction with a vibrator or with your partner. (Dilators often serve as a prerequisite to sex toys, as many women can’t insert a vibrator without previous dilation therapy.)
Remember, while it can be frustrating to not engage in penetrative sex if that is what you desire, there’s no need to feel desexualized or inadequate during the interim. Intimacy can happen in myriad ways, with or without penetration.
So, you’re interested in trying dilation therapy. Where do you go from here?
The first step is to buy a dilator set. Dr. Sherry recommends two: The first is a wearable set that she designed, which offers women the opportunity to integrate dilation therapy with everyday activities. Because these dilators were created with mobility in mind, compliance can be higher, she says. For women who prefer to dilate lying down, Dr. Sherry likes Dr. Laura Berman’s dilator set, which vibrates to increase pleasure while training.
“Dilation therapy can be DIY, if for example, you haven’t had sex in a year and you want to make the opening more comfortable,” she says. “There’s nothing wrong with trying this on your own.” That said, if you try it and it’s not comfortable or doesn’t feel right, make an appointment with your gynecologist who can show you exactly how to use your dilator kit.
The payoff is big
“Restored vaginal capacity can be a huge source of joy,” says Dr. Sherry. Regular orgasms are very good for your vaginal tissue, as they increase blood flow to the vagina and keep it lubricated. If it hurts “down there,” don’t succumb to shame or silence. Use pain as a call to action. “Let’s normalize the conversation,” says Dr. Sherry. “But first, we have to educate.” When you suffer from any kind of persistent vaginal pain, talk to your gynecologist or a sex counselor. And if there is trauma, find a good therapist. Together you can figure out what’s going on with your anatomy and develop a wellness plan just right for you.
