When to use dilators?

Dilators are devices for self-exercise aimed at widening the vaginal walls for specific sexual dysfunctions. They are made of medical-grade silicone, ensuring comfortable application and user safety. The most difficult part of using them is finding the correct size, so it is recommended to purchase them in sets (4 to 5 pieces) to increase the size periodically and thus provide a complete therapy. The most advanced dilator sets come in up to 8 sizes. They are designed for self-exercise by the patient.

Vaginal vs. Anal Dilators

Depending on the needs of the therapy, we distinguish vaginal dilators for vaginal use and anal dilators for rectal use (e.g., necessary after a patient undergoes radiotherapy). In some cases, as recommended by a specialist, anal dilators are used for vaginal therapy.

Types of Dilators

Indications for Vaginal Dilators
Female sexual dysfunction is a disorder experienced by women when their usual sexual behaviors change.

Below is a description of the most common sexual dysfunctions.

Dyspareunia

Dyspareunia is the occurrence of pain during or after intercourse. This problem affects both physical and mental health. It can lead to depression, anxiety, and low self-esteem in women who experience this condition.

Dyspareunia can be divided into:

• superficial - affects the vulva and vaginal opening
• deep - pain in the cervix, bladder, and/or lower pelvis.
  

According to another classification, dyspareunia can also be divided into:

• primary - pain at the beginning of sexual activity
• secondary - pain later in life.
  

Dyspareunia can be caused by structural, inflammatory, and infectious problems, as well as trauma, hormonal, and psychosocial issues. Emotional intimacy, sexual stimuli, and physical and psychological satisfaction also have a significant impact.

Vaginismus

Vaginismus, or vaginismus (Latin: vaginismus), is a sexual dysfunction manifested by involuntary contraction of the pelvic muscles surrounding the outer third of the vagina (the perineal muscles and the levator ani muscles). Muscle spasms can also occur, including the adductor femoris muscles, gluteal muscles, and rectus abdominis muscles. This prevents both intercourse and gynecological examinations. Vaginismus can occur as a primary or secondary dysfunction.

Vaginismus is influenced by somatic and psychological factors affecting the sexual function of a woman's genital organs. The inability to engage in intercourse is usually classified as a sexual disorder. However, organic factors can also cause vaginismus: developmental defects such as stenosis, inflammation, and post-traumatic ruptures. These problems, along with neural (and indirectly muscular) hypersensitivity, lead to muscle spasms in the vulva and vagina, preventing or hindering sexual intercourse.

Organic vaginismus is classified as both a sexological and a gynecological problem. Therefore, treatment relies on gynecological treatment, urogynecological physiotherapy, and psychotherapy. Vaginismus is more common in arranged marriages and when initial sexual encounters were traumatic. Primary vaginismus typically affects adolescents or young women who fear sexual intercourse, unwanted pregnancy, or sexually transmitted diseases. It can also be associated with childhood trauma or physical abuse.

Secondary vaginismus occurs when intercourse is possible, but vaginal spasms occur shortly thereafter, making intercourse difficult or impossible.

Secondary vaginismus may result from trauma during childbirth, surgical trauma, or recurrent vulvovaginitis.

Vaginismus can also be caused by congenital defects, such as genital atresia (gynatresia). These usually affect the hymen.

Vaginismus can be treated using various methods. However, it has been documented that the use of vaginal dilators is quite effective in enabling women to have intercourse if that is their goal. According to scientific research, sex education and psychotherapy combined with the use of dilators leads to a successful recovery in 80% of cases.

Vulvodynia

Vulvodynia is a burning sensation, chronic itching, or hypersensitivity in the area of ​​the vulva, urethral meatus, perineum, or anus. Symptoms can affect the vulva, vagina, and sometimes the buttocks. Symptoms typically persist for at least three to six months without symptoms suggesting a neurological condition.

Vulvodynia is diagnosed after ruling out other factors, including dyspareunia, inflammation, allergies, anatomical conditions, and atrophy after childbirth, menopause, radiation therapy, or iatrogenic factors such as vaginal surgery, perineal repair, or childbirth.

In 85% of cases, chronic pain stems from the muscles and fascia. Two types of vulvodynia can be distinguished:

• provoked - in response to touch
• unprovoked - when the exact location of the pain is difficult to pinpoint.

In 80% of cases, factors include instability and increased tone of the pelvic floor muscles.

Vestibulodynia

This is pain in the vaginal vestibule. Genetic and immunological factors contribute to the development of this pain syndrome. Vestibulodynia is associated with conditions such as inflammatory bowel disease, a family history of diabetes, allergies, and arthritis. Vitamin D deficiency in temperate climates is a risk factor for pain syndromes, musculoskeletal problems, autoimmune diseases, depression, and vaginitis.

Radiation Therapy

Although cancer treatment targets cancer cells, the side effects of radiotherapy also affect healthy cells. Patients undergoing radiotherapy may experience vaginal pain, dryness, burning, irritation, or discomfort during intercourse. These factors can negatively impact sexuality, which can impact quality of life.

A late radiation effect in women may include atrophy, or atrophic changes in the vaginal epithelium. Reduced sensitivity to estrogen may also be a side effect.

Treatment of Sexual Dysfunctions

Treating sexual dysfunctions does not guarantee a complete cure, but it can reduce their impact on patients' quality of life. Multidisciplinary treatment is most often recommended, addressing physical, emotional, and behavioral aspects. A team of specialists should include gynecologists, physiotherapists, sexologists, and psychologists and/or psychiatrists.

Dilators will therefore be helpful in conditions such as:

• vaginal pain,
• dyspareunia,
• vaginism,
• vulvodynia,
• vestibulodynia,
• after radiation therapy,
• vaginoplasty,
  
• vaginal surgery,
• in transgender individuals who have undergone gender reassignment surgery (male to female),
• vulvodynia

How to use dilators?

Dilators should be used with a generous amount of water-based lubricant. They can be used while lying down or standing – in this case, raise one leg and rest it on a chair. After use, wash the dilator with water and a detergent, then dry it with a lint-free cloth.

For convenient insertion, it's worth considering purchasing a dilator holder (available from brands like Intimate Rose), which will improve comfort. Vaginal dilators with a built-in holder are slightly less comfortable to hold and insert.

Which set of vaginal dilators is right for me?

It's best to start with a size that's easy to insert into the vagina and then move on to larger sizes. Choosing the right dilator also depends on your goal:

1. If you want painless tampon insertion, it's best to choose the smallest size possible.
2. If painless intercourse is your goal, it's worth using a measuring tape to determine the desired dilator size and aim for that size, starting with the smallest.
   

To determine the size, you can also perform a finger test.

• Inability to insert a finger into the vagina - sizes 1-4
• Ability to insert one or two fingers - sizes 3-6
• Ability to insert two fingers, but not three - in which case, it's best to choose sizes 5-8. Before and after use, dilators are washed in warm, soapy water and dried.

What is the role of urogynecological physiotherapy?

The role of urogynecological physiotherapy is to improve the patient's sexual life by selecting appropriate individual therapy, educating them on a healthy and active lifestyle, and improving the biomechanics and physiology of pelvic floor structures. Improving the patient's self-image is also important.

Research suggests combining pelvic floor muscle exercises with other treatment methods yields the best results in improving sexual function.
Pelvic floor muscle training aims to improve relaxation skills, restore normal resting activity, increase vaginal elasticity, and improve awareness of muscle function in this area and proprioception. This reduces the effects of connective tissue damage and myofascial pain associated with the aforementioned dysfunctions.

Urogynecological physiotherapy includes:

• biofeedback
• pelvic floor relaxation
• transvaginal trigger point massage, either manually or using pelvic floor massagers such as the Pelvic Wand
• myofascial trigger point release (diaphragm, piriformis, iliopsoas)
• use of dilators
• pelvic floor muscle exercises (contraction and relaxation exercises)
• abdominal muscle exercises
• pelvic floor muscle electrostimulation (TENS)
• infrared therapy