Clinical Review

Vaginal dilation: When it’s indicated and tips on teaching it

Author and Disclosure Information

 

Use proper positioning. Instruct the patient to lie on the bed with her knees bent and placed apart. Advise her to place the lubricated dilator in the vagina as far as it can go without causing any pain (FIGURE 1). It may be helpful for her to bear down when first inserting the dilator. An in-and-out motion is not necessary.


FIGURE 1 Inserting the dilator
Tell the patient to lie on the bed with her knees bent and to insert the lubricated dilator into her vagina as far as it will go without causing pain.Be sure to inform her to use a water-based lubricant—not lotion, petroleum jelly, or any non-water-based lubricant.

Dilate daily. The dilator should be used daily and left in place for 5 to 15 minutes. She may experience a small amount of spotting initially, but spotting should abate within 2 weeks of initiating dilator use. Each dilator size should be used for 3 to 4 weeks. When your patient is changing sizes, she should transition to the larger size over several days by dilating for the first few minutes with the smaller dilator, then changing to the larger dilator for the remainder of the time. If she experiences pain or heavy bleeding, she should cease dilation and follow-up with you.

Proper cleaning. Instruct her to wash the dilator with antibacterial soap and water and to dry it thoroughly between uses.

Follow-up. When undergoing vaginal dilation therapy, your patient should be following up with you at regular intervals, usually once a month, to facilitate compliance with the program.

Where to obtain dilators

You can purchase dilators for your medical practice and resell them in your office. Patients also can be directed to purchase dilators directly from a manufacturer (such as Syracuse Medical Devices or AmeriMed Direct) or through a number of Internet sites, including Middlesexmd.com6 or Vaginismus.com.7 Both of these Web sites also offer educational materials, including videos and books and a private support forum or blog.


FIGURE 2 Vaginal dilators come in 8 different circumferences
Vaginal dilators range in size from Extra Small at 1/2 in (13 mm) to Large Plus at 1 1/2 in (39 mm). Each is 6 in (15 cm) long, has one rounded end, and is constructed of sterilizable, medical-grade plastic.
Printed with permission of Syracuse Medical Devices, Inc., Syracuse, New York.Most dilators used in the United States are 6 in (15 cm) long and are made from sterilizable, medical-grade, latex-free, rigid plastic with a smooth surface. Some dilators are made of softer material such as silicone, and others have a vibrating inner wand.6 They are available to purchase as single dilators or in sets of 5 to 8 graduated sizes (FIGURE 2). Some sets come with a storage bag and universal handles that lock-on for insertion. Graduated circumference sizes are fairly universal in the United States (TABLE).

Average dilator sizes and circumferences*

SizeCircumference
Extra small1/2 in; 13 mm
Extra small plus11/16 in; 18 mm
Small7/8 in; 22 mm
Small plus1 in; 25 mm
Medium1 1/8 in; 29 mm
Medium plus1 1/4 in; 32 mm
Large1 3/8 in; 35 mm
Large plus1 5/8 in; 38 mm
*Based on Syracuse Medical Devices, Inc. product information.

Restoring her sexual health: Our goal

Sexual health is a vitally important quality-of-life issue; restoring that health should be our priority. We need to educate our patients on nonprescription methods to promote their vaginal and sexual health, as vaginal dilation therapy can result in the reduction or elimination of dyspareunia.

We want to hear from you! Tell us what you think.

ADDITIONAL ARTICLES ON SEXUAL HEALTH

Your age-based guide to comprehensive well-woman care
Robert L. Barbieri, MD (October 2012)

Sexual dysfunction
Barbara S. Levy, MD (Update, September 2012)

New study: ObGyns aren’t fully addressing their patients’ sexual function
(Web News, April 2012)

How to prepare your patient for the many nuances of postpartum sexuality
Roya Rezaee, MD, and Sheryl Kingsberg, PhD (January 2012)

Pages

Recommended Reading

Low-Fat Diet a Dud for Women's Heart Disease
MDedge ObGyn
Denosumab/Teriparatide Combo Bests Single-Agent Bone Therapy
MDedge ObGyn
Limit HT Use to Menopause Symptoms, Task Force Reaffirms
MDedge ObGyn
Odanacatib Adds Bone in Alendronate-Pretreated Osteoporosis
MDedge ObGyn
How to ask about, and manage, the undertreated problem of sexual dysfunction
MDedge ObGyn