A huge component of getting to pain-free intercourse is a vaginal dilator program.  Boy, do I have a lot to say about this.  First off, a lot of physicians are familiar with dilator programs and will recommend them to patients.  However, I don’t think that you can just give a dilator to someone and tell them to use it and they’ll get better.  There’s a lot of anxiety, emotion and physical pain around penetration for someone who has painful sex.  So, to give someone a dilator without instruction is not taking care of the whole picture.  I believe that an explanation behind why a dilator program is helpful and how to use it correctly is a huge part of rehabilitation.  Here is how I feel a dilator program should be used:

•  Understand why a vaginal dilator program can help:  If you have had painful sex more than once, twice or three times, it is very possible that your are anxious with each new attempt at intercourse.  Because of this, you might not be looking forward to actually having sex.  Also because of your history of pain, it’s really likely that your pelvic floor muscles are actually tightening more just before you experience penetration.  You may not actually feel this happening, but it’s probably happening.  This is because being stressed, nervous, anxious, scared will actually make your pelvic floor muscles contract, regardless of whether you are about to have sex or if you’re about to take slam on the brakes at a red light.  A dilator program can help you build confidence that you can experience penetration in the vaginal canal without it being an uncomfortable experience.  Moving up the ranks in the dilator slowly and at your pace and in a pain-free way will allow for this.

•  Using a dilator is not a sexual activity, but a rehabilitation exercise:  Same thing as above.  If you view using the dilator as a sexual activity, then the nervousness and anxiety and memories of discomfort with sex may return to you and the pelvic floor muscles will probably tighten again.  That’s why it’s important to view this as a rehabilitation exercise.  You don’t want all your sexual anxieties to come flooding in.  This is a new day and a new program, start fresh and don’t let all that baggage seep into your rehab.

• Rank your discomfort on a scale of 0-10 with 10 being the most discomfort and then never go past 2/10 when using your dilator:  Yeah, this is subjective, but we need something to work with.  If you do your dilator program and just let it hurt to high hell every time, you will never learn to relax your muscles and you will never build confidence in penetrating without pain.  This experience cannot be painful, it must be as pain-free as possible in order for you to relax and build confidence.  So, because of this, I tell patients that when they use a dilator, if anything they are doing causes more than 2/10 discomfort, they must back off.  This is essential.

• Start with the smallest size that presents a challenge and move up slowly.  This means that your first dilator might even be a q-tip, if that’s all you can insert, then you start there.  I have specific movements that my patients must go through with each dilator size before increasing sizes.
  • Work on just inserting the dilator without more than 2/10 discomfort, once this is achieved, you can move forward to the next step
  • Rotate the dilator in both directions without more than 2/10 discomfort
  • Angle the dilator in all directions like a clock around the vaginal opening without more than 2/10 discomfort
  • Gently remove and re-insert the dilator to simulate the thrusting motion without more than 2/10 discomfort
  • When all of these steps have been completed with the first dilator size, only then can you move to the next dilator size

• Use lubrication:  Why not?  Why make this harder for yourself?  Don’t be stubborn and just use lube!  KY and Astroglide can be okay for some people, but for others it is not.  These lubrications have chemicals that help them last longer, but this can burn some women.  Lubrications that don’t burn, but might need to be applied more often are Slippery Stuff, coconut oil or olive oil.  Be nice to yourself, please.

• Work up to a dilator size that is either the size of your partner or even slightly larger:  This helps in the confidence department.  No, you will not be too “loose” if you use a dilator slightly larger than your partner’s penis, toy, or whatever you are using for penetration.  I advise this because if you know you can do rehab with something of a certain size and then you have intercourse with someone slightly smaller, you know in your head that this is achievable and you might even think “No big deal!  I got this!”  That’s pretty cool, right?

• If jumping from one dilator size to the next is a huge challenge, consider ordering half size dilators:  These exist.  Syracuse makes half sizes and I think they are really helpful.