Menopause can complicate your sex life in so many ways. One very important reason is the loss of estrogen, which leaves your vagina drier and less elastic. Your vagina can also become narrower and shorter. When sex becomes more painful than pleasurable, you may start to avoid it, which will only aggravate the problem all around. For many women, vaginal dilators can be a solution.
“If the vagina is not being penetrated, it will shrink up. It will get smaller and less able to tolerate anything going inside,” says Tami Rowen, MD, associate professor in the UC San Francisco Department of Obstetrics, Gynecology, and Reproductive Sciences and a member of our editorial board. “It’s important to treat the vagina like any other body part you want to be able to use—and exercise it.”
You might think of a dilator like free weights for your vagina, except instead of progressively increasing the weight as your muscles get stronger, you gradually increase the size as your vaginal tissues expand.
The ABCs of vaginal dilators
Vaginal dilators are tube-shaped devices made from plastic or a rubber-like material called silicone. When you place them inside your vagina in gradually increasing sizes, they stretch and relax the tissue to make penetrative sex (and pelvic exams) more comfortable.
Less painful postmenopausal sex isn’t the only reason to use a dilator. These devices are also part of the treatment for vaginal tightness and sexual pain due to such conditions as:
- Pelvic floor dysfunction—weakening or injury to the muscles or connective tissue of the pelvic area, as may be caused, for example, by childbirth, overweight and obesity, chronic constipation, aging, genetic tendencies, and certain surgeries, such as hysterectomy
- Vaginismus—involuntary muscle spasms or tensing in the vagina often starting at the onset of sexual intercourse or a pelvic exam
- Vaginal stenosis—narrowing of the vagina not just from menopause alone but also from scar tissue that results from injury or damage such as from childbirth and some skin infections
- Radiation therapy to the pelvic area for treatment of cervical, uterine, or colorectal cancer, which causes scarring (vaginal stenosis), loss of elasticity of vaginal walls, and sensitivity of tissues
- Skin conditions such as lichen planus or lichen sclerosus that can affect the genital area and lead to tissue scarring and narrowing of the vagina or vaginal opening
You might wonder, “Can’t I just use a finger or two to stretch myself?” In studies, some women did prefer the more natural feel of their finger to a dilator, but Dr. Rowen cautions that fingers don’t as accurately replicate the sensation of a penis. “They put pressure on the vagina in a different way and don’t work quite as well as a dilator if the goal is penile or similar penetration,” she says.
Going on a shopping trip
Though you can buy a dilator at most pharmacies without a prescription and on websites like Soul Source, Intimate Rose, and VuVa, it’s a good idea to check with your gynecologist or primary care doctor first, to make sure this treatment is right for you and that you’re starting with the correct size.
Dilators come in sets of three to seven in graduated sizes. “The goal is to get up to the highest size you’re interested in placing inside,” Dr. Rowen says. They typically range in length from about 2 to 7 inches and in thickness from 0.5 to 1.5 inches. One product, Milli, is a single dilator that gradually expands.
Plastic dilators are more rigid. Medical-grade silicone ones are softer and more flexible. Expect to pay $80 to $100 and up for a set, depending on the sizes included, number of items per set, and brand (not covered by insurance).
How effective are they?
That’s hard to say. Experts are mixed on how well this treatment works. While a 2019 review in Drugs & Aging found dilators helpful for women with vulvovaginal atrophy and vaginal constriction due to menopause, an earlier review in the Cochrane Database of Systematic Reviews concluded there wasn’t enough evidence to prove whether they work better than other treatments for vaginismus.
One reason it’s been hard to confirm how well dilators work is that many women don’t feel comfortable using them and stop too soon to see results. They may be embarrassed, fear possible pain, lack guidance on how to use them, or not understand their benefits. In some studies, just one in four participants completed their entire treatment.
“They’re effective if you use them. That’s really the bottom line,” Dr. Rowen says. “For certain individuals they work great, and I’ve seen that in my practice.”
Putting them in their place
Try to use your dilator in a calming setting, like the bathtub, so your muscles are relaxed. Coat the dilator in a water-based lubricant (KY, Astroglide), then place it inside your vagina and leave it in for about 10 minutes. It should feel uncomfortable, but not painful. Wash it with warm water and soap after each use to avoid infection.
Dr. Rowen suggests using your dilator five times a week. When it becomes more comfortable, move up to the next size.
If you’re new to vaginal dilators and want some additional guidance, a physical therapist can teach you how to use them. Look for one who specializes in pelvic floor physical therapy. You can find one with the right expertise by searching the American Physical Therapy Association’s directory.
There’s no set recommendation for how long you will need to use a dilator to get results—that varies across women. But if you’re able to have sex comfortably at least once a week, you may be ready to stop, says Dr. Rowen.
Getting the most from your dilator
You’ll be more likely to use your dilator if you learn how to use it correctly, schedule it into your day, and make the experience as comfortable as possible. Having the right support will also increase the likelihood of seeing your treatment through. If you can’t lean on your partner, ask your doctor or physical therapist for advice, or join an online support group (such as one of these found here for pelvic pain).
Dilators work best when you use them in tandem with treatments like moisturizers (applied to the vulva or in the vagina) and vaginal estrogen (which increases blood flow and elasticity in the vagina), says Dr. Rowen. If discomfort is an issue, she suggests using an over-the-counter lidocaine cream to numb your vagina before you insert the dilator. You might also ask your doctor to prescribe a muscle relaxer (if you have vaginismus) or an anti-anxiety drug to help you feel more comfortable.
While using a dilator, your doctor may want to see you every six to 12 months to measure your progress (and more frequently if you are a cancer patient). Although dilators are generally safe, let your doctor know if you have any bleeding, urinary symptoms, or pain while using them.
BOTTOM LINE: Vaginal dilators aren’t for everyone. You shouldn’t use one if you’ve had recent surgery to the vulva or vagina, or have open sores or an active infection. And if you’ve had radiation therapy to your pelvic area, you should wait four to six weeks after finishing, because the tissue is still too sensitive and likely to injure.
Provided you don’t have these issues, there’s no reason why you should have to endure painful sex when a dilator could make the experience more pleasurable. Don’t let embarrassment get in the way of talking to your doctor. “It’s a very sensitive topic, and people have a lot of preconceived ideas and shame around their genitals,” Dr. Rowen says. “But to me, as a doctor, we’re simply treating a common condition, and this is the remedy for it.”
