The need for vaginal dilators is always indicative of a need for pelvic floor OT/PT.

If you have pain with vaginal penetration (whether it’s penis-in-vagina, sex toys, tampons, menstrual cup, finger insertion, speculum, etc.), you could have a condition called vaginismus.

Vaginismus can occur at any point in life, and factors such as anxiety, perineal/pelvic floor trauma (such as after a vaginal birth), and fear or trauma surrounding sexual encounters can worsen it. Many times, vagina-owners don’t even know they have vaginismus until they start their period, go to insert a tampon, and realize that it feels like there’s a wall there. Pain with insertion can range from mild discomfort to excruciating.

If your provider recommended a dilator set and you’ve already purchased it- yay! Just skip down to the dilator picture and we’ll go over the good information there.

If you haven’t purchased anything yet, but have been diagnosed with or suspect you have vaginismus, I highly recommend the following products:

Hard, plastic dilators can cause more discomfort than the soft, silicone dilators linked above (Intimate Rose). These, however, are only to be used with water-based lubricant! Do not use silicone-based lubricant with any silicone toys or pelvic health items.

The information surrounding dilator protocols & what to do when you finally get your dilators is something that I hear a lot of lacking information in. So…let’s dive in!

Dark-haired woman in bathtub with candles in the background. She is touching her knee with one hand while smiling

Before You Begin

Before beginning with a dilator protocol, I want you to pause and tell yourself the following:

“I am worthy of exploring & enjoying myself sexually with confidence and openness. My vulnerability makes me powerful.”

In my years of practice, I’ve found a correlation between sexual confidence & pain with intercourse. Duh. Of course there would be.

But healing your pelvic floor is only half of the battle. The other half is to heal your emotional side- the side that has correlated pain with sex. The side that has caused you to possibly stop even exploring yourself or allowing a partner to explore you.

So before you begin, I want you to explore what arouses you.

When you’re aroused, your vagina elongates & widens- this is paramount to success with the dilator protocol. Now, this widening & elongating may not happen the first few times (especially if the pain with sex has happened for a long time), but it’s still the ultimate goal.

Some ideas to arouse yourself:

candles
a bubble bath
music
touch yourself (ears, lips, hips, butt, nipples, neck, labia, clitoris…whatever works for you!)
watch porn
use an arousal app (there truly is an app for everything! start with “Emjoy”)
put on lingerie
listen to audio-only porn or a masturbation playlist
or whatever else excites you!

Being fully aroused (which can take 20-40 minutes!) makes the dilator protocol (I hate the word “protocol”, by the way- ugh) much more relatable to sex as well as creates a positive vibe around the entire ordeal.

8 dilators all in a row from smallest to largest size — Intimate Rose Dilators: sizes 1-8

The First Time

The first time you use a vaginal dilator can be overwhelming and, to put it frankly, anxiety-ridden. Dilators are meant to help with painful intercourse, but the fear surrounding painful insertion from prior experiences can make this very difficult. Remember to inhale using your ribs (open them up like an umbrella!) as you do this- it will help stimulate your vagus nerve and calm your body down.

Arouse yourself. Do what you gotta do (read above for ideas).
Prop your upper body up on your bed or a couch with lot of pillows, including one pillow on each side of your legs to support your legs. I like to recommend putting your feet about a foot apart from each other to give your perineum some space (feet wider than knees provides more space at the bottom of your pelvic floor!), and placing each pillow under each knee to position your legs & back better.
Put the dilator handle onto the dilator. The dilator handle is paramount to your comfort using these tools!
Find the smallest size dilator you feel comfortable with, and cover the top half of it with lubricant. Don’t be stingy here- apply generously! You really can’t have too much lube.
With your non-dominant hand, separate your labia. Use your dominant hand to slowly insert the dilator. You can shift the angle of the dilator to find a more comfortable angle for entrance if needed.
Remember, you’re in control. If you need to pause, then do that! If you find a spot that feels painful or uncomfortable, try inhaling with that umbrella breath to length the pelvic floor muscles.
Keep going until the dilator is inserted to comfort. Some dilators may not be able to insert fully depending on your anatomy and their length- so don’t expect it to! A good rule of thumb is to insert it about 3/4 of the length of the dilator. Only go to the point where you can tolerate before moving onto the next step.
Now we play the waiting game- use a pillow or rolled-up towel to keep your dilator in place, and focus on breathing into your pelvic floor using the umbrella breath we’ve talked about. Insert further if you can, and if it becomes comfortable.
Using your breath and distraction (heyyy TikTok!), focus on keeping your pelvic floor relaxed. The goal is to get to 15 minutes.
If you get to 15 minutes with no pain, congratulations! The next grade up would be moving it in & out of your vagina (similar to a penis-in-vagina sex motion) 20-30 times without pain as well as starting to practice moving your dilator in circles, side-to-side, and up-and-down motions.

Woman with dark hair and a red tank top laying in bed with hands up, stretching after waking up with a smile on her face — Woman happy in bed

When do I know to move up in size?

Once you’re able to tolerate at least 15 minutes with the dilator in place, 20-30 movements in and out of your vagina, and moving your dilator in various movement patterns with no more than a 4/10 on the pain scale (“ugh this is uncomfortable and annoying, but tolerable”), you should be ready to try the next size up.

To try the next size up, you’re going to go back to step 1. Do not expect to be able to do everything you’re currently doing without pain when using the next size up- moving slowly & confidently is key to dilators helping with insertion.

a woman on the bottom holding her hand on the bed while a man is on top of her, they are having sexual intercourse

When should I start having penetrative intercourse again?

Once you’re able to reach the size of the dilator that’s the same (or larger) size as whatever you’re planning to put inside your vagina, you should be good to go!

Some things to keep in mind:

You still need to be fully aroused before having penetrative intercourse- remember, 20-40 minutes of foreplay to allow for the vagina to elongate & widen! This is a rule of thumb for every single woman.
Try using the dilator size that you’ve achieved before having penetrative intercourse to prepare the pelvic floor for penetration.
Anxiety, fear, trauma, and even physiological changes (hormonal changes, pregnancy, childbirth, etc.) can cause the pelvic floor to tighten again. This may be something that you have to consciously work on throughout your life- but having a pelvic floor OT/PT who you trust is huge in this case especially!