How to Use Vaginal Dilators – Physiotherapy Dilator Therapy Guide

Pelvic Floor Physiotherapist guidelines provide information about professional therapy techniques for how to use vaginal dilators safely and effectively.

Read on now to learn how to use vaginal dilators incuding:

  • What is a vaginal dilator?
  • How to start using a dilator
  • Step by step instructions for how to use vaginal dilators
  • Additional dilator therapy techniques for self treatment
  • Precautions when using a dilator
  • When to use dilator therapy
  • Potential benefits of dilator therapy
  • Additional considerations for successful dilator therapy
  • Where to buy vaginal dilators online

How to Use Vaginal Dilators Guidelines

Vaginal dilator therapy is ideally implemented following thorough medical assessment and diagnosis.

Dilator therapy is often used at home in conjunction with concurrent treatment by appropriately trained health professionals including pelvic floor physiotherapists, oncology nurses and counselors.

What is a Vaginal Dilator?

Velvi Vaginal DilatorsA vaginal dilator is a therapy device used to prevent and treat problems including pain and anxiety with vaginal penetration.

Vaginal dilators are also known as retrainers.

Dilators are usually available in specially designed dilator kits. Dilator kits contain a range of different sized dilators to allow for appropriate size and progression of treatment over time.

Velvi Vaginal Dilators have a unique small sized dilator for the comfort of women starting out treatment (shown right).

How to Start Using Vaginal Dilators

These guidelines are intended as general information. Please follow the directions of your treating medical professional.

  • Start with the smallest size dilator. Gradually progress the size of the dilator over successive treatments as comfort permits.
  • Select an appropriate time and a warm comfortable place that allows uninterrupted relaxation.
  • Position your body lying down with your legs bent. Place pillows or  cushions under your turned out thighs to allow your leg muscles to completely relax.
  • Warm the dilator before using it by wrapping it in a flannel for 5-10 minutes to slightly warm it (avoid making the dilator too hot and test the temperature on the inside of your wrist before applying).

How to Use Vaginal Dilators Step-by-Step

Step 1 – Lubrication

Place a small amount of natural water-based personal lubricant on the tip of the dilator. Avoid lubricants containing petrochemicals as these can cause pelvic floor tissue irritation and exacerbate pain.

Step 2 – Breathing

Focus on your breathing using a series of slow deep breaths. Try to breathe with relaxed deep breaths so that your belly rises with the in breath and falls with the outbreath. This breathing technique for pelvic floor relaxation is called diaphragmatic breathing.

Continue diaphragmatic deep breathing for up to 5 minutes at the outset of the session.

Pelvic Pain and Pelvic Relaxation Therapy for Women

Pelvic Floor Muscle Relaxation Download teaches you how to breathe and relax your pelvic floor during dilator treatment at home.

This Physiotherapist CD teaches pelvic floor muscle relaxation. This is ideal for use with vaginal dilator treatment.

Research suggests that women who use meditation and music during vaginal dilator therapy may have better long-term outcomes¹.

Step 3 – Scanning

Scan your body for any areas of muscle tension from the top of your head to your toes.

Notice any muscular tension around your eyes, jaw, throat, shoulders, buttocks and legs. Mentally encourage each area to relax and loosen with each breath out. As you exhale, let the vaginal area soften with each breath. Visualize or imagine this area in a state of softness and softening further with every breath out.

Step 4 – Dilator Insertion

  • Rest the narrow end of the dilator against the vaginal opening continuing relaxed diaphragmatic breathing.
  • Gently insert the end of the dilator just into the entrance of the vagina when you feel ready to do so.
  • Gradually insert the dilator to a tolerable depth within your vagina. Keep the level of discomfort minimal and if you feel any discomfort pause for up to a minute at a time, continuing to breathe and relax your pelvic floor.
  • When discomfort has eased, progress further as tolerated stopping at regular intervals to accommodate your body to the sensation and lengthening of the tissues.
  • Never force the dilator beyond the level of personal comfort.

Step 5 – Dilator Withdrawal

When you have finished, gently withdraw the dilator and allow yourself to rest and recover before getting up.

Wash the dilator with warm soapy water, thoroughly dry and store.

Frequency and Timing Dilator Therapy

Aim to use your dilator for 5-10 minutes each session however when starting out this time frame may be much shorter according to individual tolerance.

Aim to complete dilator therapy for at least 3 alternate days of the week. Research suggests that women who use vaginal dilator therapy longer than 3 months have a trend towards improved treatment outcomes¹.

Women often need to use dilator therapy for an indefinite time course, especially since vaginal changes can still occur for up to 5 years after radiotherapy.

How to Use Vaginal Dilators – Therapy Techniques

The following vaginal dilator techniques for lengthening tissues and minimizing adhesions should never feel painful.

These are the types of dilator therapy techniques that may be discussed with your therapist or doctor regarding their suitability for use:

  • Gradually increasing the depth of dilator penetration
  • Gently rotating the handle of the dilator
  • Massage in a circular motion
  • Moving the dilator diagonally i.e.forwards and backwards, and left to right motion
  • Moving the dilator in and out of the vagina while maintaining gentle pressure against the vaginal wall
  • Maintaining gentle pressure against an area of discomfort for up to 60 seconds
  • Progressing the size of the dilator
  • Involving your partner in dilator therapy.

Precautions Using a Dilator

Some of the important precautions to take when using a dilator include:

  • Keep discomfort to a minimum when using a vaginal dilator
  • Avoid using a dilator with active pelvic infection
  • Avoid using a dilator immediately following pelvic surgery. Be guided by your specialists’ recommendations regarding all forms of postoperative vaginal penetration and dilator use.
  • Slight vaginal loss and blood staining is not uncommon following dilator use. In cases of pain or heavy vaginal loss then seek medical advice and referral for ongoing support and management.
  • Never use someone else’s dilator
  • Clean and dry your dilator thoroughly after use

When is Dilator Therapy Used?

Dilator therapy is used for a range of pelvic floor problems including:

  • Shortened or narrowed vaginal canal resulting from gynecological surgery
  • Pelvic floor muscle spasm (increased pelvic floor muscle tension or overactive pelvic floor muscles)
  • Reduced vaginal elasticity, narrowing and adhesions resulting from pelvic radiotherapy
  • Dyspareunia or difficult and/or painful intercourse
  • Vaginismus or involuntary/painful pelvic floor spasm with attempted vaginal penetration
  • Psychological problems and sexual health issues associated with vaginal penetration

Benefits of Dilator Therapy

When used appropriately, potential benefits of dilator therapy can include:

  • Improved physical comfort with sexual intercourse after pelvic floor surgery with scarring and narrowing and/or shortening of the vagina
  • Allowing pain free sexual penetration by training pelvic floor muscle relaxation
  • Reducing pelvic floor muscle tension or spasm with vaginismus
  • Overcoming fear of vaginal penetration
  • Prevention of adhesions/fibrosis from forming during and after pelvic radiotherapy
  • Allowing for use of tampons
  • Facilitating ease of gynecological examination.

Additional Considerations for Successful Dilator Therapy

There are some important considerations to be taken into account before and during dilator therapy.

Considerations include:

  • Whether or not to use dilators during the course of pelvic radiotherapy (as determined by the treating medical specialist)
  • Decreased vaginal lubrication with menopause and/or oophorectomy (removal of ovaries)
  • Thinning of the vaginal tissues with menopause
  • Concurrent counseling for associated emotional issues
  • Relaxation education and training
  • Involvement of a partner with dilator therapy.


  1. Liu M, Juravic M, Mazza G, Krychman ML. Vaginal Dilators: Issues and Answers. Sex Med Rev. 2021 Apr;9(2):212-220. doi: 10.1016/j.sxmr.2019.11.005. Epub 2020 Jan 31. PMID: 32014450.
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We Welcome Your Comments


  1. will this (dilator therapy) be able to cure vaginismus permanently?

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Dewi
      For some women it can while others may need to use dilators at intervals if the pelvic floor muscles become tightened again.

  2. Anonymous lightskin says

    Hi there, I’ve bought a set of dilators and I have diagnosed with vaginismus(absence of vagina) I don’t get my period.. So I’ve been told I need to use dilators in order to have sex. I am 21 and still a Virgjn. I’ve been with my boyfriend for 5 months now and I really want to be able to have penetration with him. Would dilating twice or three times a day speed up the process?
    Thank you

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      More frequently is not necessarily ‘better’ treatment. It’s more important that you’re relaxed and take your time using the dilators correctly when you do use them. Vaginismus is pelvic floor muscle spasm and this needs to be managed carefully with a combination of breathing, relaxation and perhaps dilator or other therapy. You will usually get the best result from consulting with a Pelvic Floor Physiotherapist (as opposed to a regular musculoskeletal physio). I hope this helps you, all the best!

  3. Im 50 years old and had a full hysterctomy 2 years ago. Ive not been in a sexual relationship for 20 years but ive been friensmds with someone for 5 years and we would like to take it further. He cannot penetrate as im too tight! Would dilators help? He has been fingering which is great but i would like more

    • Michelle Kenway Physiotherapist says

      Hi Jayne

      Yes dilators can be an effective way of allowing for penetration. These are usually used in a progressive manner starting with the smallest dilator and gradually working through to larger sizes. Dilator treatment needs to be accompanied by relaxation including breathing techniques. It can also help to practice pelvic floor relaxation strategies such as those shown in this pelvic floor relaxation video

      All the best

  4. Hi I had vulvar cancer almost 3yrs ago and had radiation but the Tumor came back less than a year later. I then had a full vulvectomy and had to slowly go thru the process of reopening my vagina as the space was the size of my baby finger after. It cannot be opened any bigger so I have been using dialators but have reached the point where I can’t seem to move beyond the 3″ circumference dialators without excruciating pain! So frustrated Tried creams & numbing gels with no luck. See my dr. Every 3mths. What is my next option?

    • Michelle Kenway Physiotherapist says

      Hi Wendy
      Thanks for your comment, I think you’re dealing with a number of factors. It’s difficult to know whether you’re just dealing with scarring and tissue tightness – there must be a lot of scarring having had the 2 surgical procedures. I wonder how much pelvic floor muscle tension is involved too if any? A good way of knowing would be seeking an assessment with an experienced Pelvic Floor Physio – some Physios do manual therapy that can help to release tissues. I think this would need to be managed in conjunction with your gynaecologist, perhaps he/she can recommend someone? Otherwise your gynaecologist may be able to suggest a procedure to assist you too? Obviously it’s important to continue with the dilators using them in a pain-free comfortable manner to maintain the gains you’ve already made and perhaps he/she can assist you with medication for your own self treatment. I am thinking out aloud here – I will be very interested to hear how you progress in the future with this issue. I wish I could help more.
      Best wishes

  5. Hi I’ve just undergone a full hysterectomy to get rid of endometrial and cervical cancer I am now about to start 25 sessions of radiotherapy to rid of some stray cells which have been detected yesterday I was told I would need dictators how long will I have to use these? I’m devastated as I e never needed or had any symptoms of vaginal discomfort
    I understand its cos of the radiation…I’ve been married 37 yrs and he’s so supportive but I just feel a emotional wreck

    • Michelle Kenway Physiotherapist says

      Hi Denise
      Yes you must feel emotionally wiped out. Just take your time progressing the dilators according to your personal comfort. Changes can occur for years following radiation therapy so it’s possible you will be using them (less frequently over time) for a number of years to maintain vaginal length and flexibility.
      All the best on your journey

  6. Hello I’m 39 years old and had sex for the first time a couple of months ago because I have always been scared it would hurt.
    It was not painful but very uncomfortable but unsuccessful he did not manage to fully penetrate me.
    Unfortunately I had heavy bleeding went to hospital and had 3 cervical tears and had to have stitches.
    I spoke to my doctor and he recommended dialators so I would get used to penetration.but I’ve looked in the mirror and can’t see my vaginal opening ! I don’t know what to do , how will I attempt to use them? I am terrified of the initial insertion even though I now know it doesn’t hurt but is very uncomfortable
    Please help if you or anyone else can give me advice I would be most grateful.

    • Michelle Kenway Physiotherapist says

      Hi Jehnna
      You are obviously having a really tough time with this. I suggest that you access some professional assistance either via a Gynaecologist or a Pelvic Floor Physiotherapist to help you with appropriate therapy.
      I wish you all the best

  7. I’m about to start using these dilators after problems following childbirth. An undetected burst episiotomy left me with scar tissue creating a ‘band’ in my vagina and penetration is uncomfortable and sometimes painful. I’m hoping this will work as I’m reluctant to have corrective surgery in case the problem worsens!

  8. I am 2 years post menopause, 48yo. I never had problems with penetration until 4 months ago when I pressed hard against my husband during intercourse and felt a quick pain. I assumed it was dryness, that I had rubbed the skin just below my urethra, but the next day I had a bulge there. Dr diagnosed prolapse. I have been doing pelvic floor exercises and estradiol.p and getting better, so we tried to have sex again, well lubed, but penetration was incomplete, the skin felt like it hurt to stretch inside so we stopped after a short time, and sadly the bulge is back! I am back to square one and am so disappointed. Dr kept assuring me sex won’t make it worse, but it did. Do I fit the profile of someone who could be helped by a vaginal dilator? I can’t have sex if it means I am hurting myself. But obviously I do t want to give up on sex if there is any chance I can get it back!

    • Michelle Kenway Physiotherapist says

      Hi Susan

      Thanks for your email. Yes progressive dilator therapy is used for problems with penetration. Starting with the smallest size dilator and progressing as tolerated. It can really help to use the pelvic floor relaxation CD to accompany home therapy (specifically designed to complement home dilator therapy). Ideally treatment is implemented by a Pelvic Floor Physiotherapist and backed up with home dilator therapy.

      I hope this helps you Susan
      Kindest regards

  9. Charlotte says

    I have been diagnosed with vaginismus and have been using vaginal dilators for a while now. I made steady progress moving up the first three sizes but have not been able to use number four. I moved back into my parent’s house instead of living with friends and feel I don’t feel as comfortable using the dilators at home. Do you have any advice about how to progress or any other techniques which may be useful to me??

  10. rosy see says

    I would like some information on where I can buy just the vaginal dilators in my home town Melbourne Australia.
    I see I can buy them on the internet but I don’t wont to do this.
    Best regards

  11. Miss newman says

    I was diagnosed with lichen planus over a year ago and have recently entered a new relationship after my husband left me 6 mths ago , I have tried sex with my new partner but the pain is awful and I wondered if dilators would help ? I’m panicking I’m never going to resume a healthy sex life ? My gp has said that I am very small down there caused by the lp ? Any advice would be great ? X

    • Michelle Kenway says

      Hi Miss Newman

      Yes I can see how this must be a worrying issue for you however if you can try not to panick – there is alot that can be done to overcome painful intercourse and worrying can actually make things worse. My first suggestion is to see if you can access treatment from a trained Pelvic Floor Physiotherapist so that she can help diagnose the problem and treat appropriately, I am not sure which country you are writing from and how readily available Pelvic Floor Physiotherapy treatment is – let me know if you can. Have you been referred to a gynaecologist for treatment?

      Another good place to start is by reading this information on pelvic floor muscle tension to understand the importance of pelvic floor muscle relaxation with painful intercourse. Pelvic floor relaxation strategies are usually used in combination with dilator therapy in a progressive manner for women who experience painful intercourse.

      Let me know what action has been suggested by your doctor if you can
      Kindest regards

      • Miss newman says

        Thank you for your quick response , my gp is referring me back to my dermatologist ? ( I’m from the uk ) I’m wondering if in the mean time it’d be a good idea to try a dilator ? X

        • Michelle Kenway says

          Hi again
          Great that you are seeing a dermatologist! Wait until after you have done this before any dilator treatment – your dermatologist may also provide you with some analgesic cream to help with dilator use. If you commence dilators without relaxation strategies or pain relief, you may simply aggravate the situation. Explain what you are seeking to do with your dermatologist (to help relax your pelvic floor muscles). Once again a pelvic floor physiotherapist would be able to assist you here too. Always keen to hear how you go – it helps other women too!
          All the best

  12. Hey there

    I was abused as a child and not sexily active now but freed out when need to do a smear test, or when using Tampons will this help with being able to do a smear test.

    • Michelle Kenway says

      Thank you for your comment – when women have been sexually abused they can develop increased pelvic floor muscle tension or tightness making smear tests, using tampons and sexual penetration painful, in addition to the psychological issues that often accompany this problem. This means that treatment is often multifaceted using pelvic floor muscle relaxation techniques along with vaginal dilators in a progressive manner (small to larger size) as well as addressing psychological issues with counselling. I hope this helps you with some direction.

      All the best

  13. Melody Thomas says

    Should the largest dilator be the size of my spouse? The dilators I have found are just under .5″ in diameter smaller than my spouse.

    • Michelle Kenway says

      Hi Melody
      It is usually best to start with the smallest most comfortable dilator and progress from that point onwards and gradually over time. Don’t forget that the dilators are manufactured from rigid material so they don’t necessarily need to be larger than your spouse. Progress as appropriate and you will know whether you require a larger size having oved through the various sizes. Take your time with your progression and focus on pelvic floor relaxation techniques outlined in this article too.
      Best of luck

  14. I have had prolapse surgery and now my virgina is narrowed about mid way up. I am about to start to use dilators and a vibro massage machine plus I will be taking hormone suppositories. What sort of time scale should I expect before there is an improvement? In what % of cases is this treatment successful. I intend to use the treatments regularly and am willing to be persistent.

    • Michelle Kenway says

      Hi Anne
      This will really vary from one woman to the next according to scarring and pelvic floor muscle tension if this is exists too. Some women find improvements within the first 3-4 weeks whilest for others it can take a number of months. Again in erms of success this varies according to different factors including compliance with treatment, the extent of scarring, and whether or not manual physiotherapy is being used in conjunction with the treatment. If you are in doubt or have difficulties seek the assistance of a pelvic floor physio to assist you as you progress.
      Best of luck

  15. I just found your site! I had a total abdominal hysterectomy 6 months ago and have been suffering with pelvic floor dysfunction ever since. I am working with a PT and one of the treatment protocols is using an at home e-stim. I am not finding this particularly useful – in fact my pain usually flares up after a session. I have read that use of vaginao dilators can help tight muscles and muscles spasms (I particularly have issues with the levator ani a muscle) even better than an e-stim machine and in a shorter amount time. Is this accurate and do you think the use of dilators could help me? Thank you for your work and time in educating and helping women with this insidious dysfunction.

    • Michelle Kenway says

      Hi Terry
      Thank you for your comments. My apologies I can’t comment on the best treatment for you in this situation. What I can say is that if you are being treated for pelvic pain, then if treatment aggravates the pain then this definitely needs to be discussed with your treating physiotherapist. A range of treatments including vaginal dilators can be used to treat pelvic floor muscle spasm – I think this article on pelvic floor muscle tension covers treatment options quite comprehensively so it could be worth you having a read of this information too. I hope this equips you with a little more knowledge to help towards overcoming this challenging issue.

      • Thank you for your quick and informative reply Michelle.
        Thank you for the article link which I found very helpful. I will bring the article and discuss it with her.
        Thank you again for the work you are doing to help suffers of Pelvic Pain.

  16. after been examined and exclaimed by physiotherapist I suffer from a prolapse just been reading about Vaginal Dilators and I think this would work better for me,
    I think it would work much better than popping a finger and squeezing and holding
    as I have to lie down during this treatment .

    As i work a full day would I be able to leave the Vaginal dilator in my Vagina

    • Michelle Kenway says

      Hi Glenys
      You would not be able to use a vaginal dilator during the day at work – dilators are used during the course of a treatment session and then must be removed. They can be used by women at home but need to be used lying down.