Vaginal Dilators May Be the Answer to Relieving Painful Sex — Here's What to Know

It's understandable if you have never used a vaginal dilator before or don't know about the benefits of using one; they largely fly under the radar. These tube-like tools, which come in varying sizes, are meant to be inserted into the vagina to help treat several different vaginal health conditions, one of the more common being pain during sex.

For many people with vulvas, they can be incredibly helpful. And the FDA recently approved Milli, the first and only FDA-cleared vaginal dilator designed to specifically help with vaginal tightness.

That said, vaginal dilators aren't something you just order off Amazon on a whim. To help demystify the device for you, we spoke to experts about exactly how vaginal dilators work, how they're used in vaginal dilator therapy, when they're recommended, and more.

Also know as vaginal trainers, vaginal dilators are long, cylinder-like objects meant to be inserted into the vagina to help decrease pelvic floor muscle tension, decrease sensitivity at the vaginal opening, and improve the flexibility of the vaginal canal, says Rachel Gelman, DPT, Intimina's pelvic floor health expert.

Though most people think vaginal dilators are meant to "stretch out" the vagina, they're really used to "calm down a stressed-out vagina," says Jess Seitz, an occupational therapist and vaginismus recovery coach.

Typically, vaginal dilators come in a set of around four to eight various sizes, "with the smallest size usually being smaller than a finger, and the largest being around the size of a standard penis," Seitz says. And while they share a similar resemblance to dildos and other sex toys, these devices are purely designed for medical use and should only be used after a recommendation from a medical professional or as part of pelvic floor therapy.

Vaginal dilator therapy is a form of therapy that uses vaginal dilators to "teach and retrain the pelvic floor muscles to respond to penetration in a positive, nonthreatening way," Seitz says.

During this therapy, a pelvic health specialist inserts the smallest vaginal dilator to "gently acclimate the nervous system and the pelvic floor muscles to safety" in an effort to prevent a patient's pelvic floor from contracting reflexively upon penetration, physiotherapist Chana Ross explains.

Seitz says the goal is to "strategically work on muscle relaxation at the vaginal opening," in addition to using tools like nervous-system regulation and pelvic exercises to aid with insertion.

Anyone with general pelvic floor dysfunction or pelvic health conditions could benefit from vaginal dilator therapy, but as Seitz notes, vaginal dilator therapy is generally a "great tool to help give our pelvic floor muscles feedback as we strengthen and relax different areas."

Vaginal dilators or vaginal dilator therapy can be used to treat a few different health conditions and issues, but one of the most common is sexual dysfunction caused by estrogen deficiencies, like during menopause.

Low estrogen levels can cause the skin of the vagina to thin and become less lubricated, which in turn can make sex particularly painful, says Lucky Sekhon, MD, ob-gyn, reproductive endocrinologist, and infertility specialist. According to Memorial Sloan Kettering Cancer Center, this vaginal issue may also result after certain cancer treatments. The use of vaginal dilators in these instances can help stop the vagina from losing its elasticity.

Vaginismus is another condition where vaginal dilators might be beneficial. Vaginismus is when the pelvic floor muscles involuntary contract and make any type of vaginal penetration — like penis-in-vagina intercourse, tampon usage, or dildo usage — painful, difficult, or even impossible, Dr. Gelman explains. During sex, some people who experience vaginismus may also note that it feels like their partner is "hitting a wall."

"A dilator can be helpful to teach a person's muscles to relax in response to penetration," Dr. Gelman explains. "A person starts with a small dilator and gradually increases the size to match the size of whatever object they are working towards." This, for example, might mean a tampon, an erect penis, or a dildo.

Vaginal dilators may also be recommended for people who have had reconstructive surgeries or surgeries on their vagina, Dr. Sekhon adds.

Vaginal dilators should never be self-prescribed. Patients should always consult a medical provider prior to using these tools, Dr. Gelman says, as certain symptoms might actually be due to other causes and would require different treatment plans. But if you've received the OK to work by yourself, here are some tips on how to use a vaginal dilator, according to Seitz.

Begin by choosing the right dilator size. Seitz recommends starting with the smallest dilator, which will typically be around half an inch in diameter and two and a half inches long. You can even begin by using your finger if the vaginal dilator seems a bit too intimidating or big. (If you have more questions about what size you should be using, don't hesitate to ask your pelvic health professional.)

Then, choose a comfortable position to lie in. "Some women prefer to lie on their back with their knees bent and feet flat on the bed, while others prefer to lie on their side with their legs slightly bent. Choose what relaxes your muscles the most," Seitz says.

Then, connect your mind and body. Using a dilator is not all about the physical sensations; it largely has to do with making sure your mind is in the right headspace, Seitz says. Before insertion, you can practice deep breathing techniques like the 4-7-8 method, which is when you inhale through your nose for four seconds, hold your breath for seven seconds, then exhale through your mouth for eight seconds. You can also put on some calming music, light a candle and dim the lights, or do anything else that might help you relax. "Some women also find it helpful to journal about each dilator session to help their minds disconnect from the pain and connect with positive experiences with penetration," Seitz says.

Once you're comfortable, apply a water-based lubricant to the dilator (or your finger) and around the entrance to your vagina. (One recommendation: Good Clean Love's water-based lubricant ($12), which is hypoallergenic and made free of parabens and harmful ingredients.) Apply the lube to these areas so the dilator will slide in more easily and also reduce any discomfort.

Before you use the dilator, you'll want to warm up your body. Seitz says to use a mirror to first look at your vagina. "Take your fingers and open the labia, and if possible, manually prepare your vagina." She recommends giving yourself an "external vulva massage" in order to "desensitize the vulva and vaginal opening." Essentially, touch your vulva and clitoris in ways that feel good to you.

Once you feel warmed up, it's time to insert the dilator. "Place the dilator on the outside perimeter of your vaginal opening, and apply moderate pressure in a clock-like pattern around the opening," Seitz says. "Then, take slow, relaxing breaths as you open your labia with one hand. With your other hand, on an exhale, slowly insert the tip of the dilator into your vagina."

Slowly insert the dilator into the vagina a little at a time. With each advancement, "complete several squeezes, hold, and release movements with your vaginal muscles," Seitz says. Continue to do this for 15-25 minutes. Note that your pain level should not be above four on a scale of one to 10. If it is, that's your cue to stop and, at another time, try with a smaller dilator or your finger.

Once finished, exhale and slowly pull out the dilator. Then, wash the dilator with warm water and fragrance-free soap.

How often you do this will largely depend on the recommendations you receive from your pelvic floor specialist, as they can vary. When using vaginal dilators in general, always speak and consult with a medical expert for more guidance specific to your body and needs.