vaginal
Treatments
WHAT IS IT?
After menopause the vagina gets drier, less stretchy, narrower, and shorter. These changes can make the vagina feel too tight and make sexual penetration painful. Vaginal dilators are tube-shaped devices, usually made of plastic. They are used to stretch the vagina and make sexual penetration less painful. They usually come in a kit that has dilators of different sizes. The smallest ones are usually about the size of a finger. You start with the smallest one that is tolerable and increase the dilator size over time. Firm plastic dilators are best because they are better at stretching the vagina than soft silicone dilators.
OUR BOTTOM LINE: DOES IT HELP?
YES. If your vagina feels too tight, and using lubricants, moisturizers or vaginal estrogen has not helped, you could try this therapy. Overall, it is a low risk treatment. It can be very helpful for some people.
Vaginal dilators can work, but many women shy away from using them. If the idea of using them makes you uneasy, or shy, consider talking about it with a women’s healthcare specialist. You may also try pelvic floor physical therapy. Often dilators are used as part of a physical therapy program.
Sometimes women with vaginal problems have difficulty talking with their partner about it. To improve communication with your partner, a counselor can be helpful.
PAIN DURING SEX
There have been very few studies of the use of vaginal dilators in perimenopausal and menopausal women with vaginal tightness and pain during sex. The little data we have indicates that this therapy may be useful.
POTENTIAL RISKS & SIDE EFFECTS
It is normal to have some spotting after using the dilator. Very rarely, a dilator can cause a vaginal tear, especially if excessive force is used. Be gentle, and if having any difficulty, ask your health care provider or physical therapist for assistance with how to place the dilator.
QUALITY OF LIFE EXPECTATIONS
We don’t have any information on whether vaginal dilators help with sexual quality of life.
IF I WANT TO TRY THIS TREATMENT WHAT ARE MY NEXT STEPS?
Vaginal dilators can be purchased online. If you decide you want to try them you might discuss it with your health care provider first. Some health plans provide guidance for using this therapy and may send you to a physical therapist with training in this therapy.
There are many websites with instructions about how to use vaginal dilators. The kits also come with instructions. The dilator is inserted with lubrication, and over time the size of dilator is gradually increased. It should be used 3-4 times a week for 10-15 minutes at a time. Do not use it two days in a row. This gives the vagina time to recover from the stretching.
Kagan R, Kellogg-Spadt S, Parish SJ. Practical Treatment Considerations in the Management of Genitourinary Syndrome of Menopause Drugs Aging. 2019; 36(10): 897–908. Published online 2019 Aug 26. doi: 10.1007/s40266-019-00700-w. PMID: 31452067
Murina F, Bernorio R, Palmiotto R. The use of amielle vaginal trainers as adjuvant in the treatment of vestibulodynia: an observational multicentric study. Medscape J Med. 2008;10(1):23. Published 2008 Jan 30. PMID: 18324333
Authors: Dr. Katherine Newton, & Dr. Leslie Snyder. Last reviewed February 15, 2021
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