Home Ask the Experts

Dilators for Endometriosis

Written by Emma McGeorge

Endometriosis is a painful condition that affects up to 10% of women of childbearing age. For some, the pain is manageable, while others experience severe discomfort during menstruation, heavy periods, painful sex, and infertility. Following the advice of their pelvic physiotherapists, many women are now using dilators for endometriosis. For more information on how vaginal dilators are helping women with endometriosis, read on.   

What Is Endometriosis?

Endometriosis is diagnosed when the tissue that is similar to that found on the inner lining of the uterus (endometrial tissue) begins to grow outside of the uterus. This tissue can wrap itself around several of the pelvic organs including the fallopian tubes & ovaries and occasionally grow in the rectum, bowel, bladder, and urinary tract. 

Symptoms of Endometriosis

Symptoms associated with endometriosis include severe and often long-term pelvic pain, particularly before and during menstruation, in addition to heavy periods. Dyspareunia, also known as painful sex, is a common symptom of endometriosis, as well as unexplained weight gain. If the bowel, bladder, or urinary tract are affected by endometriosis, patients might also feel pain during urination or bowel movements. And if the ovaries are affected, ovarian cysts can form. 

For some women, endometriosis presents no symptoms at all, and they become aware of the condition only when they have surgery for another reason, or when experiencing fertility issues. 

What Causes Endometriosis?

What exactly causes endometriosis is unknown, however, researchers have linked the growth of extra endometrial tissue outside of the uterus to the following possibilities: 

  • It is also believed that women who experience hormonal imbalances with higher levels of estrogen can be susceptible to endometriosis. 
  • Another possibility proposes that endometriosis could run in the family and be passed on genetically. 
  • While an alternative theory suggests that endometrial tissue could be transplanted outside of the uterus during surgery like a cesarean section. 
  • The last theory suggests that endometrial tissue might have the ability to travel through the blood or lymphatic system and implant itself in other parts of the body. 


Dilators for Endometriosis

Recommended by pelvic floor physiotherapists to treat endometriosis, medical devices known as vaginal dilators can help in several ways. 

Firstly, dilators help to relax tight pelvic and vaginal muscles, which in turn helps to relieve the pain associated with endometriosis. Dilators also have the ability to gently stretch and soften scar tissue that develops due to the condition. 

Additionally, using vaginal dilators can help rebuild a woman’s confidence in vaginal penetration after experiencing painful sex (dyspareunia) due to endometriosis. Dilators do this in two ways – physically and psychologically. 

Physical Benefits of a Dilator for Endometriosis

While pain medication works well to relieve menstrual aches connected to endometriosis, most women report that pain medication does little to ease the discomfort during sex. On top of that, the medication that endometriosis sufferers take to rebalance hormones can cause vaginal dryness or atrophy, which further contributes to painful sex (dyspareunia). 

Dilators can help by mobilizing the tissue in the vagina gently, improving the sensory awareness of the pelvic floor muscles during penetration, and increasing blood flow to the vaginal muscles and improving natural lubrication to ensure intercourse becomes a more pleasurable experience. 

For example, in a recent study, 26 women with dyspareunia associated with endometriosis as well as other conditions underwent dilator therapy for up to 10 months between 2 and 6 times per week. The average pain score reported during sex decreased from 8.3 before dilator treatment to 1.3 after treatment and 58% of the women reported that their dyspareunia was completely resolved.  

Psychological Benefits

Psychologically speaking, dilators are designed to address the fear that endometriosis patients harbor regarding penetrative sex, due to the pelvic and vaginal pain that the condition can cause. This type of fear initiates a panic mode in the pelvic area, triggering the vaginal muscles to spasm and constrict at the thought of penetration, which ultimately results in painful sexual intercourse (dyspareunia).    

By beginning with the smallest dilator, typically the size of a small finger, patients learn to relax and gently stretch the vaginal muscles until the size feels comfortable inside the vagina. Moving up through the ascending dilator sizes gradually eradicates the muscle memory and anxiety associated with vaginal penetration. 

Through this slow and steady process, vaginal dilators help women to rebuild confidence and feel more comfortable when it comes to sex with a real penis.    

How to Start Vaginal Dilator Therapy for Endometriosis

The first step when considering using a dilator for endometriosis is to speak with your doctor, healthcare provider, or a pelvic floor physiotherapist for guidance. Once they have carried out a pelvic exam, they will recommend the size of dilator you should start with. They will also explain how to use a dilator, how many times you should practice at home, and for how long. 

Once the starting size dilator feels comfortable to insert and leave in the vagina for 10-15 minutes up to three times per week, you will be advised to move on to the next size, and the next, until a dilator the size of an average penis feels comfortable in your vagina.  


For many women, endometriosis can be debilitatingly painful, affect their fertility, and result in severe discomfort during sex. While the exact cause remains unknown, dilators have been proven to help treat endometriosis symptoms by relaxing tight pelvic muscles and softening scar tissue, as well as reinstating women’s confidence and pleasure in sex after dyspareunia. 

If you are suffering from any of the above symptoms, schedule a pelvic exam with your healthcare practitioner to understand if you are a candidate for vaginal dilator therapy. With dilators, you can learn to treat your endometriosis naturally from the comfort of your own home.     


Endometriosis Foundation of America – What Is Endometriosis - https://www.endofound.org/endometriosis

The American College of Gynecologists and Obstetricians – Endometriosis - https://www.acog.org/womens-health/faqs/endometriosis

National Library of Medicine - Low Dose, High-Frequency Movement Based Dilator Therapy for Dyspareunia: Retrospective Analysis of 26 Cases -  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240346/