If you’ve been advised to start vaginal dilator therapy, you might be wondering why there are different dilator sizes. Why dilators are sold in sets? If one dilator is enough? Or which dilator size you should start with? Read on to learn all about dilator sizes, which size to start with, when, and how to move up to the next size dilator, as well as clear instructions on how to use vaginal dilators correctly.
A vaginal dilator is a tube-shaped medical device used to relax and gently stretch the vaginal tissues and pelvic floor muscles, thereby helping to gradually expand the vagina and reduce pain or panic during penetration. Typically made from either medical-grade silicone or plastic, vaginal dilators are available in sets of ascending sizes or can be bought individually.
Whether it’s a teenager’s fear of inserting tampons, anxiety about sex after childbirth, vaginal stress after a traumatic pelvic injury, atrophy post-menopause, or due to an underlying condition such as vaginismus or endometriosis; vaginal dilators help women to get used to the feeling of penetration and ultimately enjoy pain-free sex.
The best answer to this question will come from the gynecologist or pelvic floor physiotherapist who initially advised you to begin with vaginal dilator therapy. Depending on your condition and taking into account that the diameter of a dilator is more significant than the length when it comes to progress, the ‘right’ size dilator to start with is typically the one that you can insert without feeling panic and only a little discomfort.
The smallest dilator, for example, is often compared to the size of a slim little finger and is a common size to start with for women experiencing pain or resistance when inserting a tampon. Postmenopausal women living with vaginal dryness might be advised to begin with the third or fourth size, depending on the psychological impact the atrophy has had on their sex life. And those who are sexually active, but experiencing continued pain during penetration (dyspareunia), might be advised to start with a size or two smaller than the circumference of their partner’s penis and work up from there for more comfort and pleasure during sexual intercourse.
That said, it’s always advisable to check with your healthcare practitioner about the best size dilator for you to start with.
Dilators are available in a variety of sizes, typically ranging from the size of a woman’s pinky finger to an average-sized erect penis. Most full sets have a range of vaginal dilators in various sizes to choose from, starting at 0.45 inches in diameter and 2.8 inches long to 1.5 inches in diameter and 6.5 inches long.
This will depend on the reason behind your vaginal dilator therapy. Bearing in mind that the purpose of a full dilator set is to encourage patients to start gently with the smallest size and gradually ease up to each ascending size once the vaginal tissues and muscles are adequately relaxed and lengthened, healthcare practitioners will often recommend patients to buy an entire dilator set. Other patients, however, might be advised to purchase only two or three of the various sizes as in the cases mentioned above.
In most cases of post-surgery therapy for a vaginal septum, an imperforate hymen, or cervical cancer, as well as women recovering from radiation treatment, the use of an entire dilator set is commonly recommended. A complete range of dilator sizes is also recommended for women recovering from sexual abuse, traumatic pelvic injuries, or severe dyspareunia.
Dilator therapy can certainly be uncomfortable, but it should not be extremely painful for the duration of your session, and if it is you might want to think about moving down a size in dilators. Most women starting with vaginal dilator therapy will feel pain when the dilator is inserted for the first time, however, as you breathe, the level of pain should decrease within a few minutes to a feeling of mild discomfort as your vaginal tissues begin to relax and lengthen.
When patients begin dilator therapy, gynecologists and pelvic floor physiotherapists generally advise their patients to use the recommended starting size for a few weeks. According to each case, they will also advise how many times per week dilator therapy should be done at home and how long each session should last.
Once you feel relaxed using the smaller size and you can fully insert it without feeling any discomfort, you are ready to transition to the next size up.
Moving to the next size up is typically done gradually over a few days by starting each dilator session with the smaller size and using the next size up for a minute or two at the end of each session. Easing into the next size dilator over a few days like this helps to build your confidence regarding penetration and gradually reduces the discomfort of inserting a bigger size.
Once your gynecologist or pelvic floor physiotherapist has determined the correct dilator starting size for you, they will recommend that you practice regularly at home for best results.
Here is what vaginal dilator therapy entails:
Vaginal dilator sizes vary from the size of a small finger to an erect penis and are designed to relax and progressively stretch the vaginal and pelvic floor muscles for less discomfort and more pleasure during sex. When used regularly and consistently, vaginal dilator therapy helps to relieve symptoms associated with pelvic pain disorders, vaginismus, and dyspareunia, in addition to rejuvenating the vaginal muscles after menopause, surgery, or radiation treatment.
To understand all about dilator sizes and which one is right for you, read our guide above, or speak with a gynecologist or pelvic floor physiotherapist in your area for guidance. You can also see our guide to the best vaginal dilators as ranked by a DPT.
Mayo Clinic – Dysapeurnia - https://www.mayoclinic.org/diseases-conditions/painful-intercourse/symptoms-causes/syc-20375967
Science Direct - Low Dose, High Frequency Movement Based Dilator Therapy for Dyspareunia - https://www.sciencedirect.com/science/article/pii/S2050116121000246
BMC Women’s Health - Women’s experiences of using vaginal trainers (dilators) to treat vaginal penetration difficulties diagnosed as vaginismus: a qualitative interview study- https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-015-0201-6
My Health Alberta – Female Sexuality & Cancer: Vaginal Dilators https://myhealth.alberta.ca/cancer-and-sexuality/female-sexuality-and-cancer/vaginal-tightness/vaginal-dilators
Cleveland Clinic - https://my.clevelandclinic.org/health/diseases/15723-vaginismus
National Library of Medicine - Management of Recurrent Stricture Formation after Transverse Vaginal Septum Excision - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442265/
National Library of Medicine - Dilator Use following Vaginal Brachytherapy for Endometrial Cancer: A Randomized Feasibility and Adherence Study - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5650953/