Internal Stretching of the Pelvic Floor With a Dilator

For Dyspareunia, painful PAP exam, etc)

Dilators are tube shaped devices that come in varied sizes. They allow you to gradually stretch and desensitize the soft tissues of your vagina. By working through the different sizes you will slowly build confidence in your ability to have insertion into the vagina. It is common to start by first just holding and looking at the dilators. Then, as you are comfortable, progress to inserting the smallest dilator and just letting it rest in the vagina. This is the perfect time to practice your relaxation techniques. When you are ready, follow the guidelines below including moving the dilator to stretch the tissues. Usually you will use 1-3 sizes of dilators in each session. As one size becomes easy, progress to the next size. Your therapist will assist with how slowly/quickly to progress. There are many important factors to consider regarding the use of dilators especially when your goal is to have pain free penetration. Please stay in PT and stay in touch with your therapist to be properly guided through this process.

Plan:

• Set aside ___________ minutes most days to utilize your dilators

Supplies:

• Vaginal Lubricant

• Mirror (optional)

• Gloves (optional)

• Dilator(s)

Positioning:

• Rest in a sitting position with your back and legs supported by pillows. Some women find it most comfortable to do this in the bathtub or on their bed in a semi-reclined supported position.

How:

• Wash and dry your hands. Wash and dry your dilators.

• Apply lubricant to the outer skin of your vagina and to the dilator that you will be using.

• Use one hand to gently spread the skin (labia) away from the vaginal opening. Place the dilator at the opening of the vagina

• Perform a gentle pelvic floor muscle contraction if you can. As you feel the relaxation, gently and slowly insert the dilator into the vaginal opening. Direct the dilator slightly downward towards the bed/floor. Insert the dilator 2-3 inches in as long as it is not painful. If it is painful only insert as far as you can without increasing your pain.

• Stay relaxed and gently stretch directly downward.

• Hold this stretch for _______seconds and repeat ______ times.

• Gently move the dilator to the right and apply pressure so that a gentle stretch is felt.

• Hold this stretch for _______ seconds and repeat _____ times.

• Gently move the dilator to the left and apply pressure so that a gentle stretch is felt.

• Hold this stretch for _____ seconds and repeat _____ times.

• If your therapist has recommended that you use different sizes of dilators during each self care session progress to the next size dilator and repeat the above steps.

• Once this is comfortable and simple for you to perform in sitting/semi-reclined you can progress to doing this in standing with one foot on the tub or a chair. This is a good stretch to do in the shower.

****If you feel yourself tighten up at anytime during this; decrease the amount of pressure you are using.