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Vaginal Dilator Guide for Patients. Dilators and the Brain? Pain, Fear, and Anxiety

Vaginal Dilator Guide for Patients. Dilators and the Brain? Pain, Fear, and Anxiety

There are different reasons to use vaginal dilators. This particular post focuses on providing dilator information for women facing fear, anxiety, and/or pain with regard to vaginal touch, finger insertion, gynecology exams, use of tampons, and intercourse. My quest to find valuable, comprehensive resources for a guide for dilator use fell short. This is particularly true with regard to understanding that using dilators is NOT just to "stretch the vagina," which is often told to patients. I created documents for patients to use and wanted to share (still a work in process, but isn't it always?!).

Dilators provide an excellent way for women to transition from pain and/or avoidance behaviors to decreased anxiety and/or pain with any and all touch at and inside the vagina. Over the years, I witnessed patients bring in zip-loc bags of dilators and state comments such as "my doctor just handed these to me and told me to use them" or "I got this on the internet but once they started hurting me I stopped using them". They felt lost, alone, and defeated. The most important thing I have found, and we can confirm with research, is that pain (and associated anxiety and fear) is not just happening at a local area of the body - i.e. the vagina. The brain is involved in this process! So, in order to have success with dilators, we should consider using them in a way that facilitates decreasing brain "danger" signals and allows for a positive experience.  I am in the process of developing a full guide to using dilators for various conditions. I prepared a handout guide for my patients and wanted to share it with you.

  • If you are an individual dealing with pain or discomfort and are considering dilators, you can certainly try this guide on your own. However, I suggest working with a highly skilled pelvic physical therapist  (after you have made sure you don't have any other underlying medical diagnoses that should be discussed with your physician) who can guide you through this process and evaluate and treat you with a complete program of care to meet your goals. Directory of pelvic health professionals. 
  • There are also wonderful certified sex therapists, counselors, and educators who can support you through this process as well (best in conjunction with pelvic physical therapy.
  • If you are a physical therapist, physician, physician assistant, sex therapist, sex educator or other medical professional, feel free to provide this handout to your patients as a guide.

This handout is most useful for women who are dealing with conditions such as:

  • pelvic pain,
  • vaginismus,
  • pudendal neuralgia,
  • vulvodynia/vestibulodynia
  • history of sexual trauma. 

Click Here for the PDF You Can Print:

Vaginal Dilator Guide PDF Handout


Here's a preview of the Vaginal Dilator Guide:

Tips for Success:

  • This is a great step! The use of dilators provides the opportunity to transition away from fear and pain and toward your goals. This is for YOU.
  • Be good to yourself through this process. It is a journey. I tell my patients that the journey may have times of frustration and peaks and valleys, but there’s a lot of hope! Remember that you are not “broken” or “less feminine”. Love yourself where you are.
  • Dilators are primarily used in the privacy of your home, however, you can receive help from a qualified pelvic physical therapist trained in teaching you how to use them AND how to progress them.
  • I usually suggest that you use the dilators by yourself and not with a partner initially. The goal is to make sure that YOU feel comfortable and can guide them without any outside pressure. Even a loving partner may mean well, but this may increase your fear or anxiety without you even realizing it.
  • Prior to using dilators, it can be helpful to set the right environment – examples: taking a nice bath before; playing calm, soothing music; meditating or doing breathing exercises; playing guided imagery CDs.
  • Graded Imagery (different than guided imagery): Imagine yourself using the dilator. Picture how you feel and pay attention to thoughts and how you can direct them in a positive way. Imagine yourself without stress, anxiety or pain with the dilator you plan to use
  • You can even use a dilator on the outside of the vulva just to have some touch there and “connection” with the dilator prior to inserting – 1 min to 10 min.

Dilator Use: Ideal to use dilators every day (or night), but this can vary.

    • Position yourself reclined/lying on our back on your bed with your knees bent
    • Place a liberal amount of lubricant (water-soluble) all over the dilator starting with the smallest size (your pelvic physical therapist can also help you decide about the starting size). The recommended lubricant is one that is free of glycol (recommend Slippery Stuff or Sliquid Organics)
    • Slowly slide the tip of the smaller size dilator in - pay attention to how that feels. If you experience NO GREATER tan 3/10 discomfort (not necessarily pain), continue to slowly insert the dilator. You can pause at any time and either hold the dilator at that position or try to slide in further when you feel ready.
  • Allow the dilator to stay in place in a position that does not increase discomfort greater than 3-4/10 (0 is no discomfort or pain and 10 is severe ) fr 10 minutes. Whe you keep the discomfort level relatively low, this reinforces to your brain that the danger/threat level is low and fear/anxiety/pain levels may decrease as a result. This has a reinforcing effect that becomes cumulative during the time you use the dilators.
  • You can repeat the above step for several days and then, you can move on to the next size (or warm-up for a few minutes with the smaller size and then insert the next size). Repeat the process of slowly inserting the dilator, but the key is to make sure the discomfort does not stay increased greater than 3-4/10 (however, for example, a transient 6 that drops quickly to a 2/10 is okay)
  • You can then progress to the following:
    • Use the second dilator your progressed to for 5-7 minutes and then insert the smaller dilator and do gentle movements in/out direction (with discomfort no greater than 3-4/10) Or use the smaller dilator first and do in/out movement for a few minutes, then progress to the next dilator size and hold static for 5-7 minutes for a total of 10 min.
    • The ultimate goal is to progress dilator size at a comfortable pace (this could be weeks or month) so that you are using the largest dilator you choose without discomfort greater than 3-4/10 with movement (for your intended goal - GYN exam, tampon use, sexual activity, etc.)

Additional Options: 

  • Some individuals may progress better after doing a gentle pelvic floor contraction or “Kegel” and then relaxing the muscles while inserting the dilator. This does not work for everyone, however.
  • If you have tight pelvic floor muscles or want more stretching at the walls of the vagina, your pelvic physical therapist can teach you ways to angle the smaller dilators to them for pressure or stretching.
  • You can experiment with different leg or trunk positions as well as angles of insertion for comfort.
  • As you progress and feel comfortable, you can have a partner assist in using the dilators and/or use them as part of foreplay and transition to sexual intercourse if this is a goal.


Additionally, Dustienne Miller has a fantastic guided meditation for dilator use that can be a wonderful supplement to this guide. Click the button below for access!

Please let me know if you use it and if it is helpful for you or your patients! ~ Tracy

You can follow Pelvic Guru on Facebook or Twitter too!

Tracy Sher, MPT, CSCS owns a private physical therapy practice in Orlando, Sher Pelvic Health and Healing. She is an international instructor and faculty member in the area of pelvic physical therapy and is the Founder of Pelvic Guru.  Consider following Pelvic Guru on Facebook too for regular “pelvic” discussions and very regular updates regarding research or articles (and fun stuff too).


If you are interested in more pelvic health education, please see our online platform, Pelvic Guru Academy for some amazing courses.


  1. on August 30, 2013 at 5:11 pm

    Thank You!!! This is wonderful 🙂

    Norene Christensen, PT, DSc, OCS, CLT Four Pines Physical Therapy PO Box 8467 1090 S Hwy 89 Jackson, WY 83002 (307) 733-5577 (307) 733-5505 fax

    • Pelvic Guru on August 30, 2013 at 6:51 pm

      Norene- thanks for the comment! Let me know if there’s anything else you’d like to see on it. This is part of a larger project.

    • Amarah on March 15, 2019 at 6:42 pm

      I’m sorry I can’t find a link to the PDF

  2. Marianne Ryan PT, OCS on August 30, 2013 at 8:57 pm

    Great job Tracy, and thank you for sharing this. It is well written and I am sure my patients will benefit from it.

    • Pelvic Guru on August 30, 2013 at 8:58 pm

      Thanks, Marianne! I couldn’t find anything that explained this in this way. I’m glad it will be helpful!

  3. Mandi on August 31, 2013 at 10:51 am

    Thank you Tracy! I look forward to digging into this more, I’m in the process of changing practices so am taking a good look at all the handouts that have just become second nature to hand out (that are OLD). This will be a good one!

  4. DouglassOrtho&Spine (@DouglassDPT) on September 1, 2013 at 9:32 am

    Tracy, thanks for sharing this work! I have had the same experiences as you, the patient arrives with dilators in a bag and have never been instructed in their use. Or worse, they flinch and tighten just from looking at one! This will be very helpful, I’m sure.

    • Pelvic Guru on December 27, 2013 at 12:57 am

      Thanks for your comment. I see “the bag” very regularly. LOL

  5. Glenna Sears-Brinker, PT, WCS on September 1, 2013 at 2:33 pm

    Tracy, Thank you!. You have put into written word what I have shared verbally with patients challenged with the psycho-emotional and physical issues of pelvic pain. Although each patient’s challenges are unique, you have created a helpful guideline to initiate the healing process. I agree that the brain’s centralization of the fear, anxiety, and pain must be addressed to heal the whole person. I look forward to your future posts. Glenna

    • Pelvic Guru on December 27, 2013 at 12:56 am

      Glenna – thank you very much for taking the time to send in a comment! It’s wonderful to know that this guide is helping clinicians all over, including you. I never know unless you share…so, THANKS!!

  6. Pat Salin Huston on September 1, 2013 at 6:55 pm

    Thanks Tracy for the clear and COMFORTING handout for our patients! I have been using it ever since the course by you and Loretta Robertson a few wks ago. It is much more detailed than what I have used and verbalized. I truly love that it includes language which puts the brain to work to fight pain. Thank you!

    • Pelvic Guru on December 27, 2013 at 12:55 am

      Pat – thanks for your kind words. I am so glad that this is helpful and look forward to sharing more of this sort of info!!

  7. esty on November 20, 2013 at 7:28 pm

    Where can i buy a set from 8
    Same as showing on top page
    I’m trying for a while to find But …………..

  8. Danielle W on December 14, 2013 at 2:25 am

    This is a great guide! Only problem I’m having is finding somewhere that sells a good set of silicone dilators! is in backorder, but their set only comes with six dilators

  9. […] 12. Vaginal Dilator Guide for Patients: Part 1 […]

  10. incostress on December 26, 2013 at 11:21 am

    Superbly written Tracy. Will add the guide to the pelvic organ prolapse group.
    @danielle W try for silicone dilators (go to the gyaneacology section)

    • Pelvic Guru on December 26, 2013 at 11:22 am

      Thank you! I had not seen anything written that included the brain aspect. It’s not just about “stretching” and “forcing”. Cheers!

  11. incostress on December 26, 2013 at 11:22 am

    Reblogged this on Healthy Solutions and commented:
    Ever wondered about Vaginal Dilators and how much help they can be? Here is a fantastic article for you.

  12. Tiffa on December 27, 2013 at 6:43 pm

    I bought the Amelie Comfort dilators set, similar to the one of the second pictures you posted , but with 1 more sizes available, there’s totally 5 of them. I worked my way up from the smallest, and now I have no problem for the forth one. My bf’s size is a little bit bigger than the fourth but smaller than the final size. So I am determined to stretch myself to the last one, the fifth one. But it was almost impossible and painful, is it because I already reached my “maximum”, which I know it’s not since women’s vaginas are made to allow a baby to come thru! Anyone has the problem with the final “graduate size”? Unlike how I worked from the 1st – 2nd – 3rd – and 4th size, I struggled a bit but finally gone thru, but things seemed impossible with the 5th one!

    • Pelvic Guru on December 27, 2013 at 6:48 pm

      Tiffa – remember that this is a journey. Your are doing great! You don’t want to “push and stretch to maximum” if it is beyond a 4/10 discomfort level. I cannot give specific medical advice, but it’s important to know where you have the pain – is it right at the entrance, deep or both? Are you using enough lubricant? Sometimes we teach how to relax the pelvic floor muscles or even “bulge” them to allow the opening to relax (will be in part 2 or 3 coming up soon). Sometimes, patients do well using coconut oil daily at the opening of the vagina to moisturize the area. There are many other strategies, but don’t force it…guide it gently… I hope that helps some.

      • Tiffa on December 30, 2013 at 4:45 pm

        Thanks Tracy, yes, It is very near the entrance where I felt some stronger and harder muscles, every time when the dilator ‘passed’ thru. the rest of the insertion would be smoother. When I realized I’m not able to have sex, with my ex-bf and now-bf, I started to doubt that it is not ‘virginity’, lubrication, or my partner’s problem, so I visited a GP, tried to do a pap test but I cannot stand the speculum at all, it was painful. Then I was diagnosed with vaginismus by my gyne a month ago, after a pelvic examination, a pap test where I raised my tolerance level to as much as I can stand… it was horribly painful but am glad I did a smear, and confirmed there were no physiology problem. When I got the dilator sets I was skeptical, but with self-help like your handouts and some forums, I tried and it actually progress! So I hope my sharing would clear lots of doubts and feeling of frustrations of other women that have the same problems as me. Just believe and keep dilating!

        • Pelvic Guru on December 30, 2013 at 4:47 pm

          Excellent! Thanks for sharing more about your story. There’s so much hope for many out there… Tracy

  13. Anonymous on February 8, 2015 at 9:33 pm

    Dear Ms Sher,
    Two months ago I completed pelvic radiation (for anal cancer). I have used a dilator starting when advised. Your article is interesting, and helpful re pain and progression with the dilator sizes, but I believe that something has been neglected. Perhaps you will address them in articles re sequelae of pelvic radiation.
    You have not addressed how emotionally devastating it is to feel forced to introduce a foreign object into one’s body, to be reminded every time one does so of something ugly (cancer). I am using the dilator, but it breaks my heart every time; it has taken something that should be beautiful, private and loving (making love) and made it cold, clinical, and a constant reminder of the fact that I will never again be allowed to just be healthy, normal and sexually spontaneous. It means that several times a week I MUST think about cancer, rather than just being aware that I had treatment, and can now get on with life (compared to, eg,”broke your arm, casted , cast removed, and except for occasional arthritis, carry on”). I absolutely would not feel this way if there was a time limit to the use of these things. It is also humiliating as a health care professional to know that colleagues know something so personal about my life (think how men suffering from impotence post RT feel; do you think that they want other people knowing they’re using an implant or some other device?). I am trying to work through the despair of using these things, and do know that eventually I will manage this. I also know that had the oncologist, RN’s, and RTR’s acknowledged that dilators are NOT just a simple, non-invasive activity (such as taking calcium and Vitamin D to counter act increased fracture risk), I would have had an easier time of coping. I KNOW that I am lucky to be treated for this cancer now and not 40 years ago, I am lucky to not have ALS, MS, renal failure or a thousand other terrible diagnoses, and I know that many people might/ do consider using a dilator as not worth a moment’s distress. At the same time, I know that I am not alone in my feelings of humiliation, sadness and invasion of privacy, and I think it is long past time that cancer workers stop acting as though such feelings do not exist and are not real impediments to dilator “therapy”. Don’t you think it’s time to develop something better? Perhaps as the incidence of cancer rises and more oncologists and researchers have radiation we will see this happen.

    • Pelvic Guru on February 8, 2015 at 9:36 pm

      Wow! This was such a thoughtful and powerful response. You are absolutely right! We still have plans to do a full article on dilators after cancer radiation. This is such valuable information and I take it to heart. Thank you and wishing you best in health. I will read your comments again! Tracy

    • Celeste on May 27, 2016 at 7:43 pm

      Dearest Anonymous,
      Your pain and sweet plea breaks my heart.
      I’m soooo very, very sorry about your cancer and the treatments you’ve had to endure. I’m very happy you’re on the road to recovery.
      I’m not sure if you’re ready to hear this, but here it goes … the physical treatment to cure your cancer was the easy part. I’m afraid you have quite a journey ahead of you, and it might be a long painful one. I believe, more than any other cancer, pelvic cancer does more harm to a woman’s psyche than any thing else would or could. It literally pulls the rug from beneath all we know, rely upon and hold dear about ourselves. It leaves us clutching at the shreds of our sexuality, and strips away our power, our strength and our fundamental sense of wellbeing. While our mind grapples with the reality/unreality of our cancer, (that we can’t see or touch so is/was it really there?), we must deal with the physical in ways that would never occur to us BC.
      I desperately wish there was some way I could help you. I’m so sorry to tell you that you must climb out of this on your own, sweetie. Thereby becoming the shinny new person you will be on the other side of this horror. You WILL make it through each and every indignity, you WILL make it through each and every follow-up test and appointment. And you will survive your feelings of despair, betrayal , disbelief, and humiliation. There were many months 30yrs ago that I didn’t think I would survive the week knowing someone (my lovely surgeon) had their hands inside my body. Then I didn’t know if I could live with the thought of germs. For about a month I didn’t believe I ever had cancer (although I got 9 second opinions). And I was furious with my Dr. for not saving the removed parts for me to see. It seemed like every month or so there was some new issue, thought, fear or physical manifestation that I abjectly rejected, that turned my shaky, unreal world on its ear. I had three therapists all giving be conflicting (albeit well intentioned), advise and, unable to follow their suggestions, I felt hopeless and worthless and became sure I should be committed so that I wouldn’t hurt myself. My Doctors wanted to put me on drugs… but I don’t take drugs. They wanted me to use objects … but I don’t use objects. What my faithless, betraying body needed, my mind, my dignity and my long established | +-
      my self-preservation rejected. It was a very difficult battle and it was 2 very long years for me to pull myself from the precipice. My emotional pain felt so real as to be palatable. As time stretched on, I thought I would never feel better, whole, myself. All the self affirmations in the world couldn’t fix what had broken inside me. I worked hard every day to move on, to push through to find the light. Unfortunately, I can’t tell you when it happened. I can tell you it wasn’t magic, it wasn’t faith, it wasn’t drugs, it wasn’t religion. Perhaps, it was all those things, or none of those things. Or just the passage of time that allowed me to distance my self from me and being so very selfaware/selfabsorbed, (as I’d had to be in order to get well.) Time passed, the clouds slowly lifted and there was light and a life for me after all on this side of the world. And there will be life, a wonderful life for you too. And some things will be the same and some things will be very different. We are such remarkable, complex beings
      . With sympathy and compassion and yes love for a fellow cancer patient, a fellow human being, I wish you a safe and speedy recovery of your body, mind and spirit. xo

  14. Anonymous on February 28, 2015 at 8:39 pm

    Hi Tracy, I’m wondering if you done part 2 or 3? I need to start using dialators as you can barely get a small finger in my vagina. I haven’t had sex in over 8 years due to pain. Now divorced with my 9 yr old. I saw Stephanie at pelvic health and rehab almost 1 half yrs ago which was wonderful but afford to couldn’t continue to see her, then had Interstim implanted last October and have been in too much pain to do anything. I’m slowly getting back into it but bc I’m having such horrible vaginal spasms which I can’t walk, sit they just bring me to my knees in pain. These are daily so I need to get back to the dilators. Im so glad I found this blog. I’m so grateful so you PT who dedicate your time to those of us who struggle w debilitating chronic pain. Thank you!!

  15. The Pelvic Health Handout Project! | Pelvic Guru on September 13, 2015 at 10:42 pm

    […] Vaginal Dilator Guide PDF Handout  by Tracy Sher at (Full blog article found at this link) […]

  16. Navita on January 30, 2016 at 3:55 pm

    I was wondering if you can recommend an excellent women’s health PT for vagisinmus. I am currently comfortable inserting # 4 dilator however my lower area is in tight fist sensation all the time.

    • Pelvic Guru on January 30, 2016 at 3:59 pm

      Will depend where you live ?. Where’s that?

  17. LMG on April 18, 2016 at 2:19 pm

    Dear Pelvic Guru,
    I’ve just bought a set of dilators and am building up the courage to start using them. Reading your tips and others’ comments on here is very reassuring as sometimes it feels so lonely (even though my fiancé is supportive).
    I hope to improve soon as it has felt like an eternity.
    L x

  18. Lg on May 11, 2016 at 9:04 pm

    How deep should I be able to insert one before moving up a size

  19. New Dilator Therapy Routine. – EndoGab on April 19, 2018 at 10:28 pm

    […] If you’re just starting dilator therapy, or starting up again I hope you’ll consider really taking some time to think about how you can make it more of a positive experience. If we can lessen our suffering we should absolutely take what steps we can to do so. I hope you’ll consider my routine, or come up with your own! Lastly, I really love what this site has to say about dilator therapy so check it out HERE  XO […]

  20. Laura Williams Carpenter on May 9, 2018 at 4:29 pm

    Do you have any information about using dialators for animus? I had a physical therapist but she didn’t seem to know what kind of dialators to get for anal floor problems. I’ve looked all over the web and tried calling different therapists but have gotten no results. What I am looking for is the type of dialator you should use and how to use them treatment wise. Any help would be appreciated. I am desperate. Thank you.

    • Tracy on May 12, 2018 at 11:59 am

      Hi Laura,
      In an ideal world, it would be wonderful for you to see a pelvic physical therapist who specializes in this (even for 1-23 sessions) to make sure that an anal dilator is even the best plan of care for you. If you have already seen one or know that this is the right plan…there are some “butt plugs” that are made specifically for the anus. This is important because they ensure that the object will not get lodged too far up. They come in different sizes. There are a variety of sizes to these. The most challenging part is trying to use them on your own due to the reach factor. There are also slim EZ wands or therawands that are longer that can be used gentle at/in the anus. That may be worth looking at too.

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