Vaginal Dilation
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Vaginal Dilation
Vaginal dilation is used to describe a treatment often recommended to people who have a short and/or narrow vagina. A narrow or short vagina is common for some people with innate variations of sex characteristics, as is a dimple like opening for others. It is not something that needs to be changed, but dilation is often suggested to people who might want to experience pain-free and pleasurable penetrative sex*.
Specific variations that this factsheet might be relevant for are Congenital Adrenal Hyperplasia, 5α-Reductase 2 deficiency, 17β-Hydroxysteroid dehydrogenase III deficiency, Androgen Insensitivity (Complete and Partial), and Mayer-Rokitansky-Küster-Hauser.
Extending the width and length of your vagina via dilation is an optional exercise, and many people choose not to do this. No-one should recommend or ‘prescribe’ dilation therapy to you unless you have a clear goal around changing the shape of your vagina for a specific purpose. This should be your decision.
People may also be recommended vaginal dilation after vaginal surgery or for conditions such as vaginismus, vaginal atrophy, vulvodynia or other pelvic pain conditions that extend to the vagina. These conditions can impact the muscle tightness of the pelvic floor and the sensitivity of the vulva and vagina. Similarly, vaginal surgery can lead to the formation of scar tissue, causing tightening of the tissue in that area.
* It is important to acknowledge that vaginal dilation has historically, and in some cases still continues to be suggested to young people who are not yet sexually active. Vaginal dilation should be deferred until an individual is able to make this decision for themselves, and there is to date no conclusive evidence to suggest an advantage or improved outcomes if vaginal dilation is started earlier in life. Vaginal dilation is effective at any stage, however in some cases may be required as part of post-operative recovery
Why is Dilation Recommended?
Dilation is often recommended to change the shape of the vagina. The walls of the vagina are made of muscle covered in a mucus membrane, similar to the inside of the mouth. The surface of the vaginal wall contains rugae (roo-gee) which are pleats of extra tissue that allow the vagina to expand during sexual arousal, and in response to pressure. The use of dilators is recommended because they create pressure by stretching and pushing into the vagina. With a regular, gentle dilation practice, more elastic tissue is produced by the body which widens and deepens the vagina.
Dilation is often recommended following surgery on the vagina, and if someone wants to maintain their readiness for penetrative sex when it’s not happening regularly.
Vaginal dilation is also recommended because of the assumption that most people with a vagina will want to try sexual activities that involve penetration. It is also influenced by the belief that it is better to increase the vagina’s size ahead of time. Many people question these assumptions and report that trying vaginal dilation had a negative impact on their self-esteem and feelings towards their body. Not all sex involves penetration and focusing on dilation can lead to people paying less attention to other important parts of the body like the clitoris and other important parts of sexual intimacy, such as communication. Knowing what you like, being able to talk about things, and getting on the same page as your sexual partner opens up many possibilities.
What are Dilators?
Dilators are cylindrical (tube shaped) devices designed to be inserted in the vagina for the purpose of stretching it. They come in sizes that gradually increase in diameter and circumference. They can be made of a range of materials like glass, silicone or plastic
Dilators can come in many forms and are made from a variety of materials such as medical grade plastic, silicone or glass and are usually very smooth in order to reduce friction.
For examples of the types of dilators available visit https://www.pelvicfloorexercise
.com.au/shop/product-categories/dilators.html
Dilators are reusable but should be washed with warm soapy water and dried after each use.
Who Can Support Me With Dilation?
There are benefits to being open with people you trust and receive support from. If you have a sexual partner they could be a good support person. By talking things through and taking extra time some people discover that penetration can occur gradually over time with a partner and this can be an alternative to dilation therapy.
Some people may feel as though you need to have the vagina dilated before having penetrative sex, but many people have experienced creating their own vagina whilst gradually learning about sexual enjoyment with a partner. Gradual penetration over time as a part of sexual play can be done with a person who has a penis or a range of sex toys. This may require disclosure of your IVSC with your partner and good ongoing communication about sexual boundaries, understanding your own enjoyment and pain thresholds.
The benefits of a graduated sexual play approach are that you do not need to dilate any more than is necessary to have the enjoyable sex you want. An additional benefit to this type of approach is that the upper part of the vagina can balloon when arousal occurs and this helps with both lengthing and widening.
Other than sexual partners, people have found it useful to have support from a pelvic floor physiotherapist or somatic sexological bodyworker. These professionals can help you learn about the sensations and processes of vaginal dilation before you start self-dilatation at home. These professions are guided by codes of conduct designed to keep you both safe.
For more information and to find a practitioner the following websites have search options:
- https://choose.physio/search Use your postcode and refine your search by area
- https://www.sseaa.org/find-a-practitioner Use search terms such as anatomy, self-pleasure and pain
What Does Dilation Therapy Involve?
Dilation therapy involves gently inserting a dilator into the vagina, either by yourself or by another person. A pelvic floor physiotherapist, sexual health nurse or gynaecologist might be the person recommending dilation therapy in response to your goals about your body. In this case, they may be the ones to describe it and even show you how to do it. A sexual partner might also be involved if sexual activity is a shared goal within a relationship. In all situations consent and communication is an important and ongoing component of the dilation practice.
If starting on your own the basic steps involve the following:
- Choose a time to dilate when you will not be rushed and somewhere private where you can lay comfortably. Get yourself relaxed.
- Lie on your back and prepare the vulva by touching it with your fingers and some lubricant.
- Add plenty of lubricant to the smallest size dilator.
- Hold the dilator to the opening of the vagina and make small circular motions to massage the surrounding skin and push the labia (lips) to the sides. This step applies the lubricant to the surrounding tissue.
- Gently apply pressure at the opening of the vagina with the dilator by angling it back.
- Breathe and connect with the sensations happening, there should be stretch and pressure feelings rather than sharp pain.
- Allow the dilator to enter as far as possible without causing pain. Breath into any discomfort and allow your vagina to relax around the dilator.
- Leave the dilator in place whilst listening to something relaxing, watching a show or reading a book.
- When the dilator feels more comfortable gently move it around inside the vagina, moving it in and out, or in a circular motion.
- Gently remove and wash the dilator afterwards in warm soapy water. Dry before storing it, ready for your next session.
- Aim to reach ~15 minutes everyday,starting gradually- eg. 5 minutes everyday for a week, then 10 minutes every day for 2 weeks and then 15 minutes every day for 4 weeks before moving to the next size and starting the process again.
https://flipbooks.leedsth.nhs.uk/LN005111.pdf
https://www.pelvicfloorexercise.com.au/media/wysiwyg/downloadable/USING_YOUR_VAGINAL_DILATORS.pdf
Are There Alternatives to Dilators?
Yes there are other alternatives, the simplest being your own fingers. People sometimes start by exploring themselves whilst showering or masturbating using their figures. Keep fingernails short and smooth to avoid scratching yourself. Finger cots (pictured right) can be used on fingers or any object that you might like to try instead of dilators. Fingers are a good starting point when you are trying to learn the length and width of your current vagina .
.com.au/buy/112228/health-wellness-finger-stall-50-pack
Adult toy shops have a range of dildos and vibrators that might be more appealing. Some have features that typical dilators do not include such as bumpy designs, vibrations or designs that can stimulate the clitoris during the dilation/penetration experience. These alternatives may feel more approachable, less clinical, more accessible and may offer a more pleasurable experience than standard dilation. A design that includes various widths and angles can also help to apply pressure at the end of the vagina, and this is useful for creating length.
(Note: adult toy shops are only legally allowed to sell to people 18 years and older.)
Tips and Tricks
- Get in the right headspace ahead of time. Relax, do some breathing exercises, stretch or have a warm bath beforehand. Be kind to yourself, positive and open-minded about the process.
- Warm the dilator ahead of use by holding it in your hands or running under warm water
- Success dilating is not always straight ahead. There can be ups and downs along the way as your body tenses and relaxes in response to both internal and external stimuli. Start a dilation session on a smaller dilator than you used previously, to warm your vagina up before moving up a size. Learn when it is not good for you to dilate, this could be when you are stressed, in a bad mood, or when it is not working.
- Use a lubricant that agrees with you. Water-based lube like KY-Jelly might be good and are easy to wash off but if you find that they are drying out or getting gluggy try a silicone lubricant like Pjur. Make sure the type of lubricant you use is compatible with the material of the dilator or adult toy you are using. Silicone lubricants should not be used with silicone-based dilators as they can degrade the material over time.
- Learn your anatomy so you can feel knowledgeable about your body, and know what you’re doing and why. Understand the strength of your pelvic floor. Know when your pelvic floor muscles are switched off and switched on.
- Visualising can help you relax and focus. Visualise your vagina opening up, and being able to dilate without effort or pain.
- Results take time,consider pairing your goal related to your vagina with another goal that you are working on that you can see e.g. teeth whitening, muscle building or trying to reach further in a yoga pose. Our bodies can change with the right activities and regular practice. Don’t put pressure on yourself or accept feeling pressured by anyone else.
- Low-dose topical estrogen such as Vagifeme and Ovestin can help the elasticity and resilience of the vaginal tissues. Speak to your doctor about this.
- If you are prone to UTIs, ensure you urinate directly after dilating and maintain good hygiene.
Consider other assistive measures such as the Lattice Adaptive Reach Extension Handle By TouchBot. This can be used to extend reach which is useful for comfortably holding a dilator or dildo in place.
https://www.touchbottech.com/products/lattice-extension-reach-handle
Pleasure and Vaginal Dilation?
Vaginal dilation should not be a painful or traumatic process when it is something you want to do and is practiced in safe and healthy ways. The process of vaginal dilation can be considered or incorporated into your own regular routines and self care practices. These can be non sexual practices such as:
- Self exploration.
- Yoga and stretching.
- A mindfulness, relaxation or meditation practice.
- Paired with other physical activities such as before or after exercising.
This can help create a routine around dilation and normalise the practice so it does not feel like an additional task.
You may also wish to combine vaginal dilation with sexual pleasure including:
- Incorporating dilation into masturbation.
- Masturbation as the sole dilation activity.
- Dilation as preparation before a sexual encounter.
- Involving or using dilation as foreplay during a sexual encounter with, or without a partner’s assistance.
- Having penetrative sex with a dilator, sex toy or penis as the sole dilation activity.
Pairing dilation with clitoral stimulation, orgasm or other sexual pleasure and activities can also have a range of benefits including:
- Normalising the process and potentially involving a partner in this.
- Creating a positive association with the process, especially when paired with sexual intimacy and orgasm.
- Connecting the process to its purpose and your goals.
- Where possible, promoting the production of natural lubrication.
- Easing the process by enhancing relaxation and satisfaction as the body releases serotonin, dopamine and oxytocin.
- Creating a safe and comfortable environment and intimacy with a partner.
Benefits to Vaginal Dilation
The expected benefits of vaginal dilation is a longer and wider vaginal opening that can comfortably accommodate a range of sexual activities.
Other benefits include:
- Avoiding unnecessary vaginal surgery.
- Greater connection with your body and sexuality.
- More pleasurable sexual activities.
- Control over the pace of the process.
- A sense of accomplishment.
Risks of Vaginal Dilation
The risks of vaginal dilation include feelings of failure, frustration and low self-esteem that can come from focusing on changing a part of the body you believed was not good enough as it was. Dilation is uncomfortable and can cause some people pain and a small amount of bleeding. Pain is not gain, too much pain can lead to additional problems. A good dilation practice should keep discomfort to a low-medium level with no more than occasional blood spotting. If you stop dilating or having penetrative sex for an extended period, you may lose some of the vaginal length and width you have previously gained. There is a small chance that being too forceful with dilation or being very fearful and afraid whilst doing it can cause problems such as vaginismus, chronic pain, UTIs or vulvodynia.
Having goals, being empowered and staying positive can also help counter some of the psychological risks that can accompany dilation. These include developing unhealthy expectations about your role in sex, fearing negative evaluation by a sexual partner and having your progress with dilation becoming an obstacle to intimacy and trust. These may be particularly relevant if you are dilating so that you do not have to disclose your IVSC to your partner.
Surgical Options and Vaginal Dilation
There is no current evidence that shows one surgical option or procedure is better than another, with each procedure having both positives and negatives. The options available to you and method used depend both on personal factors such as your anatomy and goals, and the experience of the surgeon. It is important to note that all surgical options will require adherence to some form of temporary or ongoing vaginal dilation during recovery and in some cases the years following the procedure.
Some surgical options include:
Vecchietti Vaginoplasty
The Vecchietti procedure is one of the less-invasive surgical options and can be performed laparoscopically through a small incision. Unlike other procedures this option does not use any grafted or relocated tissues to create the vagina. Instead, it relies on continued pressure and movement of a small olive-shaped bead placed into the vagina. The bead is positioned in the vagina and connected by stitches to a device in the abdominal cavity that moves the bead upwards. The upward movement of the bead creates and deepens the vagina by about 1-2 cm per day over 7-10 days, until a vaginal depth of around 10 centimetres is reached. The bead and stitches are removed in your follow up appointment and you will be instructed to perform daily vaginal dilation while recovering from the procedure as part of your aftercare. This is one of the most common methods used in Europe.
Davydov Vaginoplasty
The Davydov procedure is one of the less-invasive surgical options and can be performed laparoscopically through a small incision. It involves moving a portion of your internal abdominal membrane into the newly created vagina to allow new cells to develop and heal the skin inside of the vaginal canal. This usually takes around 6 months after the procedure. This procedure is favoured as it carries a lower risk for scarring or losing the created length and depth of the vagina. Aftercare involves daily vaginal dilation as prescribed by your surgeon while you recover from the procedure. This is one of the most common methods used in Europe.
Abbe-McIndoe Vaginoplasty
The Abbè–McIndoe procedure is a more-invasive surgical procedure. It involves taking a skin graft from the inside of the buttocks or inside of the mouth, though in some cases lab-grown vaginal tissue, amniotic membranes, or inorganic surgical material may be used instead. The graft or other material is placed over a mould used to maintain the space for the vaginal canal. This grafted tissue forms and lines the new vaginal walls. Like other surgical options, aftercare involves vaginal dilation as prescribed by your surgeon while you recover from the procedure. This is necessary to maintain and preserve the length and depth of your vagina (around 10 centimetres). This technique is most commonly performed in the United States of America.
Intestinal Vaginoplasty
An Intestinal vaginoplasty (also called a sigmoid colon vaginoplasty) is one of the most invasive surgical options and carries increased risks. It is used primarily in cases of vaginal agenesis where there is no vaginal depth or tissue. In this procedure a portion of the colon or ileum (part of the large intestine) is used to create a lubricated vagina. Risks include bowel related complications, inflammation or colitis. One associated complication is the risk of excessive mucus discharge, which omits odor and may require the constant use of menstrual products such as a sanitary pad or tampon. This option requires abdominal surgery and has longer recovery times than other methods. The dilation methods described in this factsheet may not be suitable for this type of surgery so please follow the dilation procedure outlined by your surgeon.
Your Body, Your Choice
Vaginal dilation or opting for a surgical pathway is something that should always remain in your control, and is always your choice. You know your body best and should be empowered by your loved ones and care team to make choices that are right for you and your body.
Vaginal dilation or associated surgery does not have to be something you chose to pursue to have a happy and fulfilling sexual life or relationship. Many people explore sexual pleasure without changing the size of their vagina. Not all sex involves penetration They focus their attention on sexual skills, orgasm and understanding pleasure in the surrounding areas, such as the clitoris.
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