Reviewed July 2020
I have vulvodynia, here’s what it’s like using a dilator
During the early days of her vulvodynia treatment, Kay Thomas was sent to Ann Summers to buy a dildo. Intended as a stand-in for a dilator, a tube-shaped device used to stretch the vagina, the dildo would be softer and less clinical, and inserted gradually to desensitise the vagina to the feeling of penetration.
This process is known as dilation, an aspect of vulvodynia treatment that is usually done alongside physiotherapy and sometimes medication. Vulvodynia is a vulval pain condition characterised by a persistent and unexplained pain in and around the vulva and vagina,1 which may be triggered by touch and prevent any sort of penetration — even with a tampon.
Without proper guidance from her doctors, Kay ended up buying a dildo that was too big, which didn’t help with her symptoms at all. “It was kind of pointless, because the pain was so bad just inserting the tip [of the toy]. There weren’t a lot of options or sympathies, shall we say. The message I got was: ‘Well, you need to suck it up and put it in’,” she says.
After that, and learning that she had an additional complication called hydrocele inguinal canal, which is a collection of fluid in the groin region that causes swelling, Kay decided to give up on dilation. She is now working on insertion with her fingers, but doesn’t do it regularly enough to know whether it’s having an impact.
Not every woman with vulvodynia will need or want to go through dilation, but for those who have already had a degree of physical therapy and are still nervous about vaginal intercourse or insertion, or who are in severe pain, it may be recommended.
“If dilation provokes pain, you should leave it until the next session. You can gradually increase the length of time you insert the dilator for, but you always take it out before your symptoms start. You’re always using it within the limits of your pain”
“It’s about a gradual process, but in a way that the woman stays comfortable,” says pelvic health physiotherapist Helen Forth. “What you’re doing with dilators is making sure that you’re preventing pain. If dilation provokes pain, you should leave it until the next session.
“You can gradually increase the length of time you insert the dilator for, but you always take it out before your symptoms start. You’re always using it within the limits of your pain.”
Dilation can work to retrain overactive pelvic muscles and to create positive associations with penetration, relieving tension and helping that person to relax. While vulvodynia is a complex condition that can be caused by a range of factors, it is often linked to an overactive pelvic floor. “Rather than being relaxed at rest, the pelvic floor is in a shortened, tight position: being held with a certain amount of tension as a result of the pain that person is experiencing,” says Helen. “The pelvic muscle overactivity becomes the cause of the pain, and addressing that is the aim of our treatment.”
Pam Clynes first experienced “burning, raw” vulval pain over seven years ago. Unable to wear underwear or sit down without excruciating pain, she went to the doctor thinking that she had a yeast infection or UTI, and left with an antibiotic which didn’t have any effect. She spent the next two years searching for answers.
“All my doctors handled my situation as an emotional thing or a sexual trauma. Some minimised my pain, others told me I was ‘crazy’. I received a lot of: ‘Drink a glass of wine and relax!’ comments,” she says.
“I started to know more about my own vagina, really from the inside. It did help and I still use dilators”
Eventually, Pam was able to seek help from vulvodynia specialists, who diagnosed her promptly and started her on several different treatments at once. This included dilation alongside biofeedback — a mind-body technique that seeks to increase control over involuntary bodily functions and reactions by raising our awareness of them.
It’s essential that treatment recognises the interplay between physical and mental aspects of the condition, says gynaecologist Dr Tania Adib: “Inevitably, vulvodynia causes psychological distress. Chronic pain is very wearing and chronic pain on the vulva has psychosexual implications. It’s a very difficult condition to treat and these women need medical and psychological support.”
While penetration with a dilator hurt at first, Pam’s relief at receiving treatment and being taken seriously helped her to persevere. “I learned a lot about my muscles: how to contract and let loose, to experience how my vagina expanded and how breathwork helped to manage the pain,” she says. “I had become a little bit scared of letting anyone or anything close to my vagina. With dilation, I lost that fear. I started to know more about my own vagina, really from the inside. It did help and I still use dilators.”
Both Dr Adib and Helen caution against the use of dilators without guidance from a medical professional. “Women shouldn’t just be buying dilators. We have to make sure there is nothing else going on that we can identify as a medical condition. It’s only once we’ve excluded all of those, if you’re continuing to have pain, then we diagnose vulvodynia,” says Dr Adib.
Plus, it’s essential to have the process properly explained to you before you start dilation, says Helen: “Always use dilation with the guidance of a specialist physiotherapist. Don’t just order dilators off Amazon.”
Featured image is a cartoonish illustration of four dilators of increasing size, with the smallest at the left and largest at the right. The dilators are white with purple shading, and the background is pale blue
Page last updated July 2020