Vaginal dilator therapy: uses & how to start safely

If you regularly experience vaginal pain when you have sex or insert a tampon or menstrual cup, your pelvic floor muscles may be holding tension. While it's common and usually not related to a serious medical issue, pelvic floor tension can be uncomfortable and interfere with day-to-day activities.

One potential treatment for pelvic floor tension is vaginal dilator therapy, which involves using a smooth, cylinder-shaped device to help your pelvic floor muscles become more comfortable with penetration. Anyone can try vaginal dilator therapy, but it's often most effective when guided by a pelvic floor physical therapist.

"Dilator therapy is a gradual process that helps your body and mind build comfort and confidence with penetration," says Morgan Dunn, PT, DPT, a Hinge Health pelvic floor physical therapist.

In this article, learn more about the benefits of vaginal dilator therapy and how to do it, according to Hinge Health pelvic floor therapists.

What is vaginal dilator therapy?

Your pelvic floor muscles can hold tension that can contribute to pain during sex, gynecological exams, or inserting a tampon or menstrual cup. Vaginal dilator therapy can help by using smooth, tube-shaped devices in graduated sizes to gently help your pelvic floor muscles become more comfortable with penetration and release tension. Dilators come in sets with multiple sizes, allowing gradual progression as comfort increases.

Vaginal dilator therapy is typically prescribed by healthcare providers and guided by pelvic floor physical therapists. "While vaginal dilator therapy alone can improve symptoms of tension and pain, vaginal dilators are most effective when combined with pelvic floor PT, relaxation techniques, and addressing any underlying factors contributing to tension or pain," says Dr. Dunn.

Who can benefit from vaginal dilator therapy?

Vaginal dilator therapy helps with various conditions where vaginal tightness, tension, or pain interferes with intimacy, medical exams, or quality of life. Some of the most common contributors to pelvic floor tension and vaginal pain include:

• Vaginismus: Involuntary tightening of pelvic floor muscles, which Dr. Dunn says can be related to sexual or medical trauma, can make penetration painful or feel impossible.

• Menopause-related changes: "Age-related hormonal shifts can reduce the elasticity of vaginal tissue and pelvic floor muscles, potentially causing discomfort with penetration," says Dr. Dunn.

• Post-surgery or radiation: It's common to experience pain and tension around vaginal tissue after pelvic surgery, gynecological cancer treatment, or radiation therapy.

• Postpartum healing: Recovering from significant tearing, episiotomy, or scar tissue can contribute to pelvic floor tension. "Your pelvic floor adapts to significant changes during pregnancy and birth, and sometimes tension develops as part of the healing process," says Dr. Dunn.

• Gender-affirming care: Transgender individuals preparing for or recovering from bottom surgery may also experience pelvic floor tension that benefits from vaginal dilator therapy.

• Pelvic floor dysfunction: Persistently tense pelvic floor muscles, which can happen due to stress, injury, pelvic surgery, or the body's protective response to pain, can cause pain or difficulty with penetration.

"Whatever the reason someone needs dilator therapy, it's a valid and effective treatment option that can help reduce symptoms and improve quality of life," says Dr. Dunn.

How vaginal dilator therapy works

Vaginal dilator therapy is a gradual process that helps retrain your pelvic floor muscles and nervous system by building comfort with penetration while reducing fear or anxiety. "We see the best results when starting with the smallest dilator that's comfortable and slowly progressing to larger sizes over weeks or months," says Dr. Dunn.

Dilator therapy is most effective when combined with relaxation techniques (deep breathing, mindfulness), proper positioning, and pelvic floor exercises. A pelvic floor PT can teach you how to coordinate breathing with vaginal dilator insertion, address muscle tension patterns, and progress at the right pace for your body.

Exercises for pelvic floor relaxation

Pelvic floor physical therapy exercises can help release tension in your pelvic floor muscles, which can be helpful before a vaginal dilator therapy session. "I always recommend doing some deep breathing and stretching as preparation to help the muscles relax and calm the nervous system," says Dr. Dunn. The below exercises are a great place to start.

• Diaphragmatic breathing. Deep belly breathing can help calm your mind and body before and during vaginal dilator use. It can also improve coordination between your breath and pelvic floor muscles, which may help the pelvic floor relax and make dilator insertion more comfortable.

• Reverse kegels. Instead of squeezing and lifting like during a kegel, a reverse kegel exercise is when you gently bear down and consciously relax the muscles of your pelvic floor. “As you take a deep breath in, the muscles open up, which can make dilator insertion more comfortable," says Dr. Dunn.

• Happy baby. This gentle stretch helps to lengthen and relax the pelvic floor muscles. This can help calm tension and make it easier to insert a dilator.

• Child's pose. Similar to happy baby, this gentle stretch helps lengthen and relax the pelvic floor muscles.

• Butterfly stretch. The inner thigh muscles connect to the pelvic floor. "Stretching those before you insert a vaginal dilator can help reduce tension and make the experience more comfortable," says Dr. Dunn.

Exercises like diaphragmatic breathing, reverse kegels, happy baby, child's pose, and butterfly stretch can help prepare the pelvic floor for vaginal dilator therapy. Breathing techniques help your pelvic floor muscles relax and coordinate with your breath, while gentle stretches help lengthen the surrounding muscles and reduce tension. Practicing these movements before using a dilator can make insertion more comfortable and help your body gradually adjust over time.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

How to use vaginal dilators safely

Using vaginal dilators safely involves choosing the right starting size, proper positioning, adequate lubrication, and gentle, patient progression. 

Here's how to use a vaginal dilator safely and effectively:

• Start with the right size. Begin with the smallest dilator you can insert comfortably — even if it seems "too small." Success builds confidence. "Your PT can help assess the right starting point," says Dr. Dunn.

• Choose a comfortable position. Many people find lying on their back with knees bent and feet flat works well. Others prefer semi-reclined with pillows for support, or lying on their side. Dr. Dunn recommends experimenting to find what feels most relaxed for you.

• Use plenty of lubricant. Apply a water-based lubricant generously to both the dilator and your vaginal opening. Don't skimp — more lube typically yields better results.

• Practice relaxation first. Take several deep breaths, focusing on relaxing your pelvic floor muscles. "Some people find it helpful to practice relaxation exercises before attempting insertion," says Dr. Dunn.

• Insert slowly and gently. Angle the dilator slightly downward (toward your tailbone) and insert slowly. Stop if you feel pain. Mild pressure is OK, but sharp pain is usually a signal that the dilator is too big or that you're progressing too quickly.

• Rotate the dilator. Move the dilator in a circle (clock pattern) to find any tender spots. Use the dilator to press gently in a tender spot for up to two minutes while practicing deep breathing and relaxation of your pelvic floor muscles. Avoid direct pressure on the urethra (the 12 o'clock position).

• Move in and out. If you have pain with thrusting, you can glide the dilator in and out. Start by moving the dilator in and out a half inch and gradually increase. As your tolerance increases, glide the dilator all the way in, move it in a circle to reassess for tender spots, and treat as needed.

• Progress gradually. Move to the next size only when the current size feels comfortable for several sessions in a row. "You should be able to insert it comfortably and move it in and out without pain while keeping pelvic floor muscles relaxed," says Dr. Dunn. Rushing progression can be counterproductive and sometimes stall progress.

• Clean properly. Wash dilators with mild soap and water before and after each use. Allow the dilator to air dry completely before using it again.

• Be patient with yourself. Remember: Progress isn't always linear. Some days will feel easier than others, and that's completely normal. Give yourself grace as your body and nervous system adjust.

When should you not use a vaginal dilator?

Don't use vaginal dilators if you have an active vaginal infection (yeast infection, bacterial vaginosis), unexplained vaginal bleeding, acute pelvic inflammatory disease, or open wounds in the vaginal area. Get clearance from your healthcare provider after pelvic surgery or if you're unsure whether it's safe to start.

Tips for vaginal dilator therapy success

Small adjustments to your dilator therapy routine can improve comfort and outcomes — from timing your sessions strategically to addressing emotional factors that contribute to pelvic floor tension.

• Schedule regular sessions. Check with your PT regarding frequency and duration, but in general, to improve tolerance and support exposure, try to complete the therapy at least a few times per week even if it’s just for a few minutes at a time. "Consistency matters more than duration when it comes to helping your body and nervous system adjust," says Dr. Dunn.

• Time it right. When your nervous system feels stressed or activated, dilator therapy can feel more uncomfortable. Many people find dilator therapy easier after a warm bath or when feeling relaxed (not rushed or stressed). Doing the above PT exercises can also help improve the experience.

• Address the emotional component. Anxiety, fear, or past trauma are common contributors to pelvic floor tension. Consider working with a talk therapist if emotional factors are contributing to your symptoms.

• Communicate with your partner. Healthy communication with your partner can help you feel heard and supported as you work through pelvic floor tension with vaginal dilator therapy. "If painful sex is part of your concern, keep your partner informed about your progress and any adjustments needed during intimacy," says Dr. Dunn.

• Track your progress. Try to keep a record in your phone or a notebook of which size dilator you're using and how it feels. Tracking can help you recognize improvements that might feel slow day-to-day and encourage you to stay committed to your goal.

• Work with a pelvic floor PT. Professional guidance ensures proper technique and appropriate progression while addressing any barriers to success. Virtual PT through Hinge Health makes expert support accessible and convenient from home.

• Combine with other treatments. Pelvic floor tension often involves a combination of mental, emotional, and physical factors. As a result, dilator therapy usually works best alongside relaxation techniques, pelvic floor exercises, and addressing any underlying medical conditions.

When to see a pelvic floor physical therapist

While some people successfully use dilators independently, working with a pelvic floor physical therapist significantly improves outcomes for most people. Consider seeking PT guidance if you:

• Feel unsure about where to start or how to progress

• Experience significant pain during dilator use

• Have tried dilators on your own without progress

• Need help coordinating breathing and relaxation with dilator insertion

• Have complex medical history (surgery, radiation, trauma) that affects dilator therapy

• Want personalized guidance and support throughout the process

Need extra support navigating vaginal dilator therapy? It's never too late (or too soon) to ask for help with pelvic floor tension or pain. Hinge Health offers virtual pelvic floor PT where therapists can guide you through dilator therapy in the privacy of your home.

Common questions about vaginal dilator therapy

Does vaginal dilator therapy hurt?

When pelvic floor muscles are holding tension, you might feel pressure or discomfort with dilators — but it shouldn't be painful. "If you're experiencing sharp pain, that's a sign to move back a size," says Dr. Dunn. "It can be counterproductive to move through pain, because we want to retrain the body and mind to stop associating penetration with pain or danger."

How long does dilator therapy take to work?

Everyone is different, and results vary from person to person. According to Dr. Dunn, it can take weeks to months to see improvement with vaginal dilator therapy, depending on your individual situation and consistency.

Can I use dilators during my period?

Generally, yes, though some people prefer to skip vaginal dilator therapy during menstruation.

What type of lubricant should I use?

It's best to use water-based, unscented lubricant. Many dilators are made of silicone, which could be damaged by a silicone-based lube.

When should I contact my healthcare provider during dilator therapy?

While some pressure or mild discomfort can be normal as you start, certain symptoms require medical attention. Contact your healthcare provider or pelvic floor PT if you experience a sudden increase in pain, signs of infection (fever, unusual or foul-smelling discharge, increased redness or swelling), bleeding that doesn't resolve, or symptoms that worsen despite proper technique.

PT tip: Listen to your body

Vaginal dilator therapy isn't just a physical process — mindfulness and relaxation are just as important. Try to listen to your body and scale back if needed to calm the stress response, which can contribute to additional tension and pain.

"The goal of dilator therapy is to replace fear with control by giving you autonomy over the pace and depth of insertion," says Dr. Dunn. "Dilators help interrupt the fight or flight response and allow muscles to release tension, breaking the cycle of muscle guarding from anticipatory pain."

How Hinge Health can help you

If you have pelvic pain, bladder, bowel, or other pelvic symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References

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2. Grimes, W. R., & Stratton, M. (2023). Pelvic floor dysfunction. In StatPearls. StatPearls Publishing.  https://www.ncbi.nlm.nih.gov/books/NBK559246/

3. Jokar, F., Fani, M., Isfahani, N. T., & Sabahi, R. (2025). Effectiveness of biofeedback with dilator therapy for sexual function in women with primary vaginismus: Randomized controlled trial study. International Urogynecology Journal, 36(3), 557–565. doi:10.1007/s00192-024-06011-y

4. van Reijn-Baggen, D. A., Han-Geurts, I. J. M., Voorham-van der Zalm, P. J., Pelger, R. C. M., Hagenaars-van Miert, C. H. A. C., & Laan, E. T. M. (2021). Pelvic floor physical therapy for pelvic floor hypertonicity: A systematic review of treatment efficacy. Sexual Medicine Reviews, 10(2). doi:10.1016/j.sxmr.2021.03.002

5. Wallace, S. L., Miller, L. D., & Mishra, K. (2019). Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Current Opinion in Obstetrics and Gynecology, 31(6), 485–493. doi:10.1097/gco.0000000000000584