Vaginal Dilation Protocols for Patients

Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Explain to a patient the rational for using dilators
2. Outline best practices for dilator use

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Read Disclaimer & Fine Print

CLINICAL ACTIONS:

Vaginal dilators can be an effective treatment choice in the management of vaginismus

Make a differential diagnosis to determine that the patient suffers from primary or secondary vaginismus
Determine that the patient would be capable of inserting dilators
Determine which size vaginal dilator the patient can currently tolerate
- There are a number of vaginal dilator sets available on the market
- The sets with the largest number of dilators and the smallest incremental changes between sizes will be best to prescribe for patients
Prescribe a dilation plan for the patient

SYNOPSIS:

You have determined that your patient should be prescribed the use of dilators for primary or secondary vaginismus and you have ascertained that fear will not make her unable to continue the protocol. You can either stock the dilators in your office for use (preferred method) or have patients order them online and guide her usage until she is able to achieve intercourse with no pain.

KEY POINTS:

Ascertain if there is vaginal atrophy/atrophic vaginitis that would benefit from topical estrogen cream
- If so, topical estrogen can be used while dilating
- If there is severe vaginal atrophy you may want to start the patient on topical estrogen cream a week or two before starting dilation
The first dilator insertion should take place in the office
- Watch for any significant fear reactions and allow the patient to ask any questions she may have
Instruct the patient to use the dilator at home for approximately 10 minutes daily
- After a few days of use, the dilator should be rotated and moved in every direction to help facilitate stretching
Dilators should generally be used for approximately one week before progressing to a larger dilator size
- Determination of timing between sizes can and should be made on a case by case basis
Best practice is to have each size dilator inserted for the first time in the office
- There are times when the larger size may be difficult for a patient to insert and working with the provider will insure greater success
Reassure patients that it is normal to feel some discomfort during dilation and any given dilator may not be painless until she has moved on to the next size
Be aware that not all dilator sets are the same and some of them have larger variations between sizes which can make them more difficult for patients to use
- Ideally dilators will have minimal differentials between sizes, especially as the circumference gets larger.
DIAGNOSIS CODE: F52.5

Learn More – Primary Sources:

Women’s experiences of using vaginal trainers (dilators) to treat vaginal penetration difficulties diagnosed as vaginismus: a qualitative interview study

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