Sexual Health
CMECNE

Vaginal Dilation Protocols for Patients

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Learning Objectives and CME/Disclosure Information

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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Related ObG Topics:

Practical info on sexual health for your women's healthcare practice
Vaginismus – What Is It?
Primary Vaginismus – Signs, Symptoms and Treatment Options 
When is Painful Intercourse Secondary Vaginismus?
Practical info on sexual health for your women's healthcare practice
Dyspareunia – Is it a Diagnosis or a Description?

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