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
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.
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
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.
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.
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
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