Will using a dilator help my pelvic floor issue?
A new patient recently told me a previous health care provider told her to use a dilator 15 years ago but couldn’t tell me why it was prescribed! Many patients I see are familiar with the concept of vaginal dilators, however when it comes to when or how to use them, there seems to be much more uncertainty.
Before we talk about dilators, let’s review the general categories of pelvic floor dysfunction.
Underactive conditions include urinary incontinence and pelvic organ prolapse. A lack of strength leads to decreased muscular support in these conditions.
Overactive conditions such as dyspareunia (pain with sex) or constipation are hallmarked by increased tone in the pelvic floor musculature and difficulty in relaxing these muscles.
Impaired muscular control includes difficulty with contracting or relaxing the pelvic floor, and/or poor coordination between the pelvic floor and abdominal muscles.
Dilator use can be helpful with some but not all of the conditions above. A condition that may benefit from dilator use is vaginismus. This diagnosis falls under the category of overactive pelvic floor dysfunction. There are many causes to this condition, but it may be tied to physical or emotional trauma. Patients may have difficulty with a gynecological exam, putting in a tampon, or participating in sexual activity. Although each patient’s case is different, many of those with vaginismus may benefit from the incorporation of vaginal dilators into their program in order to improve tolerance to vaginal penetration.
Dilators will not replace the care of a trained physical therapist due to many other factors that need to be addressed in pelvic floor dysfunction. Education and instruction on appropriate downtraining and relaxation techniques reduce muscular tone of the pelvic floor and are an important part of rehabilitation for those with overactive pelvic floor conditions. Proper instruction on how to use and progress dilator therapy is also imperative to prevent exacerbation of symptoms prior to and during this intervention. The experience and expertise of a trained pelvic health therapist will guide you through to proper use of a dilator to ensure your safety as well as appropriate progression.