Accommodators and Dilators

A dilator is a smooth silicone, plastic or rubber cylinder that is used to stretch the tissue of the vagina (opening and length). They come in many sizes and are sold individually or in kits ranging in sizes that start thinner and shorter, and get progressively thicker and longer.

Accommodators/Dilator Therapy is Often Used to Treat:

• Vaginismus
• Dyspareunia (pain with intercourse)
• Post-radiation of the vagina
• Post-surgical symptoms

Accommodator/Dilator Therapy Will Help:

• Pelvic exams become more comfortable.
• Allow for insertion of a finger, tampon, or penis into the vagina.
• Lessen discomfort with sexual activity.
  

Physiotherapy has been shown to be an effective part of a multidisciplinary approach in decreasing pain during penetration and improving sexual functioning. Pelvic health physiotherapists can provide guidance with using accommodators and dilators.

Instruction on Effective Accommodator/Dilator Use:

• Only start when you are mentally and physically ready.
• Find a comfortable place to lay on your back (in a semi-reclined position) with your knees bent and apart (this can be your bed or an empty bathtub).
• You can use pillows behind your back or knees to make you more comfortable.
• Make sure you can reach the opening of your vagina with your hand. You can use a hand mirror to see your vaginal opening.
• Use relaxation techniques and positive thinking. Put on your favourite music that will help you relax.
• Do some deep breathing and pelvic floor relaxation (such as Reverse Kegels)
• Start by being able to comfortably touch your genital area, gradually moving closer to the vaginal opening without experiencing pain.
• Use a generous amount of lubricant on the accommodator/dilator and at the opening of the vagina.
• Start with the #1 accommodator/dilator, or whatever number/type a physiotherapist or health care practitioner determines is appropriate to begin with.
• Spread the labia (the folds of skin at the opening of the vagina) with one hand, and hold the accommodator/dilator with the other hand.
• Breathe and relax your pelvic floor muscles.
• Place the tip of the accommodator/dilator at the opening of the vagina.
• Angle the accommodator/dilator downwards (towards your spine) and/or find the path of least resistance that is comfortable for you.
• At no point should you be pushing through any pain. This will not be productive.
• Progress gently and slowly at all times.
• Slowly insert the accommodator/dilator as far as you can comfortably, and hold it there for 2-3 minutes (or the length of time recommended by your health care professional).
• Remove the dilator, wash it with a mild soap, and let it dry.
• Advance to the next accommodator/dilator once you can insert the current one completely into your vagina without any discomfort.
• Progress through the sizes in your set until the desired amount of accommodation is reached (depending on your personal goal).
• Introduce a partner once you feel comfortable with the insertion of the accommodator/dilator.
• Avoid attempting penetration during the accommodator/dilator treatment period. Other forms of sexual arousal and activity are okay (consider seeing a sex therapist to get more advice on this).
• The frequency and time of accommodator/dilator work depends on various factors.  You can discuss the length of time that is appropriate with your medical healthcare provider or pelvic health physiotherapist.