The Ins and Outs of Vaginal Dilation

The Ins and Outs of Vaginal Dilation for Vaginismus

Do vaginal dilators freak you out? Do you have resistance to using them? Or have you just never had much success with them? If so, you are not alone. These are common problems and I hope to provide some answers for you to make your path to healing a little smoother and less scary.

Perhaps the biggest stumbling block to using vaginal dilators is the fear and anxiety related to their use. The more severe vaginismus patients may order a set of dilators but frequently are unable to open the package.

For women who have the more severe forms of vaginismus, getting started with vaginal dilators is almost impossible unless some type of treatment program is established.

Styles and Materials of Vaginal Dilators

Vaginal dilators are made of plastic, silicone or glass and come in a variety of shapes and sizes. One starts with the smaller dilators and progresses to the larger dilators. This allows the vaginal muscles to stretch. The larger diameter of the plastic or silicone dilators are often manufactured too long and it is for this reason that I introduced shorter customized Pacik glass dilators.

Getting Started with Vaginal Dilation

For those who wish to dilate on their own, patience is key. As with physical therapy (PT) for tight muscles, it takes time to stretch muscles that are either tight or in spasm. Start by using the smallest dilators in the set to determine if any of them can be introduced without pain. The size that is not painful is your starting point. In the beginning, use this dilator for at least thirty minutes before advancing to the next size.

Sometimes the next size can be tolerated for only 5-10 minutes. If this is so, remove the larger dilator and finish with the comfortable dilator for a total of about two hours. Each day see if you can advance to a larger dilator for a longer period of time, understanding that this process may take several months.

How much, How long?

Dilation for two hours a day and sleeping with a comfortable sized dilator every second night seems to be of great benefit for most of our patients. Keeping a daily log of your dilation allows you to see the progress you are making and holds you accountable to yourself.

Anxiety Control

It is expected that you may struggle with fear and anxiety as well as performance pressure to please your loved one. There are a number of tricks that you may use including soft music, lighting candles, having un-rushed time, dilating in a warm bathtub, drinking a glass of wine, turning off the cell phone and the use of vibrators. Any device or thought that is joyful or relaxing helps while dilating.

Advanced Vaginal Dilation Techniques

PacikGlassDilatorsPacik glass dilators are available in similar sizes in circumference to the Pure Romance line of vaginal dilators but half the length (approximately 3.5 inches). These dilators are custom made for our patients with medical-grade tempered Borosilicate (Pyrex) glass to make dilation more comfortable.

Pacik Glass Dilators

Since Dr. Pacik retired on September 1st, 2015, we are not selling the Pacik Glass dilators through our office anymore but we do have a web page with the manufacturer Crystal Delight where you can still order them. You can order the dilators as a set or individually with or without a pouch.


The Pacik Crystal Bullet Twist Dilator is helpful for women who have progressed to the larger dilators. This dilator is about a size 5 to 6. The twist portion is “screwed” in taking advantage of a screwing motion to insert the dilator while at the same time creating massage of the vaginal muscles. The bullet end can be rotated in circles to help expand the opening of the vagina.

Transitioning to Intercourse

The goal of dilation is to be able to transition to intercourse or for single women to know that intercourse is possible. Dilation is also helpful in being able to undergo a GYN exam. Your goal is to achieve intercourse after dilating comfortably with the # 5 or # 6 dilator.

To Sum it all Up

The correct technique of using dilators to overcome vaginismus is of considerable benefit to women who struggle with vaginismus. It is hoped that these recommendations will be of value to the woman who is able to dilate on her own.

Botox Treatment Program and Speeding Things Up

If you fail to progress with dilators on your own, you may be an excellent candidate for the Botox treatment program, which uses Botox to relax the vaginal muscles with progressive dilation under anesthesia. Extensive post procedure counseling and follow-up help women achieve pain free intercourse in more than 90% of our patients.


Peter T. Pacik, MD, FACS