Menopause can be very drying – eyes, hair, mouth, skin, vagina. As estrogen diminishes, so does the amount of moisture available and our body’s ability to suck it up and retain it.

In none of these places is the dryness really welcome: dry eyes can fog our vision; dry skin itches and wrinkles, and a dry vagina can make penetrative sex unpleasant, even painful.

The vagina doesn’t just get drier in menopause; it can actually get narrower, shorter, and less flexible. All of these can contribute to pain during sex. And, as we already know, there is no shortage of causes for painful sex, especially after pregnancy or throughout menopause and perimenopause.

Fortunately, vaginal dilators are a good tool for managing these changes. To get the best results, you’ll need the right equipment, a little training, and some patience. With time, you may be able to increase the width and depth you’re able to tolerate (even enjoy!) and restore some elasticity.

We strongly recommend you start by consulting a pelvic physical therapist, if possible. A pelvic PT can tell you if something else is causing your pain (like organ prolapse) and advise you on how to proceed with dilators.

What are vaginal dilators?

Dilators are generally made of plastic, rubber, silicone, or glass, are tube shaped, and come in a set of 5 to 8 graduated sizes. Inserted in the vagina, they gently stretch the vaginal walls over time.

Dilators range in size from half an inch in circumference for the smallest to just over an inch and a half at the largest, according to Syracuse Medical Devices, Inc. They are smooth-surfaced, rounded at one end, and may come with an interchangeable handle for easier use.

Who are dilators good for?

Most women use dilators to enable them to enjoy vaginal sex again, though they may also be used to prevent or reverse atrophy due to lichen sclerosis or menopause. Women who have a fear of pain due to cystitis or other factors may also find dilators help them relax, as it puts them in control of the level, pace, and timing of penetration.

Additionally, women who have had cancer may find changes in the vagina beginning as a result of treatments or surgery; starting with dilators as soon as possible may help avoid vaginal atrophy from developing or worsening.

How do you use them?

You want to ensure maximum relaxation, so be sure you have plenty of time and privacy.

Our ob/gyn Director of Health, Dr. Rebecca Dunsmoor-Su, says women in perimenopause and menopause should always always use a lubricant when inserting anything into the vagina. As long as your dilator isn’t made of silicone, a silicone-based lubricant is best, as silicone stays slippery longer. If your dilator is made of silicone, stick to water-based lubes like our Personal Lubricant to avoid damaging the dilator’s surface.

Unless a pelvic PT tells you otherwise, it’s usually best to start with the smallest dilator in your set. Lube it up, then lie on your back with your knees bent, feet flat, and insert the dilator as you would a tampon. But go slowly, applying gentle pressure. If you feel any pain, stop. You should feel pressure only – never pain. If you don’t feel much of anything, you may need to try the next size up.

The Memorial Sloan Kettering Cancer Center suggests doing Kegels to help you insert the dilator, as these exercises can help relax your pelvic floor muscles. You can also do Kegels during the process, as it may allow you to go in a little farther.

Once inserted, you can push in and pull back on the dilator to gently stretch the length of your vagina. Soft circles can help with increasing width. Feel free to add more lubricant as needed to keep things comfortably moist. About 10 minutes is all you need at one time.

Once you’ve finished, remove the dilator, wash with warm, soapy water, and store according to your dilator’s instructions.

Advice differs on how often to use the dilators, but at least 4 times a week seems like a good average. If there’s no pain or irritation, you can probably do more. But be patient. Use each size for several weeks until the next size up causes no discomfort. It may take several months to achieve the results you want.

How do you choose them?

Like so many things, there are a dizzying array of options. We suggest you find a good site that offers not just products, but good information and advice. Dr. Rebecca really likes Seattle-based Babeland for its very no-nonsense, informed approach to healthy sexuality.

Dr. Rebecca also suggests sets that come with a vibrating wand that cam help with relaxation, even add pleasure. Babeland offers the Intimate Basics Dilator set, which is on Dr. Rebecca’s list of good options.

If you’ve used a dilator, we’d love to hear how it worked for you. Feel free to tell us about it in the comments belowfind us on Facebook or in Midlife & Menopause Solutions, our Facebook group.