In my last post, I discussed the benefits of diaphragmatic breathing and reverse Kegels to relax pelvic floor muscles and reduce pain during sex (read this post here). While the concept of diaphragmatic breathing and reverse Kegels were challenging for me initially, I eventually got the hang of it and they became an essential part of my pain and stress management toolbox. This was the first part of my pelvic floor physiotherapy plan. The second part of my treatment involved the use of dilators. In this post, I discuss the beginning of my dilator journey with my pelvic floor physiotherapist.
Don’t forget to read to the end for this post’s #TLLCTuesdayTip!
What on Earth are Dilators?!
If you have Lichen Sclerosus, chances are you’ve heard of or use dilators as they wind up in most of our programs at some point in our journeys. In fact, while researching pelvic floor physiotherapy, dilators came up so often I bought myself a kit before my first pelvic floor physiotherapy appointment. I read they are most commonly used to aid with painful sex by recreating space in the vagina and desensitizing the mind from interpreting something entering the vagina as ‘danger'.
At the time, I had no idea what to look for, so I bought one of the first dilator kits I found online by CalExotics. The kit comes with five 100% silicone dilators. They are ergonomically curved with a loop at the bottom for your finger, with each dilator increasing slightly in length and width from the previous one. I cringed looking at the largest dilators. I couldn’t conceive inserting them without pain and tearing, but I knew it would be a while before I got there.
How to Use Dilators to Create Space in the Vagina and Help with Painful Sex
I was taught to slowly insert the dilator and leave it in for a minute while taking deep breaths. After the initial insertion, you slowly massage ‘around the clock’, making gentle back and forth motions in the 4-8 o’clock areas.
I would do this for 15-20 minutes a day, beginning with the smallest dilator. Over time, as you increase the size of the dilators, you create more vaginal space, which can help reduce pain during sex.
*Caveat. This is how I was taught to use dilators. There are many techniques and ways to use them. In fact, I now incorporate additional techniques (I will blog about this in future posts.
The Physiotherapy-Dilator Process
As I mentioned in ‘Physiotherapy for Painful Sex’ (link), part of my initial examination involved my physiotherapist inserting a finger inside my vagina to feel the vaginal and pelvic floor muscles. Surprisingly, the insertion of her finger did not cause me pain. I chalk this up to her being incredibly gentle, slow, and talking me through each phase of the examination. Thus, after my first physiotherapy appointment, I tried the smallest dilator at home and it wasn’t a bad experience. At this point, I didn't have instructions on how to use them; I simply wanted to see if I was able to insert it myself. I was able to tolerate it well; there wasn't much pain or burning.
During my second physiotherapy appointment, Jane, my pelvic floor physiotherapist at the time, walked me through using dilators with the second dilator. Perhaps unsurprisingly, there was some initial resistance and tensing on my part. This tensing of my vagina/pelvic floor was my body’s subconscious defense mechanism. It was my body's way of protecting me from what coded as danger (i.e. anything entering my vagina).
This is quite common for vagina owners with Lichen Sclerosus. You might find yourself saying, “This happens to me too” as you read this.
Key Tips I Learned to Reduce Tensing Against Dilators
Work with your senses. Use visuals, sounds, and touch to help downregulate stress and tension in the body (specifically the pelvic floor and vaginal muscles).
The following list contains examples of how you can leverage your senses to help ease muscle tension and facilitate the use of dilators to reduce pain. I encourage you to play around with what works for you. Not everyone is visual. Therefore, visual cues and imagery may not work for you; you may find yourself focusing on auditory practices instead. These are examples of what worked for me:
- Touch/physical sensation. Apply a generous amount of lubricant to your dilator. Hold the tip of the dilator at the opening of the vagina; do not insert it right away simply hold it there. Feel and focus on the cooling sensation of the lube/dilator at the vaginal opening. My physiotherapist suggested imagining the dilator as a popsicle. (I should note, it was a very hot summer day while we were doing this).
- Visualization and imagery. As you slowly insert the dilator, imagine a color. I imagined the aqua-blue of the ocean, as the ocean is a very calming and grounding place for me. I put the two pieces together and focused on the cooling sensation and color of the ocean while slowly inserting the dilator, and moving it in and out.
- Auditory sensation. While inserting the dilator, play some relaxing spa music. Something you find calms your senses and soul. I played around with this one; sometimes using spa music, other times putting on a meditation. Specifically, I enjoyed working with my dilators while doing a body scan mediation.
Body Scan and Dilators
My pelvic floor physiotherapist sent me a body scan meditation to try at home when I was using my dilators. I found the body scan to be incredibly helpful for reducing tension in my muscles and fostering a strong mind-body connection, specifically to my pelvic floor.
In brief, a body scan is a guided meditation practice where you pay attention to each part of your body, usually from toes to head or vice versa. The teacher will have you focus on one part of the body, asking you to notice how that part feels, in particular, noticing any tension you may be holding. Then, they have you breathe into that area and imagine the tension melting away.
I would play a body scan with a dilator inside me. Sometimes I would just leave the dilator in, and other times I would gently slide it in and out. I would pay extra attention to my hips, vagina, and pelvic floor, really focusing on relaxing the muscles and breathing into them to create openness and space. Over time, this would help retrain my brain by showing it that inserting the dilator into my vagina wasn’t a threat; my body could let down its guard. I was safe.
An Obstacle with Dilator Progress
After about 6 sessions and a lot of dilator work, yoga poses, and reverse Kegels at home, I worked my way up to the second largest dilator. My pelvic floor physiotherapist and I decided it was OK to continue on my own since the tension in my pelvic floor had significantly improved and I wasn’t experiencing much pain with the dilators at this point.
This, however, was short-lived.
Soon after using the second largest dilator, I began experiencing general pain and discomfort, which left me confused and frustrated. I didn’t understand what I was doing wrong, but that’s because I didn’t know then what I know now about Lichen Sclerosus. I have learned a lot since I was diagnosed with LS and began using dilators. It’s been a long journey of learning and I look forward to continuing to share what I’ve learned in future blog posts.
In sum, there were both positive and negative aspects from my first experience with dilators. On the positive side, I learned amazing de-stressing techniques that not only helped release tension in my pelvic floor but helped reduce overall tension. If you have Lichen Sclerosus, you know first-hand how interconnected our symptoms are with stress, which is why I was grateful to have tools to help de-stress. On the negative side, the dilators being pain-free was short-lived. In my next post, I will discuss why I stopped using the dilators for a while and what you may want to consider if you have Lichen Sclerosus and are starting your dilator journey.
Get in Touch with Me; Share Your Thoughts!
Do you use dilators? What has your experience been? What challenges did you face/are you facing with them? Let me know in the comments below or feel free to contact me via social media. I would love to hear from you!
#TLLCTuesdayTip: Your dilator journey very likely won't be linear. You may experience some setbacks. Know that this is part of the process and you will get through it.