If you’re a woman who is having radiation therapy (RT) to the pelvis, you may have told to use vaginal dilators. Using dilators is like a stretching exercise for the vagina. Even if you’re not planning to be sexually active, you may still need to use dilators to help make pelvic exams more comfortable.

What are vaginal dilators?

• A vaginal dilator (also called an insert) is a plastic rod or cylinder with a rounded end. It’s put in the vagina to open (dilate) or stretch the tissues. This will keep the vaginal tissue healthy after having radiation treatments, so it’s comfortable to have a pelvic exam or sex. You need to use the dilator at least 3 times a week, for 12 months.
• Your radiation therapist or nurse will tell you about dilators when you have your teaching about internal RT. You’ll likely get 1 to 2 dilators. You can also buy vaginal dilators online. They come in different colours and are made of different materials. If you don't want to buy a dilator, you can also use a thin tapered candlestick, but be sure to use a finger cot or condom. If you have questions, talk to your healthcare provider.

Why do I have to use vaginal dilators?

• You need to use dilators after radiation therapy (RT) because the tissues of the vagina are often damaged by the radiation. It’s kind of like having a sunburn to the vagina. The tissue will be tender and irritated while you get radiation and may last for up to 2 or 3 weeks. Skin reactions immediately following RT are best treated with water-based creams.
  
• Because the walls of the vagina are wrinkled, scarring and healing can make it smaller and tighter than it was before. If you use a dilator regularly, scar tissue will break down while it’s still thin and filmy. This will let the vagina slowly heal and keep its normal size and elasticity.
• Using a dilator will also help you stay confident about having an object put in the vagina. Some women who have pain in the vagina may develop a fear of penetration or intercourse. Practicing with a dilator will help you feel confident that you can still have intercourse or pelvic exams, without pain.
• Using dilators is a way to prevent tissue damage from RT which affects the vagina for years after treatment is finished. However, it will only work if you use the dilators regularly and for the time that’s recommended.
• RT affects the vagina for years after treatment is finished, so it’s a good idea to use the dilators for 12 months. After this time, you can use them anytime you have tightness or pain.
• Women with other types of cancer who have menopause symptoms and trouble with vaginal tightness might want to try using a dilator. This can help build confidence that an object can be inserted.
  
• If you are unable to progress to the next size dilator, schedule an appoitment with a pelvic floor physiotherapist or with your family doctor for a vaginal exam.
  

How do I use a vaginal dilator?

1. Find a quiet, private place where you won’t be disturbed for about 15 minutes. You may want to bring a book or your phone with you if you think you might get bored.
   
   
2. Lie back and relax. Practice a few pelvic floor exercises.
   
   
3. You may want to put your clean finger in your vagina first as it’s a dilator too.
   
   
4. Put enough water-based lubricant (e.g., Astroglide®, K-Y® Jelly, Liquid Silk®) to cover the outside of the dilator. If you do this in a warm bath or shower, water can work like a lubricant, but it might also wash away the natural lubrication that your body makes.
   
   
5. Put the dilator at the opening of the vagina. First, tense your pelvic muscles and as you relax, gently put the dilator in the vagina until you feel any resistance or discomfort.
   
   
6. When you have relaxed the pelvic floor muscles, try to push the dilator in farther until you feel resistance or discomfort. When you’re not turned on (aroused), the vagina is quite short. This changes when you’re aroused and planning to have intercourse. The dilator will likely only go in a few inches—this is normal. If you can only put the dilator in 1 inch (or less), do that and relax for a minute. Then, try to gently push it in a little bit further. Keep going. It will likely be uncomfortable, but if it’s painful, don’t push any farther. Don’t contract your pelvic floor muscles while you’re using a dilator. If it hurts too much to use a dilator, talk to your healthcare provider.
   
   
7. For the best stretching, gently press the dilator against each side of the vagina. Also press at the top end of the vagina because most scarring happens in this area.
   
   
8. If any part of the vagina wall feels tender or tight, very gently press the dilator into that area and hold it for a few seconds so that the tissue can stretch. After you do this, leave the dilator in and try to stay relaxed for 10 minutes. You have to hold the dilator in or it will slowly slip out—this is normal. To get the most benefit, keep the dilator in for 10 minutes. Do this at least 3 times a week. If you’re still having intercourse, you still need to do this regularly.
   
   
9. Take out the dilator. It’s normal to have a bit of bleeding or to see blood on the dilator. If there is more than a tablespoon of blood, call your doctor or healthcare provider.
   
   
10.  Dilators can be cl​eaned with warm soapy water, rinse well so there is no soap residue and dry the dilator completely. Store it in a clean dry place.
    
    

What if the dilator is too big?

If you find that the dilator is too big, start with a smaller one or just use your fingers. If you don’t have a dilator that’s small enough, talk to your doctor or healthcare provider about other options. Start with whatever is comfortable for you and work up to a dilator that’s the same size as an erect penis, sex toy, or the object that you normally use.​​​