How to Treat Vaginal Pain with Vaginal Dilators
According to ACOG (American College for Obstetricians and Gynecologists) 75% of people with a vagina have suffered or are suffering from sexual pain at some point in their lives.
Although the prevalence of these pains is significant and disabling in some cases, the scientific literature on the subject remains relatively sparse, as evidenced by an article in the British magazine THE WEEK .
They also count that the most popular medical publication tool PubMed reports 393 clinical studies on dyspareunia, 10 on vaginismus and 43 on vulvodynia. Comparatively, erectile dysfunction displays 1954 studies on the counter.
Can we therefore - legitimately - question the existence of a real gap in the treatment of sexual disorders which concern vaginas compared to penises?
What is the difference between vaginismus, dyspareunia, vestibulodynia or vulvodynia?
Let us briefly recall that we are talking about vaginismus when penetration is impossible, as if the body were an obstacle, which is called dyspareunia situations where the penetration of an object remains possible, but causes pain, vestibulodynia , when the pain is located in the vestibule (entrance to the vagina), during penetration or outside of it and finally vulvodynia in case the pain concerns the external genital area in general causing discomfort and inconvenience and this can occur even outside of intercourse.
These pains have been grouped together under the name of “ disorders related to genito-pelvic pain or penetration ” by the DSM in 2013. (Diagnostic and Statistical Manual of Mental Disorders).
In fact, the common cause of sexual pain related to penetration is attributed to a reflex contraction of the pelvic floor muscles in general, and not simply of the constrictor muscle of the vulva - as many may think more specifically - making any penetration impossible and/or painful.
It has indeed been demonstrated that in people with vaginismus, the muscle tension measured in the pelvic floor musculature as a dilator approached the vaginal canal was significantly greater than in people without sexual pain. And that this tension involved complex and extensive muscle bundles of the pelvic floor, not just those surrounding the vaginal canal.
When should vaginal dilators be used?
Vaginal dilators are highly recommended in cases of vaginismus and/or dyspareunia; whatever the causes. They allow the person using them to regain control over the muscular relaxation necessary for the pelvic floor muscles to achieve painless penetration.
Although they are commonly referred to as vaginal dilators, this term does not quite do them justice as nothing is actually " relaxed " when using them.
The use of dilators is recommended for many reasons. They help train the soft tissues in and around the vagina to function properly.
They help to soften postpartum, post-operative or even post-radiotherapy scar tissue or they help to soften and lengthen the pelvic floor muscles as part of planned exercises. They are also useful in reducing hypersensitivity to touch.
Pelvic floor rehabilitation plays a vital role in improving the tone, flexibility and control of the muscles that make up the pelvic floor. In order for penetration to be painless, these muscle fibers must be able to relax and stretch around whatever is being inserted into the vaginal canal. Dilators can help achieve this through proprioception (muscle memory).
They thus allow you to evolve gradually, allowing you to manage the muscular relaxation around what is introduced into the vagina, gradually increasing the dimensions, under your control.
It is recommended to train little but frequently. Start with a minimum of one minute with the aim of doing sessions of 5 to 10 minutes, ideally 5 to 6 days a week.
Moving from one dilator to a larger one can take weeks. The goal is to progress slowly but surely.
Too rapid an evolution can cause pain which will induce involuntary spastic contractions and therefore even more pain.
If the progression is stopped or even slowed down, do not hesitate to consult: your physiotherapist, gynecologist or sexologist or psychotherapist to determine the reasons.
It is recommended not to leave the exercises until last before bedtime, the fatigue of the day will have gotten the better of your motivation.
Instead, ideally try after your bath or shower, the vasodilatory and myorelaxant effect of hot water can help you to be naturally more relaxed.
The goal is to go as deep as you can, without ever causing pain. You may feel a little discomfort the first few times, but never tolerate pain.
How to use vaginal dilators? What exercises to do and how often?
It is therefore recommended to:
- Start with the smallest dilator.
- It is best to be in a semi-reclining position on your bed, sofa or armchair. Knees bent and feet flat on the ground.
- In order to prepare for the session, using a few abdominal breaths could help you release any muscular tension.
- A helpful first step is to hold the tip of the dilator at the entrance to the vagina and try to identify the sensation of muscle relaxation with each exhalation. This may help you identify the tension that builds up in the perineum as penetration approaches so you can better manage it.
- Consider coating your vulva and the tip of the dilator with water-based lubricant . There is no need to try to guide the movement of the dilator. Let it find its place naturally.
- Hold the dilator in this neutral position for 1 to 10 minutes, trying to maintain maximum relaxation of your pelvic floor. If you no longer feel the dilator, that's good news; you've reached an ideal level of relaxation. Repeat the exercise daily.
- When using the dilators try to focus on your breathing or bodily sensations. Try not to be taken over by your thoughts or focus too much on your emotions.
- When you are ready to move on to the next step, consider starting the session with the previous size, which you can keep for up to a minute. Just enough time to get used to it again. The goal is to nevertheless start with the dilator of the next size directly.
- You are ready for the next step when you tolerate the dilator for 10 minutes without discomfort or pain and with a satisfactory degree of relaxation.
- There is no need to move the dilators at first, the main exercise is to identify the sensations of muscle relaxation around the pelvic floor during penetration and to train your body to this mechanism through proprioception.
- In some cases and depending on your progress, you can make the exercise more complex by practicing contracting as hard as possible around the dilators when they are inserted in order to identify the muscle relaxation that follows. The stronger the contraction, the stronger the muscle relaxation. Muscles work like a rubber band, the more you pull on them, the stronger the relaxation will be.
Finally, it is essential to emphasize the psychosomatic component of sexual disorders related to painful penetrations. Indeed, it is more than advisable to seek the care and kindness of physiotherapists, osteopaths and/or perineologists, in conjunction with a psychotherapist and/or sexologist, because it is clear that this body and mind approach, via cognitive-behavioral therapies or hypnotherapy, contributes to considerably increasing the comfort of people suffering from this type of pain.
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