Debunking Dilators: The What, Why, and Which of Dilation (Part One)

Author:

Caitlyn Tivy, PT, DPT, OCS

Perhaps you’ve heard of dilators — also known as vaginal trainers — before, but you weren’t sure where to learn more about them. Maybe you’ve never heard of them, but you’re looking for ways to manage pelvic pain. Perhaps you’ve already tried using dilators, but weren’t very successful. You can read all about them here.

Hey Scarleteen readers! It’s Caitlyn the pelvic health physical therapist here, talking this time about all things dilators. Perhaps you’ve heard of dilators — also known as vaginal trainers — before, but you weren’t sure where to learn more about them. Maybe you’ve never heard of them, but you’re looking for ways to manage pelvic pain. Perhaps you’ve already tried using dilators, but weren’t very successful. Regardless, you’re in the right place!

“Vaginal dilator” is the most commonly used medical term for these devices, though many clinicians and researchers are shifting to the term “vaginal trainer.” Many pelvic PTs—myself included!—prefer the term trainer. Not only does “training” sound less aggressive than “dilation”, it also communicates a key concept of trainer use: it should be an active, participatory process in which the user is in control, rather than an experience that is happening to them as a passive recipient.

I also generally refer to these devices simply as just “trainers”. This terminology is inclusive for everyone with genitalia that allow for use of these devices. For these reasons, I’ll use the term “trainer” for the remainder of this article.

If you search online using the terms “pelvic floor trainer” or “vaginal trainer”, you may see ads for other devices designed to help people learn to perform pelvic floor exercises, or “kegels,” properly. These devices are not the same as the trainers we’re discussing here, but not to worry: I’ll include a guide to finding the right type of trainers later!

What exactly are these trainers?

The trainers we’re discussing here are medical devices used to decrease pain and improve flexibility in the tissues of the vaginal and neovaginal canals. (Neovagina is the medical term for a vagina that is created surgically for folks who weren’t born with a vagina. When I use “vagina” for the rest of this article, you can assume it includes neovaginas as well.) Trainers also come in variations made specifically for rectal use, though these types of trainers are beyond the scope of this article.

Trainers can be made from a variety of materials. They are typically cylindrical in shape. At first glance, they can look a bit like sex toys, but that’s not their intended use. Trainers are designed to provide therapeutic stretching and pain relief for the tissues of the vaginal canal. Let’s learn more about the many cases in which trainers can be useful!

What are trainers used for?

Flexibility and comfort are important for overall vaginal health. Here are a few common reasons why folks choose to use trainers:

To reduce excess tension (hypertonicity) in the pelvic floor muscles
To reduce pain/tenderness in the vaginal canal
To decrease discomfort during gynecological pelvic exams
To improve comfort when using internal menstrual products like tampons or a cup
To heal after neovaginoplasty surgery (aka penile inversion vaginoplasty or “bottom surgery”)
To reduce scar tissue formation after treatment for certain cancers

This list of reasons isn’t exhaustive, but it covers many common motivations for trainer use. People with the following medical diagnoses can often benefit from trainers:

Chronic pelvic pain
Dyspareunia (pain with vaginal intercourse)
Anodyspareunia (pain with anal intercourse)
Vaginismus (vaginal muscle spasm)
Vulvodynia (pain in the labia/“lips” or at the vaginal opening)
Endometriosis
Non-relaxing pelvic floor
Urologic chronic pelvic pain (aka painful bladder/painful peeing)
Dysmenorrhea (painful periods)

Trainers can be a helpful tool in the management of many pelvic health conditions.

How do I know which type of trainers to get?

Since each person and their body are unique, different types of trainers work better for different folks. Trainers are most commonly made from silicone or hard plastic, though glass versions do exist. Let’s break down the pros and cons of a few common options:

Trainer Brand	Pros	Cons
Intimate Rose	Silicone is flexible and comfortable to insert Can warm trainer up in your hands before insertion Available in 8 progressive sizes Can buy individually or in packs Extender handle* available	More expensive than plastic versions Can’t use with silicone or oil-based lubricants (must use water-based)
VuVa Tech	Cheaper than silicone options Can use with any lubricant; lube provided with order	Hard plastic can be more challenging to insert Can feel a bit cold initially No handle/extender option Usually have to buy full set
Soul Source	Comes in silicone and plastic options Plastic version be chilled for a cooling/pain-killing effect Can buy individually or in packs Offers an option specifically for use after gender affirmation surgery	Fairly expensive No handle/extender option
She-ology	Made of medical-grade silicone Shorter overall length (3 in) reduces intimidation Slightly curved shape with significant taper to make insertion easier Large sizes can accommodate a bullet vibrator to further relax muscles	Can only buy in sets of 3 or 5 Can’t use with silicone or oil-based lubricants (must use water-based)
Milli	A single rechargeable device that expands gradually, 1 mm at a time Soft silicone covering for comfort Optional vibration settings to further relax muscles	Very expensive Can’t use with silicone or oil-based lubricants (must use water-based)

*Extender handles can help improve reach for less flexible folks and people with larger bodies.

Medical device suppliers are continually releasing improvements to the trainers they offer. Many offer promotions to help reduce the cost of trainers. If you are in the United States and have health insurance with an HSA (health savings account), you can use the money in your HSA towards the purchase of trainers.

If a full set of progressive trainers is a bit too steep for your budget, it’s still worth starting with 1-2 individual trainers. You can make a lot of progress with just a couple of sizes.

How do I pick the correct size?

In general, it’s best to start with a smaller size than you think you could tolerate: this increases the odds that inserting your trainer will be essentially pain-free. You can always size up later when your body is ready.

Most websites that sell trainers will label each size with its height and width. For reference, the average “regular flow” tampon is less than half an inch wide. If inserting a tampon or a single finger is difficult for you, you’ll want to start with the smaller trainers that are less than half an inch wide.

If tampon/finger insertion is pain-free for you, but vaginal sex (with a penis or a toy) is uncomfortable, you can start with a medium-sized trainer. This is why purchasing at least two trainers can help: if one is too big, you can easily switch to the smaller size, and vice versa.

Okay…now what??

You’ve decided that you’d like to give trainers a try and you’ve purchased some for home use…but now, you’re not sure what to do next! Never fear: in part two of this short series, we’ll discuss the ins and outs of using your trainers, from hygiene and safety to practical tips to make practicing more comfortable. Check it out here!