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How to Use Dilators in the Treatment of Vaginismus and Menopausal Sexual Pain

Vaginal dilators play an important role in vaginismus treatment and menopausal sexual pain. Regardless of the type of treatment for these conditions, dilators are almost always needed to overcome penetration difficulties in both younger women and also for women who have menopausal sexual pain.

Both of these conditions are marked by considerable pain with penetration attempts. For younger women with vaginismus this includes the inability to use tampons, pain with finger penetration, and difficulties with penetration pain during pelvic speculum examination and intercourse. The pain is related to muscular spasm in younger women and dryness and vaginal atrophy in menopausal women. When severe, this is known as secondary menopausal vaginismus. A milder case of penetration pain in menopause is known as dyspareunia.

Vaginal dilators are manufactured in a variety of styles and materials graded in size from #3 to #8 with the common sizes being numbers 4-6. Size relates to the widths of the dilators (the smaller the number, the narrower the dilator). Wide dilators such as #7 and #8 are needed for partners with larger than normal erections. During my experience using dilators for vaginismus patients, I found that many of the dilators were too long as the size increased. Since the normal vagina is about 3 ½ inches long, a dilator that is 5-6 inches long will protrude from the vagina and impair mobility during dilation. It is for this reason that borosilicate dilators were developed all of which are 3 ½ inches long, regardless of the width.

Too often dilation recommendations by professionals in the field underestimate the length of time needed for effective dilation and the correct progression of the dilators. To understand how to use dilators in the treatment of both vaginismus and menopausal sexual pain, I recommend the following resources:

  1. A blog written by Dr. Peter T. Pacik titled How to use Vaginal Dilators” (link
  2. A one-hour film available as a download by Dr. Peter T. Pacik titled Understanding and Treating Vaginismus (link:

-Dr. Peter Pacik MD, FACS

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