Hitting the wall: Overcoming vaginismus

Tips for getting to the next level

Vaginismus is commonly treated with gentle and progressive stretches of the pelvic floor muscles using a dilator set.  The goal is to reduce the protective response by the brain associated with vaginal penetration for painful gyn exam, use of tampons and/or intimacy.  Regardless of which dilator set you chose to use, at some point you may reach a plateau that you just can’t seem to overcome.  Perhaps you are frustrated with using the dilators daily or maybe you can’t stretch beyond the 3rd or 4th dilator.  The lack of progress can be frustrating and you may feel like giving up.  You are not alone! It is important to note that plateaus are not uncommon, and many women experience this issue.  At Carolina Pelvic Health Center, Inc. we work together with our patients and their partners to overcome obstacles and to help them feel confident and comfortable during intimacy.

Overcome frustration or burnout   

Take a break!

Sometimes vaginismus treatment can feel more like a marathon than a sprint. If you find yourself dreading and putting off your dilators, you may need some time off. It’s perfectly normal and OKAY, and it’s likely you won’t lose much, if any ground. Taking a break for one week from dilator stretches is a good way to give your body and mind a reprieve and reinvigorate your dedication to dilator stretches.  

Reconnect with your partner

Stay connected:

During your week off  and throughout treatment, try other ways to enhance your intimacy with your partner. Holdings hands, taking a walk together, giving each other back rubs are nice ways to stay connected without having to focus on vaginal penetration.

Take time for yourself:

Have FUN!

Vaginismus treatments can seem all consuming and you may find that you don’t have time for all of the other fun things in your life.  Remember to take time to do activities you enjoy. If you enjoy exercise, take time to go to the gym or take an extra yoga class.  Maybe you enjoy cooking or art work? Even listening to music and dancing around the house can be a fun break from the daily grind and help with relaxation.  

Moving on: Getting to the next dilator


Often patients tell us that they get stuck on a particular dilator size,  feel the next dilator is too big or they feel a full sensation. Maybe it is so painful or scary that even the thought of trying prevents them from using the next dilator. It is helpful to know that is a common experience.  We are here to help you progress to the next size to help get you to comfortable, pleasurable sex, and the following are a few ideas to jump-start your program. 

Try a new position:

Typically patients are instructed to lie supine in a semi- reclined position when using dilators.  This is a very easy position to start with simply because it is easy to reach the vaginal opening.  To help relax the pelvic floor muscles further, try bringing one knee up towards your shoulder and then insert the dilator. This is a modified happy baby pose position and is a gentle way to passively relax the muscles to allow for easier insertion.  Positioning with both lower legs supported on a chair or ottoman may help you keep your hips and pelvis relaxed while you insert your dilators. 

Side-lying is another great position to try inserting the dilator.  Lie on one side with your knees up toward your chest and a pillow between your knees to relax your hip and leg muscles. Then gently insert the dilator into the vagina from behind.  You may need your partner to help guide the dilator into the vagina due to the different angle of insertion.  

Use your dilators during your period

Yes, this is a great time to use dilators!  There is plenty of natural lubrication and blood flow to the vagina during menstruation.  Many of our patients find they are able to progress to the next dilator size or the dilator size that was painful is now more comfortable or pain free.  Using the dilator at this time may reduce apprehension and decrease the association of vaginal penetration and pain in the brain- a primary goal of dilator work. 

We also recommend attending therapy during your period if your visit happens to fall during your cycle.  We can progress your tolerance to stretch of the pelvic floor muscles and vaginal tissues.  This is particularly helpful if using tampons is one of your goals. This is also a good time to progress other components of your home program if you are not comfortable doing pelvic floor work during your period.



Aerobic exercise is a great way to increase circulation throughout the whole body including  the pelvic floor muscles and vaginal canal.  Consider doing 30 minutes of aerobic exercise during the day that you are going to do dilator stretches.  You may prefer different styles of yoga as well. Exercise reduces anxiety and calms the nervous system.  When we are calm and relaxed our muscles are able to relax easier allowing for more comfort and stretch with the dilators.  



Change lubricants:

When it comes to lubricants, you have 3 main choices: Oil based, water based, and silicone.  Within each category, there are LOTS of options.  Some are more slippery, some are slightly thicker and in gel form, and the feel or ‘slip’ of the lubricants vary greatly. Silicone lubricants tend not to dry out or become absorbed, which can be desirable. So if you are feeling stuck with your dilator routine, maybe a lubricant change will do the trick. While we can help to steer you in a direction based on your needs, sometimes trying them out is the best way to determine what you like the best. That said, there are a few additional things to consider when choosing your lube:

  • Silicone lubricants will break down silicone dilators- if you are using silicone dilators, make sure you are not using a silicone lubricant.
  • Some water-based lubricants include glycerin, which may be irritating for women with frequent yeast infections.
  • Just say no to heated, flavored or warming lubes: Trust us. Don’t do it. (The term ‘fire in the hole’ comes to mind).
  • Natural oil-based lubricants, such as coconut oil, olive oil, vitamin E oil are often popular because they are affordable and easy to find, and feel good to dry or irritated tissues.  While many women use these without issue, there are increased risks with use oil-based lubricants, including of yeast infections and bacterial vaginosis (known as BV). If this is your preferred lubricant, make sure to monitor for itching, discharge and/ or irritation and talk with your therapist or visit our product page for other recommendations.

Make a Mess!

Don’t be sparing with lubrication- put a towel down and you are good to go! You may also find that a combination of lubricants is helpful. For example, to reduce friction with initial insertion, liberally apply a moisturizer or lubricant of choice to your vaginal entrance (see above for options & things to consider) and the lubricant you prefer to your device. Keeping your tissues hydrated will help to reduce friction on the skin, and the wetness of the lubricant can improve ease of dilator insertion.  You may also find that using a small liquid medicine dropper or syringe to apply lubricant inside the vaginal canal can help with deeper dilator insertion. As always, reapply regularly if you are feeling friction or when you move to the next dilator.

Ask your therapist how to apply these principles to your home program to enhance your progress with dilator stretches.  

If you are using dilators at home without the guidance of a pelvic floor physical therapist and have questions give us a call @ 919.571.9912 to schedule a free consultation and learn more about how we can help you with intimacy.