Debunking Dilators: The When, Where, and How of Dilation (Part Two)

Hey Scarleteen! I’m Caitlyn, a pelvic health physical therapist and health writer. If you’ve made it here from the first part of my series on vaginal dilators (aka trainers), congrats! If not, and you’re looking for more info about what trainers are, the conditions for which they’re useful, or how to choose the correct type, hop back over to part one.

If you’ve already read the first part of this series and you’re ready to learn more about using trainers safely and effectively, you’re in the right spot – let’s dive in!

Starting to use trainers can be intimidating for a lot of folks, especially if you’ve previously experienced pain and discomfort with activities involving insertion of something into the vagina⁠ (vagina: The internal passage leading from the opening of the vulva to the cervix of the uterus.) or neovagina⁠ (neovagina: The medical term for a vagina that is created surgically for people who weren't born with one.) *. It’s important to understand that these trainers don’t permanently stretch the vaginal canal or change its size or shape. Instead, they are designed to reduce pain and improve tissue flexibility, much like stretching your other muscles when they are sore.

We’ll discuss the basics of trainer use here, but if you’re struggling with your trainer practice, personalized input from a professional can be invaluable. A pelvic rehab provider, like a pelvic physical therapist (PT), can help verify if trainers are indeed a good option for you. They can provide you with tailored education to help you use your trainers in a comfortable way.

*When I use “vagina” for the rest of this article, you can assume it includes neovaginas.

How do I start using my trainer(s)?

First things first: find a comfortable, private space in which to practice with your trainers. Ideally, choose a time when you can dedicate at least 15 minutes to your practice session.

• Thoroughly wash your hands and your trainers. I can’t overemphasize the importance of hygiene! Wash your hands and your trainer(s) with warm, running water and a mild, unscented soap. If you happen to own a sex⁠ (sex: Different things people choose to do to actively express or enact sexuality and sexual feelings; often this involves genitals, but not always. ) toy cleaner, you can use it to clean⁠ (clean: In a sexual context, usually a word used to suggest a person doesn’t currently have anysexually transmitted infections. That term, however, stigmatizes people with illness. Less stigmatizing choices are "negative," "clear" or "STI-free.") the trainer(s). Be sure to thoroughly rinse off any cleaning product left on your hands and trainer(s).

• Make your space comfortable. You may find that lying on your back on a soft surface like your bed or a soft rug is a good location to practice. Ensure that the room is comfortably warm, and have pillows nearby to support your body. Gather any other supplies you may need, like lubricant⁠ (lubricant: A fluid used in order to make kinds of sex (such as masturbation, vaginal intercourse, anal intercourse or manual sex) more pleasant and comfortable, and/or to help prevent condoms from breaking by decreasing friction.) , a clean hand towel, and a timer.

• Set a tone of relaxation and safety. This can look different for each person: some folks like to dim the lights and play relaxing music. Some people prefer silence. Others enjoy lighting a scented candle and snuggling up under a warm blanket. Choose whatever makes you feel as cozy, safe, and comfortable as possible!

• Find a comfortable body position. For many people, lying on the back with knees bent, thighs apart, and feet on the ground is the easiest position in which to practice. You may prefer to “butterfly” your legs and place the soles of your feet together; cushions or pillows under the outer thighs can make this position more supportive. You may like to prop your torso up on a couple of pillows to improve your ability to see and feel what’s happening. If you use a wheelchair or another assistive device that makes lying down difficult, you can recline instead: if your wheelchair can tilt, try reclining it 45 degrees and locking it there for stability. Alternatively, you may choose to transfer to a reclining chair or to a bed with cushions to support your torso on an incline. What’s most important about whatever position you choose is that it allows you to relax as fully as possible.

• Take a few minutes to breathe and connect with your body. Once you’re comfortable, spend 2-3 minutes (or longer if you’d like!) observing your breath. Placing one hand on your upper abdomen just below the ribs can help you feel your breath filling and emptying.
  • Find a breathing pattern that feels comfortable and relaxed: if possible, encourage your exhales to become longer than your inhales. If that feels strained, though, don’t force it!
  • Perform a brief mental scan of your body from head to toe. Notice if you feel tension or discomfort in any particular body part(s), and if so, direct your attention into that area. As much as possible, allow the area to soften and release (but again, no need to force it!)

How do I insert a trainer?

If you purchased a set of progressive trainers, it’s almost always best to start with the smallest available size. Think of it like cooking: you can always add more salt (i.e., a larger trainer) to the recipe if needed, but it’s difficult to correct for excess salt if you accidentally add too much.

Apply a dime-to-quarter-sized amount of lubricant to the tip of your clean trainer. Use the tip of the trainer to gently coat the outside of your vaginal opening⁠ (vaginal opening: The external opening to the vagina.) with some lubricant. You can use your non-dominant hand to gently separate the labia⁠ (labia: On the vulva, both inner (labia minora) and outer (labia majora) sets of skin with sensory nerve endings which surround the vaginal opening.) (lips) to better expose the vaginal opening.

Note: plastic trainers can be used with any lubricant you like. If you’re using a silicone trainer, you’ll need to pair it with a water-based lubricant. I personally recommend Good Clean Love’s Almost Naked Organic Lubricant and Sliquid’s H20 Lubricant, especially since there's some recent research that shows these two don’t kill beneficial bacteria in the vaginal microbiome.

Rest the tip of the trainer against the outside of your vaginal opening and just pause. Give your body a few moments to get used to the sensation, and notice if your muscles instinctively tense (this is common!). Allow yourself to breathe and relax here without any expectation for what comes next. This gives your muscles a chance to release completely; your body heat will also warm the trainer and lubricant, which can make them more comfortable.

As you feel ready, gently and slowly advance the tip of your trainer into the canal, just past the vaginal opening. Pause here and notice how you’re feeling. If you’re encountering resistance, try exhaling through your nose or mouth to encourage your muscles to soften. Full belly (diaphragmatic) breathing can help reduce discomfort and calm your whole nervous system.

Breathe here for several moments, focusing on relaxing and releasing all your muscles. Scanning your body and progressively releasing any tension you encounter can decrease the intensity of uncomfortable sensations during this practice.

When and if you feel ready, you can advance the trainer a bit further. Again, pause and observe your physical and emotional reactions to inserting the trainer deeper. Take several slow, deep breaths in each new position: this gives your tissues time to stretch and accommodate to the trainer with every change. If you feel comfortable, you can insert your trainer fully, keeping the flared end outside the vaginal opening.

Using trainers Should. Not. Hurt. “No pain, no gain” does NOT apply here (nor to most things). If practicing with your trainer is miserably painful, you’re unlikely to make real progress, and you may even set yourself back.

If you’ve been trying to use trainers for a while now and you’re encountering a lot of pain, it may be time to consult with a pelvic PT for more guidance. There are a lot of other techniques and options that can help people with this type of pain, so don’t despair!

Once you’ve inserted your trainer to a comfortable depth, rest in this position for several minutes, breathing and relaxing. When you’re ready to remove the trainer, do so slowly and gently, pausing and slowing down if you experience discomfort.

How long should a trainer practice session last? How often should I use my trainers?

The ideal length and frequency of practice sessions vary a bit depending on the person and their condition. Unfortunately, the scientific research on optimal trainer use is still a bit lacking: as professionals in the field, we only have a few studies on which to base our clinical recommendations. Here are a few common practice formats:

• 15-20 min when progressively dilating/training (i.e., gradually introducing larger trainers one after another)
• No longer than 10-15 min, 3x/week to avoid burnout
• 2-5 min, more often (3-7x/week); or 5-10 min, less often (3-4/week) when performing movement-based training (more on this to come)

The recommendations for trainer use vary widely, but there are a few common threads. In general, trainer sessions can be short and still be effective. I tend to agree with the <15 min recommendation: less is more, especially when you’re just getting started!

Finding the right frequency is also key. I find that in most cases, 3x/week is ideal: it’s often enough to maintain progress between sessions, but not so frequent that it becomes a huge burden on your schedule.

In some cases, higher frequency and/or duration are necessary. Following neovaginoplasty⁠ (neovaginoplasty: A type of bottom surgery. Neovaginoplasty, or vaginoplasty, is a surgical procedure to create a vagina for someone who wasn’t born with one.) , some providers recommend training 2-3x per day for 6 months. People who have had radiation therapy for certain gynecologic cancers may also need to train for longer to prevent scar tissue build-up. However, these are highly specialized cases in which working directly with a pelvic rehab professional is critically important.

How do I progress my practice?

The most obvious way to progress your trainer practice would be to increase the size of trainer you’re using. However, there are several methods of progression to consider:

• Move to the next larger trainer size. I find this is most effective when someone starts their trainer session with a smaller size that is already comfortable. Spend the first few minutes of your session with your smaller trainer inserted: this allows your muscles to soften and prepare for the next size.
  • Note: there’s little benefit in advancing to the next trainer size if you have discomfort with the size you’re already using. There’s no right or wrong speed at which to progress your trainer practice: give your body plenty of time to respond to one size before progressing to a larger one.

• Use a movement-based approach to training. If you’ve ever done yoga or stretched before your muscles were warm, you’ve probably encountered some muscle pain. Muscles respond best to stretch when they are warmed up: they love movement and blood flow! The muscles of your pelvic floor are no different: they stretch better when you allow them to move during the stretching process. Here’s how to use this behavior to your advantage:
  • Once you’ve inserted your trainer to a comfortable depth, exhale and gently squeeze your muscles around the trainer. Hold the squeeze as you finish your exhale, then release and relax your muscles completely.
  • Repeat this squeeze-and-release pattern a couple more times to get used to it. If this feels okay, you can use the relax phase to stretch further: as you release the squeeze, gently press the trainer against the muscles on the right side of your vaginal canal. Maintain this pressure as you breathe and relax further into it.
  • Repeat this pattern of pressing on the left side and towards the back of your vaginal canal, relaxing into the pressure each time. (Avoid pushing your trainer against the front wall of the vagina: your urethra⁠ (urethra: The urinary tract, where people pee from. On a penis, the opening to the urethra is at the head of the penis; on a vulva, the opening is above the vaginal opening and below the external clitoris.) lives there and it doesn’t like direct pressure!)
  • If you’re comfortable with all of this, you can try gently moving the trainer in and out (deeper and shallower in the canal). This is a helpful technique for folks who have a goal decreasing pain during vaginal intercourse⁠ (vaginal intercourse: When a penis or sex toy is inserted into and held by the vagina while partners move their bodies as feels good to them for the purpose of either sexual stimulation and/or reproduction.) .

• Change up your body position. The muscles of your pelvic floor don’t exist in isolation: they interact with the muscles your hips, abdominals, back, and more. Moving other body parts can help stretch the pelvic floor muscles in new ways, and this can reduce discomfort even further. Here are a few variations to try before or even after inserting your trainer:
  • Bring one or both thighs in towards your chest
  • Straighten out⁠ (out: Short for ‘out of the closet’. When someone’s LGBTQ+ identity is known to other people.) one leg at a time so it is relaxed on the floor or bed
  • Bridge your hips/pelvis up towards the ceiling and lower back down several times
  • Transition slowly to all-fours (hands and knees) and lower your hips back towards your heels (like child’s pose, if you’re familiar with yoga)

Let the reactions and sensations of your brain and body guide any progressions you perform with your trainers. If any of these progression techniques cause substantial discomfort, back off: you can always try again another day!

How long do trainers take to work?

The answer to this depends entirely on your end goal. Consider two people with vaginismus⁠ (vaginismus: Painful muscle spasms in the vagina as a response to pressure/contact. Sometimes has no known cause, and sometimes happens after psychological or physical trauma.) (muscle spasm that causes pain with insertion of anything into the vagina):

• Person A’s goal is to be able to insert a light flow tampon⁠ (tampon: A firm, disposable roll of absorbent cotton or other fiber that goes inside the vagina to absorb menstrual blood.) without pain
• Person B’s goal is to have pain-free vaginal intercourse with a partner⁠ (partner: In a sexual context, a person with whom someone is having some kind of sex. The term "partner" can be used for all kinds of relationships, not just serious ones. "Partner" can also mean the person someone is with in a romantic or familial partnership.) whose erect penis⁠ (penis: One of the two external reproductive organs of people often assigned male at birth.) is 1.5 inches wide

Person A is likely to achieve their goal before Person B, both because the tampon is smaller in size, and because it won’t be moving once it is placed. This doesn’t mean that Person B should just give up! They must simply expect that it may take longer to achieve their goal.

A recent research review article found that people who practiced with their trainers for more than 3 months had better outcomes than those who practiced for less than 3 months. Keep in mind that this result was based on averages from many individuals – each person is unique and requires an individualized approach to trainer use.

A few notes on safety and hygiene

Here are few tips to keep in mind when practicing with trainers:

• Practice good hygiene
  • Keep your hands and your trainer(s) clean
    • We discussed this previously, but it bears repeating: wash your hands and your trainer(s) with mild, unscented soap and warm, running water before and after each practice session.
    • The soap you use should be gentle: check the ingredients list to ensure it doesn’t contain any products to which you’re allergic.
  • Pee after practicing
    • Much like peeing after sex, peeing after practicing with your trainer flushes bacteria out of the urinary tract, which may help prevent infections like UTIs.
  • Practicing on your period⁠ (period: The fluid – or flow – which contains blood, from the shedding of the uterine lining usually at the end of each menstrual cycle. Sometimes periods may be less fluid and more globby; this is the state that is often mistaken for blood clotting.) : a personal choice
    • It’s totally safe to use trainers during your period, if you have one. However, some folks prefer to take a few days off from practicing during the heaviest days of their flow, and that’s perfectly fine, too!
    • If you do practice on your period, be sure to first remove any internal hygiene products like tampons or menstrual⁠ (menstrual: Having to do with menstruation.) cups. You may choose to lie on a towel during practice for easy clean-up of any mess.
  • Dealing with infections or injury: take some time off
    • Don’t practice with your trainers if you’re fighting an active pelvic infection⁠ (infection: When harmful microbes, or germs, or harmful levels of microbes/germs, enter the body and multiply, causing illness. The common cold, flu viruses, sexually transmitted infections, chickenpox, impetigo, rabies and diphtheria are some kinds of infections.) (like a UTI, yeast infection, or flare-up of STI symptoms). The same rule applies if you have any cuts or skin irritation on your labia or inside your vaginal canal. Give your body the time it needs to recover completely before resuming trainer use.
• Lube is your friend!
  • When practicing with trainers, it’s hard to overdo lube. Lubricants can improve comfort during trainer insertion and with movement of the trainer.
  • Before selecting a lubricant, check the ingredients list for any products to which you have allergies. Again, please pair silicone trainers with water-based lube.
• Go s l o w l y
  • Trainer practice is a marathon, not a sprint: there is no benefit to rushing or pushing through pain to get to the next level. In fact, progressing too quickly and ignoring your body’s signals can actually set you back. Take your time, and be patient with your body both during and between sessions.
• It’s okay to distract yourself sometimes
  • Research suggests that people who practice mindfulness (such as focusing on their body and breathing) during trainer sessions tend to have the best results. However, it’s not always possible to be 100% present, 100% of the time.
  • If you occasionally need to distract yourself during a trainer session, choose a soothing distraction, like watching a calming video or playing with a fidget toy. High-intensity distractions, like loud social media videos or a suspenseful movie, usually aren’t the best choice.
• Trauma triggers: pair your physical practice with mental health care
  • If practicing with your trainers brings up past trauma⁠ (trauma: A serious or critical physical and/or emotional injury or physically and/or emotionally painful experience.) , it’s important to process this. You may find that journaling for a few minutes after each session helps you track and understand your emotions and experiences during practice. A few minutes of gentle, full-body stretching; guided relaxation; or meditation can help you recenter after a session.
  • If you have a therapist, consider discussing your trainer practice with them: talking with them about your progress and the challenges you face during sessions can help you understand and process your responses to training.

Practicing with trainers can be an extremely valuable addition to a pelvic healing program. However, getting started and progressing with trainers can be challenging, so don’t be afraid to reach out to a professional for help!

Patience and self-compassion are key for anyone working with trainers: it’s important to give yourself time and plenty of self-care throughout the process. I wish you lots of luck and improvement on your trainer journey – you’ve got this!