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

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.

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!

Similar articles and advice

  • Caitlyn Tivy PT, DPT, OCS

Part two of a series on vaginal trainers from Caitlyn Tivy, a pelvic health physical therapist and health writer. This part of the series explains more about the specifics of using them.