Instructions on the Use of Vaginal Dilators for the Treatment of Vaginal Agenesis:

A Guide for Teen Girls

If you are reading this guide, it is likely that your gynecologist has recommended vaginal dilators to help you create a vagina. Vaginal agenesis (absence of the vagina) is a condition some young women are born with. Dilators usually come in a set of varying sizes. As the vagina stretches, the next size dilator is prescribed. The use of dilators to create a vagina is safe and does not involve surgery. The following guide is intended as general information. It is not a recommendation for treatment nor should it be considered medical advice. Please consult with your gynecologist if you have any questions.

Before You Begin

You must first receive teaching and counseling from your doctor or nurse. It may feel funny in the beginning to ask questions but it is very important so you understand how your vagina will be created.

How do the dilators work?

The dilators work by stretching the skin in your vaginal area, slowly over time. Most girls with vaginal agenesis are born with a vaginal dimple (where the vaginal skin puckers in a little bit). Other girls may have a small vaginal opening. When a dilator is placed in this area with pressure, the skin stretches and a vagina is formed. If you use the dilator more frequently, the process will take much less time, and you can probably guess that it takes much longer when you rarely use the dilator.

How long will it take to create a vagina?

The process of creating a vagina can take as little as 2-3 months or as long as 18 months, depending on how often you use your dilator and if you are using it correctly. Generally, if you use the dilators properly for about 20 minutes, twice a day, and apply pressure, it will take about 3-6 months to create your vagina. You might guess that it will take a lot longer if you do not use your dilator(s) consistently. Most young women have good results when they remember to use their dilator(s) at about the same time every day. Pick a time such as first thing in the morning or before you go to sleep so you'll get into a routine. Once you feel comfortable, the dilator can be held in place with one hand so you can do other things like read, watch TV or talk on the phone.

How will I know if I am using the dilators correctly?

Before you take your dilator(s) home with you, your health care provider should show you how to use it and allow time for you to practice placing the dilator in the right spot. You will use one dilator at a time beginning with the smallest size. It is best to be in a semi-reclining position with your knees flexed. Ask if you can use a mirror to help you find the spot where you will be applying pressure.

Getting Ready

Set aside about 20 minutes, twice a day when you won't be interrupted and can have privacy in your bedroom or place of your choice. Work this out with a parent or other family member so they can make sure that you won't be interrupted unless you don't mind. It can help to hang something on your bedroom door such as a Do Not Disturb sign, which will signal others in your household that you are not available for a while.

1. Try to take a warm bath for at least 10 minutes before you use your dilator. Although this step is not absolutely necessary, the warm water helps to soften the skin where you will be using the dilator and allows your skin to stretch more easily.
2. Check the dilator for cracks or rough edges, especially if you are using a glass dilator . If the dilator is damaged in any way, do not use it, and contact your doctor.
3. Wash your dilator with warm water and mild soap then dry it of
4. Apply a small amount of water-based lubricant, such as K-Y Jelly or Surgilube Jelly, on the tip of your vaginal dilator.
   

Using the Dilator

Lie on your back and bend your legs (the same position for a pelvic exam), and place the lubricated dilator against your skin below your urethra (where your urine leaves your body), right around your vaginal dimple (this is the beginning of an indentation, where your vagina will be). You can find this spot by slowly and gently sliding the tip of the dilator along the spot right under your urethra.

Using pressure, hold the dilator in place for about 20 minutes. Push the dilator at an angle in the direction of your lower back or tail bone and simply hold it in place. Do NOT use an in and out motion. You should be able to feel the pressure but not pain. If you have pain, you may be pushing too hard. If you don't feel anything, you may not be using enough pressure. After a few tries, it will feel like the right amount of pressure.

After you Dilate

Keep your dilator in a safe place where you will remember to find it the next day. Although your dilator does NOT need to be sterilized, it's a good idea to get in the habit of rinsing it off with mild soap and water and drying it before you put it away. Some girls have suggested buying an inexpensive locking box to store the dilators for privacy.

Keep scheduled appointments with your doctor, so he/she can check on your progress! As your vagina stretches, your gynecologist will have you use the next size dilator which is slightly thicker and longer than the one before. It's a good idea to bring your dilator with you to your appointments.

Written by the Center for Young Women's Health Staff

Updated 12/5/2005

Related Information:

• A Guide to Vaginal Agenesis in Teens
• McIndoe Surgical Procedure for Vaginal Agenesis
• Related Links