Ask the Doctors: How Do Dilators Work?

Hello! I work for a company that makes dildos, and had a customer call today; when I talked with her, she mentioned that her gynecologist had recommended using a dildo to widen her vaginal walls because the vaginal walls get tighter with aging. (She sounded like she was over sixty.)

I have never heard of this. Have you?
–Customer Service

When a post-menopausal woman is not taking hormone replacement and isn’t very sexually active, her vaginal walls get thinner and the mucosa more dry, and the effect of this can seem as though the vagina has shrunk. In some women, particularly after periods of celibacy, the vagina does undergo some shrinkage, or stenosis — though my guess is that for many, the symptom of dryness plus less supple vaginal walls will make it seem though the vagina has gotten smaller, when in reality is just isn’t expanding with arousal the way a pre-menopause vagina can do. In addition there is introital stenosis, which means that the opening to the vagina has shrunk (which can make it seems as though the whole thing has gotten smaller); that also affects some women.

This page gives a pretty good descriptions of all this. Please note that some sites recommend Replens, an over-the-counter product meant to address vaginal dryness — but it has mineral oil in it, so it is NOT safe with latex condoms (and in fact oil drys out tissues itself); I don’t recommend it. If a woman is interested in hormone replacement, I would suggest use of estrogen cream, rather than taking pills by mouth — though of course I’m not the kind of doctor who prescribes HRT at all.

Note that smoking makes this worse, so if you speak to your customer again, you might ask her whether she is a smoker. It’s my belief also that a healthy amount of exercise, especially pelvic motion, is good for these conditions.

I wouldn’t recommend just stretching the vagina with a larger dildo *unless* the woman is taking HRT (hormone replacement therapy), and she should certainly use a good lubricant if she does (and during any other insertive sex including intercourse). While stretching the vagina is possible, it must be done extremely carefully unless she is protecting her vaginal walls’ sensitivity and flexibility with HRT. The women at A Woman’s Touch in Madison, WI have actually designed vibrating dilators in three sizes; they maintain that the vibration helps reverse some of these menopausal side effects. If she DOES use a dildo, she should take it easy and use it frequently, and go for as much arousal as she can, as that will help matters. Not just using it “medicinally” without having any fun.

If she has not been masturbating or doing other arousing, orgasm-producing activity, anything like this she does (which respects the limits of her body as it is now) is likely to be of some help — though aside from HRT I do not believe there are any quick fixes. I keep mentioning HRT but I am not recommending it, by the way. Here’s why HRT might not be advised.

The woman should discuss this with her doc and do her own research and decision-making, I would say. Thanks for going the extra customer-service mile to support her well-being!


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Dr. Carol Queen

Carol Queen has a PhD in sexology; she calls herself a "cultural sexologist" because her earlier academic degree is in sociology: while she addresses individual issues and couple's sexual concerns, her overarching interest is in cultural issues (gender, shame, access to education, etc.). Queen has worked at Good Vibrations, the woman-founded sexuality company based in San Francisco that turned 35 years old in 2012, since 1990. Her current position is Staff Sexologist and Good Vibrations Historian; her roles include representing the company to the press and the public; overseeing educational programming for staff and others; and scripting/hosting a line of sex education videos, the Pleasure-Ed series, for GV’s sister company Good Releasing. She also curates the company's Antique Vibrator Museum. She is also the founding director of the Center for Sex & Culture, a non-profit sex ed and arts center San Francisco, and is a frequent lecturer at colleges, universities, and community-based organizations. Her dozen books include a Lambda Literary Award winner, PoMoSexuals, and Real Live Nude Girl: Chronicles of Sex-Positive Culture, which are used as texts in some college classes. She blogs at the Good Vibes Magazine and at SFGate's City Brights bloggers page and contributes to the Boston Dig. For more about her at carolqueen.com.

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