When is vaginal dilator therapy recommended for genitourinary syndrome of menopause?

Genitourinary syndrome of menopause can affect the vulva, vagina, bladder, and urethra as oestrogen levels change. Tissue may become drier, less flexible, or more sensitive. A dilator is a smooth device used gradually, with lubricant, to support comfortable stretching and tolerance of insertion.

Dilators do not treat every cause of pelvic or vaginal pain. A clinician may first assess dryness, infection, skin conditions, pelvic-floor muscle tension, and other explanations. If muscle guarding or fear of pain is present, pelvic-floor physiotherapy and supportive counselling may be included.

Use the size, material, lubricant, and schedule advised by your clinician. Treatment generally starts with a size that can be inserted comfortably and progresses only when the body is ready. Stop if you feel sharp pain, bleeding, or increasing soreness; forcing insertion can reinforce muscle guarding.

Vaginal moisturisers may support day-to-day comfort, while lubricants can reduce friction during insertion or sex. If symptoms are driven by low oestrogen, your clinician may discuss local treatment options alongside dilator use.

Arrange a medical assessment for new vaginal bleeding after menopause, persistent pain, unusual discharge, sores, fever, or urinary symptoms that do not settle. Seek prompt care for heavy bleeding, severe pain, or feeling faint. These symptoms need evaluation rather than self-directed dilator use.

Ask whether tissue changes, pelvic-floor tension, or another condition is contributing to your symptoms; which size and lubricant to begin with; how often to practise; and whether local oestrogen or pelvic-floor physiotherapy would be suitable.