MRKH: Instructions on the Use of Vaginal Dilators

Key Facts
  • MRKH is a disorder of the female reproductive tract–approximately 1 in 5,000 females are born with it.
  • Girls are often diagnosed between the ages of 15-18 when they don’t get a period.
  • Treatment options may include dilation, surgery, or a combination of both.
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If you’re reading this guide, it’s 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. The following information explains how to use vaginal dilators to create a vagina. It is safe and doesn’t involve surgery. Please note: This guide is not a recommendation for treatment nor should it be considered medical advice. Please consult your gynecologist if you have any questions.

The use of vaginal dilators should only be started after you have a complete exam, after your gynecologist makes the diagnosis of vaginal agenesis, and when you understand all of your options and have time to make a decision that’s right for you. Your gynecologist should review the following instructions with you. Monthly follow-up with your gynecologist is recommended while you are dilating.

Before You Begin: You must first receive teaching and counseling from your gynecologist or a trained clinician. It may feel awkward in the beginning to ask questions, but it’s very important so you will know 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 young women with vaginal agenesis are born with a vaginal dimple, where the vaginal skin puckers in a little bit. Other young women have a small vaginal opening or a shorter and/or narrower vagina. When a dilator is placed in this area and pressure is applied, the skin stretches and a vaginal canal will form.

How long will it take to create a vagina?

The process of creating a vagina can take as little as 2-3 months or up to 18 months or longer, depending on how often you use your vaginal dilator and if you’re using it correctly. Generally, if you use it properly for about 15-20 minutes, twice a day, and apply pressure, it will take about 3-6 months or less to create your vagina. It will take a lot longer if you don’t use it consistently. Most young women have good results when they remember to use their dilator at about the same time every day. Pick a time such as first thing in the morning and 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 such as read, watch TV, or talk on the phone.

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

Before you take your dilator(s) home with you, your gynecologist or nurse 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 and you will usually begin with the smallest size until you’re ready for the next size. It’s best to be in a semi-lying down position with your knees bent. Ask if you can use a mirror to help you find the spot where you will be inserting the vaginal dilator.

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 no one bothers you. 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’re not available for a while.

  1. If possible, take a warm bath for at least 10 minutes before you use your dilator (optional). Although this step is not absolutely necessary, the warm water helps to soften the skin where you will be placing the dilator so it will stretch more easily. This can be especially helpful when you first begin dilating.
  2. Wash your dilator with warm water and mild soap then dry it off.
  3. 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 (in a semi-reclining position) and bend your legs (the same position for a pelvic exam). Place the lubricated dilator against your skin below your urethra (where your urine leaves your body), right in your vaginal dimple. If you have a small vaginal opening, place the dilator in the opening. You can find the spot by slowly and gently sliding the tip of the dilator in the area 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 feel a lot of 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 zippered case (such as a cosmetic or pencil case)  in a bureau drawer or someplace else where you will remember to find it. Although your dilator does NOT need to be sterilized, you should wash it with mild soap and water and dry it completely before you put it away.

Keep scheduled appointments with your gynecologist, 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 wider than the one before. Bring your dilator with you to your gynecology appointments.

Deciding to use dilators should be YOUR decision and no one else’s. If you decide that you are ready to create a vagina with dilators, your parents and medical team should support you. You may decide not to create a vagina and that’s okay too. There’s no right or wrong decision, but it’s important to feel comfortable either way. If you decide to use dilator(s) and you don’t get good results after using them for many months, your gynecologist may suggest surgery.