His and Her Health

My pt uses her hands during my physical therapy sessions, but suggested I used dilators at home to gently press around the opening, holding it in place for 30 seconds any place where I feel pain until the muscle relaxes. I have multiple types of vestibulitis, tight muscles being one of the secondary contributors.

ANyway, my question is do I just use the dilators in a clinical way (which is what I've been doing) or can you or are you supposed to be aroused when you do this exercise?? I mean I was wondering if I used them with my husband's assistance if are approach should be clinical or making a bedroom activity? Actually I'm not even sure if the arousal thing would work since for me it feels sort of like uncomfortable accupressure.

My other concern is that my doctor said that my skin is very thin and delicate in the vestibule area--prob from bcps. I had a small tear several weeks ago. WIll pressing around the opening aggravate things? I do feel a bit of muscle release when I do this, but I'm using lidocaine when I do this exercise because generally pressing around the area is painful. Should I be doing this exercise without the lidocaine? My doc did say I could use the the lidocaine before pt which is what I usually do. I guess I'm mildly concerned about tearing the area because I can't feel what's going on with the lidocaine. I can feel muscular things, but not the skin.

I've been on the estrogen testosterone cream/stopped bcp and have been using lidocaine daily for 2 weeks now. I was instructed not to have sex because of the birth defects the testosterone can cause....so I really don't know whether the tissue has strengthened and healed yet. Maybe I should try it without the lidocaine to get some sort of indication as to whether things are improving?

Hi Lotus,
I'm obviously not a doctor but I can pass on the "word" if it helps at all. I was talking to a former patient of Dr. Goldstein and she said after her surgery the doctor encouraged her to use the dialators not just clinically but to try to encourage positive thinking around them. Basically she put it simple terms...he had given her dildos with a prescription to masturbate (obviously he didn't say it quite like that). If you haven't had surgery, it might be different for you, but my physical therapist also suggested when i was using dialators to try and associate positive thoughts with them. She never mentioned anything about my boyfriend assisting so I can't help you there.

She also told me to use lidocaine to try to minimize discomfort. From my experience, I could feel the burning sensation with or without the lidocaine. I suppose you could always try doing your exercises once without to assess where the pain is at, but my PT basically said the lidocaine is there to make it less of a painful experience.

With vestibular pain we already go through enough mentally....and in my experience the mental side of things can be harder sometimes than the physical aspect. I imagine the less pain the better, especially when it comes to trying to play down the nerves in that area. As I'm no doctor, hopefully the physical therapist on here will also respond, but those things are just what I've heard and experienced.

Hope that helps at least a little!

Lotus, I have patients use the dilators for several reasons: One is to stretch or provide as you termed "acupressure" to the muscles and to help release the trigger points, another to reintroduce the whole penetration to the vagina issue and thirdly to desensitize (reduce pain) in this area. I have them start with a smaller size as we deem appropriate and increase the size when ready. If patients have thin tissue that often tears, it may be best that your PT get an okay or for you to get the ok from the MD. As PTS, we are not allowed to tell patients to use medications (including lidocaine) as it is prescribed. If you have a prescription and are told to use it as needed and before PT, I am sure the doctor will okay its' use with the dilators. But again, you need to get the
doctor's approval.
As for making it sexual or not, will end up being your choice. I give them to be part of home exercise program and to be used alone or with the partner. It can help you become at ease with penetration and let you learn in which positions you are more comfortable and pelvic muscles relaxed and which are worse for you. I hope this helps
Good Luck!

<small>[ 05-08-2009, 12:20 PM: Message edited by: Moderator ]</small>

THanks for the feedback guys!