Almost everyone reaches for the smallest dilator first. It feels logical — start tiny, work up. But in my experience with women in clinic, the pencil-thin one is rarely the right place to begin, and starting there can quietly set you back.
Why not the thinnest?
A very thin dilator is hard to feel. When you can barely sense where it is, the mind starts searching — is it in? am I doing it right? is it going to hurt? — and that searching keeps the nervous system switched on, which is the opposite of what you want. A slightly fuller size that you can actually feel gives the body something clear and steady to relax around. Comfort, not thinness, is what teaches safety.
How to choose your starting size
Forget the number on the dilator. Choose by feel:
- Pick the largest size you can rest against the opening without the muscle gripping or panic rising
- It should feel present and manageable — noticeable, but not alarming
- If it makes you brace before you’ve begun, step down one
- If you barely register it, you can usually step up
The right size is the one where your breath stays slow. That is your starting line, wherever it happens to fall.
A few principles that matter more than size
Over the years a handful of gentle rules have mattered far more than which dilator you hold:
- Never leave a dilator resting inside — keep a slow in-and-out movement over the muscle
- Always finish by coming back down through the sizes, so you end calm
- A little every day does more than a lot once a week
Sizing is just the first decision. What carries you forward is doing it gently, in order, and often — which is exactly the path the app walks you through, one stage at a time.
Gentle next steps
When you’re ready, two quiet ways to begin
Understanding is the first step. The rest comes from gentle, steady practice — at your own pace, in private, with a companion by your side.
The Vaginismus Book
A gentle, science-based guide to understanding what’s happening and why. “Knowledge removes fear.” In English and German.
The TVZ App
Your private, step-by-step dilator companion. Follow a gentle 9-stage path, log each practice, and build confidence at your own pace. Everything stays on your phone.
Start where you feel safe, not where you think you “should” be.
Warmly,
Dr Julia Reeve
Gynaecologist · Psychotherapist · Sexologist · Author of The Vaginismus Book
Dr Julia Reeve
Gynaecologist, psychotherapist and sexologist based in Amsterdam, with over thirty years working with women experiencing vaginismus. Author of The Vaginismus Book and creator of the TVZ dilator companion app.
This article is for general information and education. It is not a substitute for individual medical advice. If you have persistent pain or distress, please see a qualified healthcare professional.