Afraid to Start Vaginal Dilators? How to Overcome the Fear of the First Insertion

As a gynaecologist, psychotherapist, and sexologist, one of the most common messages I receive about Vaginismus is not:

“How do I insert the first dilator?”

It’s this:

“I haven’t even started. I’m terrified.”

The fear of the very first insertion is often stronger than the physical difficulty itself.

And that fear is real.

Let’s talk about it properly.

Why the First Dilator Feels So Overwhelming

When someone has vaginismus, the body has learned one central rule:

Penetration = danger.

Even if logically you know a medical dilator is safe, your nervous system may react as if you are under threat.

This reaction can include:

• Tightening of the pelvic floor

• Racing thoughts

• Avoidance

• Nausea or shakiness

• Catastrophic thinking

The fear is not weakness.
It is conditioning.

The Trigger Thoughts That Appear Before Starting

Before the first insertion, women often report intrusive thoughts like:

• “What if it hurts like before?”

• “What if I fail?”

• “What if I can’t get it out?”

• “What if I damage something?”

• “What if I panic?”

• “What if this proves I’m broken?”

These thoughts activate the sympathetic nervous system — the fight-or-flight response.

When that system turns on, the pelvic floor contracts automatically.

This is the exact opposite state needed for successful dilation.

The Fear Is Often Older Than the Dilator

For many women, the anxiety is not just about plastic medical tools.

It may be connected to:

• A painful first sexual experience

• A traumatic medical exam

• Strict or shame-based sexual upbringing

• Fear of disappointing a partner

• Previous failed attempts

The dilator becomes a symbol of all of it.

Understanding this reduces shame.

What Desensitisation Really Means

Desensitisation is not “just push through it.”

It is gradual nervous system retraining.

It works like this:

1. Exposure in very small, controlled steps

2. Pairing exposure with relaxation

3. Replacing catastrophic thoughts with neutral ones

4. Repeating until the brain learns: “This is safe.”

The goal is not bravery.
The goal is safety.

Step One: Separate the Thought From Reality

Before even opening your dilator set, write down:

“What am I afraid will happen?”

Be specific.

Then ask:

• Has this happened before with something this small?

• Is this fear based on memory or prediction?

• What would I tell a friend in this position?

Replacing:
“This will hurt.”

With:
“I will go slowly, and I can stop at any time.”

This shifts the nervous system.

Step Two: Start Without Insertion

Many women try to jump directly to internal insertion.

Instead, try this progression:

• Look at the smallest dilator

• Hold it in your hand

• Place it on your thigh

• Place it near the vulva

• Touch it to the entrance without inserting

Pause.
Breathe.
Let your body learn there is no threat.

This alone can reduce anxiety dramatically.

Step Three: Understand Your Anatomy

The entrance of the vagina is surrounded by pelvic floor muscles — the area most sensitive in vaginismus.

Once something passes this muscular ring, sensation usually decreases.

That is why the first few millimeters can feel intense.

Beyond that, the vagina is elastic and designed to stretch.

Understanding this reduces catastrophic thinking.

Why Forcing the First Attempt Makes It Worse

If the first attempt feels rushed or pressured, the nervous system learns:

“See? This is stressful.”

If the first attempt feels slow and controlled, the nervous system learns:

“I survived. I was in control.”

Control is the antidote to fear.

When Fear Is Stronger Than Pain

Interestingly, in many early dilator attempts, the anticipation of pain is worse than the actual sensation.

The brain amplifies predicted danger.

This is why cognitive restructuring is essential in treating Vaginismus.

You are not just stretching muscle.
You are retraining neural pathways.

A Gentle Mental Reframe

Instead of thinking:

“I have to get this inside.”

Try:

“I am teaching my body safety.”

That shift changes everything.

Signs You May Benefit From Professional Support

Consider working with:

• A pelvic floor physiotherapist

• A sex therapist

• A trauma-informed gynaecologist

If:

• Panic feels overwhelming

• You freeze or dissociate

• Past trauma surfaces

• You avoid even touching the dilators

There is no shame in needing support.

The Truth About the First Dilator

The first dilator is the smallest.
It is usually narrower than a finger.
It is not meant to hurt.
It is meant to retrain.

The fear before starting is often the biggest hurdle in the entire process.

Once the first successful insertion happens — even partially — confidence rises dramatically.

Momentum begins.

Final Thoughts

If you are afraid to begin, that does not mean you cannot succeed.

It means your nervous system has been protecting you.

The goal is not to fight your body but work with it.
The goal is to teach it that penetration can be safe.

And that process begins long before the first insertion.

💡 Ready for the next step?

🌿 Access The Vaginismus Zone

CHECK OUT THIS SIMILAR BLOG POST:
https://www.drjuliareeve.com/blog/how-to-insert-the-first-dilator-with-vaginismus-step-by-step-guide