Liu Marisa, Juravic Mark, Mazza Genevieve, Krychman Michael L
University of California Irvine, Department of OBGYN, Irvine, CA, USA.
Materna Medical, Mountain View, CA, USA.
Sex Med Rev. 2021 Apr;9(2):212-220. doi: 10.1016/j.sxmr.2019.11.005. Epub 2020 Jan 31.
Vaginal dilators are often prescribed to facilitate an adaptive brain-body connection to decrease anxiety and pain that can be experienced in anticipation of sexual intercourse among populations of women with sexual pain syndromes. Postmenopausal women, cancer survivors, and women with a wide variety of pelvic floor disorders who experience genito-pelvic pain/penetration disorder (GPPPD) are often advised to incorporate vaginal dilators into their pelvic floor rehabilitation program and treatment regimens to enable penetrative intercourse with less pain. However, little is known about the behaviors of dilator users, what treatment protocols are most effective, how patients are currently using their dilators, and how effective are clinicians in helping their patients achieve success with their dilation therapy.
A recent PubMed literature search was performed using the key words vaginal dilator, vaginal dilator therapy, sexual quality of life, vaginal stenosis, vaginal dilation, vaginismus. A total of 29 English articles were reviewed and summarized. Articles were excluded for the following reasons: not in English and unrelated to dilator therapy.
This article will summarize the current research on vaginal dilators and discuss needs for future research to maximize patients' compliance and success with this treatment. Much of the summary data regarding user behavior will come from the early survey data with Milli, a novel, patient-controlled electronic dilator that slowly expands 1 mm at a time from its smallest diameter, 15 mm to a maximum diameter of 40 mm. Milli is currently being used by more than 1,000 women, and 3-month follow-up data were recorded on 335 of those patients.
Dilators exist in multiple forms (plastic, latex, and medical grade material), may come individually or in sets, and many have special features such as vibration or the ability to be heated or cooled before use. Little is known about patients' use of dilators and the Milli's 3-month survey serves as an insight to patient dilator behavior. The most common medical goals for patients undergoing dilation treatment were return to penetrative intercourse and pain reduction during coitus. Patients were dilated on average 2.72 days/week; 56.8% of patients had suffered from sexual pain for 2 or more years and 36.3% had previously used static dilators. More than 70% of Milli users purchased Milli and are using Milli without the direct guidance of a clinician. The most common emotions patients used to describe their treatment were not only "anxious," "frustrated," but also "empowered" and "optimistic." The most common dilatory session duration was 6-10 minutes, mostly in the evening/bedtime (68.3%), located in the bedroom (96.8%). Adjunctive treatment included the following: vaginal moisturizers, local estrogen products, coital lubricants, and genital pelvic floor physical therapy. During the dilation sessions, women most often watched TV/videos, practiced mindfulness, or listened to soothing music. Factors that showed trends toward improved patient outcomes were length of dilation treatment (greater than 3 months) and use of meditation and soothing music. Factors not associated with improvement trends were as follows: when/where patients dilated and patient demographics including age, race, or religious preferences.
Patients who purchase dilators have often suffered with their condition for a long time and had difficulty finding a competent health-care clinician well versed in sexual pain syndromes that can help them. When patients did find a clinician, there were no clinically proven standardized protocols or formalized guidelines to give to patients about how to best use their dilators. Larger long-term interventions investigating a standardized dilation protocol are planned in future studies to better elucidate the effective and optimal dilation treatment plans. Liu M, Juravic M, Mazza G, et al. Vaginal Dilators: Issues and Answers. Sex Med Rev 2021;9:212-220.
阴道扩张器常用于促进大脑与身体的适应性连接，以减轻患有性疼痛综合征的女性群体在预期性交时可能经历的焦虑和疼痛。绝经后女性、癌症幸存者以及患有各种盆底疾病且经历生殖器-盆腔疼痛/插入障碍（GPPPD）的女性，通常被建议将阴道扩张器纳入其盆底康复计划和治疗方案中，以使性交时疼痛减轻。然而，对于扩张器使用者的行为、哪种治疗方案最有效、患者目前如何使用扩张器以及临床医生在帮助患者成功进行扩张治疗方面的效果如何，我们知之甚少。
最近在PubMed上进行了文献检索，使用的关键词为阴道扩张器、阴道扩张器治疗、性生活质量、阴道狭窄、阴道扩张、阴道痉挛。共查阅并总结了29篇英文文章。因以下原因排除了一些文章：非英文且与扩张器治疗无关。
本文将总结当前关于阴道扩张器的研究，并讨论未来研究的需求，以最大限度地提高患者对这种治疗的依从性和成功率。许多关于使用者行为的汇总数据将来自对Milli的早期调查数据，Milli是一种新型的、患者可控制的电子扩张器，每次从最小直径15毫米缓慢扩张1毫米，最大直径为40毫米。目前有1000多名女性在使用Milli，其中335名患者记录了3个月的随访数据。
扩张器有多种形式（塑料、乳胶和医用级材料），可以单个或成套出现，许多还有特殊功能，如振动或在使用前加热或冷却的能力。对于患者使用扩张器的情况知之甚少，而对Milli的3个月调查为了解患者扩张器使用行为提供了一些见解。接受扩张治疗的患者最常见的医疗目标是恢复性交和减轻性交时的疼痛。患者平均每周扩张2.72天；56.8%的患者遭受性疼痛达2年或更长时间，36.3%的患者此前使用过静态扩张器。超过70%的Milli使用者购买Milli并在没有临床医生直接指导的情况下使用。患者用来描述其治疗的最常见情绪不仅有“焦虑”“沮丧”，还有“有力量感”和“乐观”。最常见的扩张疗程持续时间为6 - 10分钟，大多在晚上/就寝时间（68.3%），地点在卧室（96.8%）。辅助治疗包括以下几种：阴道保湿剂、局部雌激素产品、性交润滑剂以及生殖器盆底物理治疗。在扩张疗程中，女性最常看电视/视频、练习正念或听舒缓的音乐。显示出患者治疗效果有改善趋势的因素包括扩张治疗时间（大于3个月）以及使用冥想和舒缓音乐。与改善趋势无关的因素如下：患者扩张的时间/地点以及患者的人口统计学特征，包括年龄、种族或宗教偏好。
购买扩张器的患者通常长期受其病情困扰，难以找到精通性疼痛综合征且能帮助他们的称职医疗保健临床医生。当患者确实找到临床医生时，对于如何最佳使用扩张器，没有经过临床验证的标准化方案或正式指南可供患者参考。未来的研究计划进行更大规模的长期干预，以研究标准化的扩张方案，从而更好地阐明有效和最佳的扩张治疗方案。刘M、尤拉维奇M、马扎G等。阴道扩张器：问题与解答。性医学评论2021；9：212 - 220。
