With solid vaginal dilators, the patient starts with the smallest dilator size, then gradually increasing until the largest dilator size is reached. This practice can be accompanied by breathing exercises in order to relax the pelvic floor muscles. Dilation acts should not cause pain or bleeding. Dilatation with rigid dilators must be done carefully as vaginal perforation and urethral injury may occur. There is no consensus on the frequency and duration of using vaginal dilators. In case of vaginal expanders, the therapist or the patient introduces the deflated balloon into the vagina and then inflates it gently until the required diameter is obtained. Following
gender-affirming vaginoplasty, patients may be required to use vaginal dilators multiple times daily to maintain the depth and length of the neovagina. Different size dilators may be used, typically starting with a smaller diameter and increasing the size over the course of several weeks post-surgery. Over time the frequency of dilation can be reduced to daily and eventually to every few days as instructed by surgeons. == Image gallery ==