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Dilation

Dilation is the term commonly used refering to the process of ‘stretching’ the neo-vagina following vaginoplasty. During the early stages immediately after surgery dilation is important to avoid contraction of the tissue, and to prevent formation of scar tissue at stitch lines which would otherwise harden and become non-stretchy, causing potential loss of depth, width and making future dilation and/or sexual intercourse painful or difficult.

Techniques, durations and regularities for dilation regimens vary between surgeons.

Techniques

Each surgeon may specify a different technique, and look and feel of dilators or stents supplied by different surgeons may vary. However, the mechanics are much the same through different techniques.

Neo vaginas are generally not self-lubricating like the vagina of a cisgendered person. Therefore a lubricant needs to be used. Many different lubricants are available, and an appropriate one will be recommended by the surgeon, however some popular ones include KY lubricating jelly and Aquagel. Trade names may vary from country to country.

Usually the dilators or stents come in a variety of sizes. These tend to vary in width but remain the same length. Different surgeons may supply or recomend a set that varies in number from two to six different diameters. During dilation it is common to start with a smaller dilator and then change to larger sizes as the dilation session progresses. Over time as the vagina heals, it may become possible to begin dilation with a larger stent, and the smaller ones will become unnecessary. Some people find though that the smaller stents are useful to leave a ‘trail’ of lube down to depth to help make inserting the larger dilators easier. Over time a person can work up to larger sizes, and eventually can go bigger than the largest stent they may have been provided using a larger set purchased or, more usually, using sex toys.

Frequency of dilation

This varies between different surgeons. As two examples, some Thai surgeons may require an initial dilation period of between two and four hours per day. UK surgeons tend to require less, due to different surgery techniques, and this can be initially three sessions of fifteen minutes per day. Note that quoted times of dilatin are generally once the dilator has reached full insertion to depth. Sometimes, especially shortly after surgery, it may take some time to reach depth with the dilator and this is normal.

As the neo vagina heals, dilation frequency can be reduced. Usually it is a case of how easy the patient finds dilation that dictates this. Getting a dilator quickly to depth each time, and being able to start dilation with a larger dilator is a good sign that frequency of dilation can be reduced. You should always consult with your surgeon first, and they may give you information on periods of time after which frequency can be reduced.

A typical schedule from a UK surgeon might be as follows:

  • Three times daily with fifteen minutes at depth for first 6-12 weeks
  • Twice daily up to six months
  • Once daily up to 12 months
  • Twice weekly thereafter, dropping over time

This is just a rough guide.

Hygiene

Initially after surgery, there may be a douching regime specified. Initially this may also include a sterilising agent in the douche fluid, and/or pessaries inserted into the vagina. Douching washes out the vagina, and removes debris such as lube, dead skin cells and after surgery, dissolving stitches.

Note that longterm douching can be harmful, as the vagina in cisgender women is protected by a healthy bacteria culture that prevents development of infections and yeast cultures such as Thrush. It is important once the neo vagina is able to cope to minimise douching to only when necessary and to avoid use of sterilising agents unless directed to by a surgeon or medical practitioner.

The stents also must be sterilised after each use. Usually wiping clean is not sufficient, and a sterilising agent such as Hibiscrub solution should be used. Your surgeon will provide specific advice. Stents should be kept dry in an airtight box (such as a Tupperware type box) when not in use.

See Also

  • List of transgender related topics