Use It or Lose It: The Importance of Dilation Following Vaginoplasty
Julie Vu with her set of Soul Source dilators.
Source: YouTube.
Vaginoplasty is a Gender Reassignment Surgery procedure that transforms the transgender person's genitalia into female genitals, including a neo-vagina.
Post-operative vaginal dilation is an integral part of the initial surgery recovery and the regular maintenance of a transgender person's neo-vagina. Typically, dilation begins a few days after surgery and is almost always required for life. Without proper dilation, the skin graft inside the vagina tends to contract which leads to shortening or closure of the neo-vagina. This is an irreversible result—one cannot regain the original vaginal depth by simply resuming or doing more dilation. Dilation may not be pleasant but
it's essential to follow your surgeon's dilation protocol in order to prevent loss of depth of your new vagina.
Dilation Explained
The purpose of dilation is to maintain the depth of the neo-vagina. Dilation helps prevent contraction of the skin graft inside vagina and also improves the elasticity of vaginal wall in order to comfortably accommodate penetrative sex.
Dilation involves inserting a lubricated dilator into the neo-vagina and keeping it in there for a specified amount of time. The size of dilator and the length of dilation time varies depending on the surgeon's protocol and patient's needs. Your surgeon will advise about the proper use and frequency of post-op dilation and it's important to follow their advice above all as it may be specific to your case.
Initially, one can expect dilation to take up to 2-2.5 hours per day, with the time and frequency decreasing after you reach 18-24 months post-op. Yes, it's a commitment!
Dilation is also not as comfortable as one might hope. "[The dilators are] hard, they're plastic, they're cold, they're uncomfortable to be inside you,' said
Julie Vu on YouTube.
Does Sex Count?
There's some debate as to whether or not sexual intercourse can count as a dilation session. 'If [after a year post-op] you have sex once every week, you're good to go, you don't have to dilate with these instruments,' says Vu.
Maddy McKenna concurs, "The only bonus it that if I have a sexual companion, 30 minutes of sex counts as 30 minutes of dilation."
"You have to dilate once a week for the rest of your life, unless you're having sex,"
says Nomi Ruiz, a transgender singer and host of the podcast
Allegedly NYC. "So now when I'm not having sex, it's kinda sad, because you're really reminded of it. You're like, 'Oh, God, I have to dilate now because I'm not getting laid. Fuck.'"
However, sexual intercourse in place of dilation may not be sufficient. This is something that you should discuss with your surgeon.
To begin, patients dilate with the largest dilator that comfortably fits inside the neo-vagina. As the weeks progress after surgery, larger dilators are introduced and the length of time with the largest dilator is gradually increased.
Dilation Isn't Fun But It's Worth It
When dilation isn't done according to the recommended routine, the skin graft inside the vagina can contract and close up which leads to the shortening—and even closure—of the neo-vagina. Unfortunately, once this happens it can't be fixed by simply resuming or doing more dilation. A revision surgery is usually necessary.
A
2015 study concluded that the most common complication from Vaginoplasty was narrowing of the vagina. A more recent study that was presented at WPATH 2018 by urologists from Hahnemann University Hospital reported an overall incidence of revision surgery after Vaginoplasty was 7.9% in 240 patients of
Dr. Kathy Rumer, and that the second most common reason for revision was neovaginal stenosis (2.1%). Researchers concluded that
not following the dilation regimen was significantly associated with increased risk of complications or revision.
"Vaginal openings are similar to pierced ears in that if you don't use earrings regularly, the piercings will eventually close," says Dr. Rumer. "So we always say, 'DILATE!!! DILATE!!! DILATE!!!'"
Dilation Tips
Follow your surgeon's dilation guidelines!
Find ways that help make the process go by faster.
Use a lot of lube. (Water-based, not silicone.)
Stretch before and after dilating.
You will need several towels or waterproof pads to place under you while dilating.
Chux pads or puppy training pads are a good solution if you don't have laundry facilities.
You can take a painkiller after dilating, but not before because it would increase the chance of hurting yourself.
Try urinating or having a bowel movement before your dilation session as it can make it more comfortable.
