O SRS Dilation Following Vaginoplasty – What Is It Important And How To Do It

Vaginoplasty is a gender reassignment surgery procedure performed by surgeons to transform a person's male genitalia into a new vagina / female genitals. To maintain a good functional vaginal depth following surgery, it is important that the patient performs vaginal dilation.

Post-operative vaginal dilation is an integral part of a person's recovery. Without vaginal dilation, the patient risks having the skin graft inside vagina tighten up. This means they could lose vaginal depth and width, which is irreversible.

Vaginal dilation can be painful and uncomfortable. It can also be incredibly time-consuming. However, it is the only way to prevent the loss of vaginal depth.

What does vaginal dilation do?

A vaginal dilation program focuses on maintaining the vaginal depth of a neo-vagina using certain tools. Dilation involves inserting lubricated vaginal dilators into the new vagina, keeping it inside for a specific duration. The lubricated dilator helps prevent skin graft contraction inside the neovagina. It also helps stretch the vaginal walls so patients can comfortably accommodate penetrative sex.

Vaginal dilation may take up to two hours per day and is performed at three separate times (50 minutes in the morning, afternoon, and before bedtime.) The first few months after getting penile inversion vaginoplasty, the patient would need to commit to performing dilation twice a day at 100 minutes per session.

Can Sexual Intercourse Replace Vaginal Dilators?

There is some debate over whether having penetrative sex can replace a dilation session. In general, surgeons still advise performing vaginal dilation as sex may not be enough to stretch the vaginal wall. However, patients can also discuss this matter with their surgeon. 

Correct Vaginal Dilation Preparation

Do note that the vaginal dilation program varies with each patient.

• Make sure the dilator is clean before inserting it into the vaginal opening
• Use warm water and antibacterial soap to clean the dilator
• Apply water-based lubrication to the dilator. Do not use silicone-based lubricants.
• Gently insert the dilator into the vaginal opening at a 45-degree angle until it is just under the pubic bone.
• There should be a small amount of resistance and tenderness when dilation begins. However, stop immediately if there is too much pain or resistance.
• Insert the dilator until only one or two white dots remain outside the neo vagina. Leave the dilator insider for 10 minutes.
• Dilate three times daily for at least three months after the vaginal packing has been removed.
• Use soap and water to clean the vaginal canal after each dilation schedule.

Dilation Instructions

In the first three months after penile inversion vaginoplasty

Dilator Color: Violet
Dilator Diameter: 1-1/8"
Frequency: Three times a day

Three to six months after sex reassignment surgery

Dilator Color: Blue
Dilator Diameter: 1-1/4"
Frequency: Once a day

Six to nine months after sex reassignment surgery

Dilator Color: Green
Dilator Diameter: 1-3/8"
Frequency: Every other day

Nine to twelve months following sex reassignment surgery

Dilator Color: Orange
Dilator Diameter: 1-1/2"
Frequency: Once or twice a week

Risks and Complication of Vaginal Dilation

Immediate risks of vaginal dilation include:

• Bleeding
• Infection
• Clitoral Necrosis
• Vaginal Prolapse

Some complications may appear later in the dilation program, including fistulas, granulation tissue, and urinary tract infections.

Sources:

[1] https://transcare.ucsf.edu/guidelines/vaginoplasty

[2] https://www.mtfsurgery.net/dilation.htm