Vaginal dilation is a term used to describe the process of ensuring that a post-op male-to-female woman's neo-vagina does not lose depth or width. In persons born intersex dilation is used to increase or maintain the size of the vaginal space.
While most often performed with either no pain management or over the counter drugs, in severe cases it may be performed under sedation or even general anesthesia. This is because the process of stretching the vaginal tissue can cause significant discomfort depending on your level of pain tolerance.
Any technique of vaginoplasty performed will require vaginal dilation of the patient for the rest of her life with a set of vaginal stents. This is due to the surrounding tissues, including the PC muscle, trying to move back to their original positions, forcing the neovagina closed.
Scar tissue will form at any place that two pieces of tissue (in the form of grafts) are joined together in this manner. Scar tissue has very different properties than the rest of the skin. The two most important differences are that as it heals it becomes much less elastic and it contracts as it heals.
As if this wasn't enough, when the neovagina relaxes and contracts between dilations, it develops wrinkles. These wrinkles will actually start healing together, narrowing the diameter of the neovagina. This will continue until the tissue has enough time to heal, so adequate dilation must be maintained during the healing process.
After the initial healing process it is possible to regain lost vaginal depth and or width by using progressively larger dilators, but it is a slow and difficult process. Therefore it is necessary to encourage proper dilation technique during the early stages of healing.
Dilation is started several days after surgery, when the temporary packing inserted during surgery is removed. After several weeks of several dilations per day, the patients will eventually be able to cut down to one dilation per week. It is important to note that sexual intercourse does not count as a dilation — the body requires the hard presence of the stents to keep the vagina from losing depth.
There are several methods and routines for vaginal dilation and each surgeon recommends their own method, and while each may be vastly different each method achieves the same result. The key is to follow the surgeon's instructions.
The following is an example of one SRS surgeon's dilation regimen. It is not intended to replace instruction by your surgeon, but as a hint of how much commitment is required to dilate properly.
Note: The times indicated include an estimated time for setup, insertion, removal and cleanup.
Always use a water soluble lubricant, a silicone based lubricant may allow an environment for infections.
Dilation with a stent is preferably done while lying flat in bed, over a protective underpad of some sort to protect the sheets. A water based lubricant is applied to both the stent, and at the vaginal opening. A thin film on the stent surface that will be in your vagina is usually all that is necessary although some people and surgeons will instruct patients to use a condom on the stent for sanitation reasons.
If you can't feel the opening, using a handheld mirror might help when inserting the stent. Using the narrowest of stents that goes in easily, guide the hand held end of the stent in an arc downwards (under the public bone) while pushing (with your fingers) the inside end towards your head, but parallel to the floor or bed. You may encounter initial resistance from the pubococcygeus muscle, gently relaxing it will make insertion easier.
If feces or gas is present in the colon this is a possible source of discomfort. Using the restroom before (to pass stool) and afterward (to urinate) will increase the comfort so that you can remain compliant with the care of the vulva and vaginal area. In addition, urinating after dilating will reduce the chance of urinary track infections.
Once inside the vagina, do not push down or up or you may perforate the rectum or urethra (both serious complications). Push towards your head parallel to the floor with sustained (gentle) pressure, but not enough to produce pain. After the recommended number of minutes, insert the next larger size stent per surgeon's instructions and repeat, adding lubrication on the stent and at the vaginal opening as necessary. At no point during dilation should you experience genuine pain unless you are attempting to use a stent too large for your level of recovery or are using improper technique.
Once dilation is complete, the external genitals are wiped clean with a moist hand-cloth or wet wipe (a type of toilet paper). Placing the stent in a chlorhexidine gluconate solution, or cleaning with soap and water will prevent it from being a source of infection during initial healing. Rinsing with warm water for either cleaning method will prevent irritation of the vaginal tissue. During the first week of dilation there is a good chance of blood on your stent followed by spotting on your pads. This is a normal part of recovery.
Some surgeons recommend regular douching during the initial healing process to remove contaminated lubricant as well as tissue and bodily fluids that may have accumulated in the vagina. Once healed, douching is not recommended unless there is an issue of sanitation; in which case normal saline (water with 0.9% sodium) is usually good enough to clean without disrupting beneficial bacteria. Yeast infections are a separate issue of long term care which cisgender women have to deal with also so a probiotic is advised once you are healed to the point where there is a need to populate the vagina with beneficial bacteria.
Dynamic dilation is a term invented by Dr. Suporn Watanyusakul for a prolonged dilation that involves rotating motions to proactively break up scar tissue around the vagina's internal tissues. It is not recommended unless explicitly instructed by your surgeon.
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