Dilation
If you opt for vaginoplasty, dilation will be necessary for the rest of your life. This is a commitment that takes up a lot of time and should not be underestimated. After an orchiectomy and vulvoplasty, you do not need to dilate. But what exactly does it involve? You can read about it on this page.
About dilation
After vaginoplasty surgery, the vagina tends to narrow. Dilation is necessary to keep your vagina open (both in depth and width). How often and for how long you need to dilate depends on the surgical technique used to create the vagina. Advice on how long and how often you need to dilate after the operation may vary between healthcare providers. It is important to know that you will need to continue dilating regularly for the rest of your life.
Before undergoing vaginoplasty, it is important that you learn to control the muscles in the genital area (pelvic floor muscles) properly. These muscles affect urination, bowel movements, sexual activity and dilation. A pelvic floor physiotherapist will teach you to control these muscles before and after the operation. Below, you can read about what the pelvic floor muscles are, what they do and how you can use them. You can also find further information about the pelvic floor muscles and dilation in this animated video from Amsterdam UMC.
Pelvic floor viewed from below
What is the pelvic floor?
The pelvic floor consists of muscles and ligaments that form the base of the pelvis. Between these muscles are the openings for the urethra, the vagina and the intestines (see the figure above). Blood vessels and nerves also run through the pelvic floor. When you tighten your pelvic floor muscles, you can hold in your urine and poop. When you need to urinate or have a bowel movement, these muscles need to relax. The pelvic floor muscles also contract during sex, for example during an orgasm. To allow penetration and dilation, the pelvic floor muscles must be relaxed.
Tense pelvic floor muscles
If you are unable to relax your pelvic floor muscles properly or (unconsciously) tighten them too much, this can constrict the urethra, vagina and anus. Possible causes of a tense pelvic floor include stress, frequently holding in urine or stools for too long, negative feelings about one’s genitals or negative sexual experiences.
A tense pelvic floor can lead to:- Problems with urination and bowel movements
- Difficulty with dilation
- Problems with sex
- Pain
- Better ability to empty the bladder and easier bowel movements
- More ease during dilation
- Good blood flow to your genital area (this is important for wound healing)
It is therefore important that you work with a pelvic floor physiotherapist to relax your pelvic floor. During your pre-operative appointment with the pelvic floor physiotherapist, you will be given advice and exercises on how to relax these muscles.
What you’ll need
To carry out dilation properly, you will need a few items.
Dilation kit
The healthcare facility where you have your operation will let you know which dilation kit you need and whether you need to purchase it yourself. A commonly used dilation kit is, for example, the one from Intimate Rose (pictured above).
Mirror
Use a hand mirror or a small standing mirror so that you can see clearly what you are doing.
Lubricant
You’ll need lubricant to ensure smooth dilation. Choose an unscented, water-based lubricant. You can also use this lubricant during penetrative vaginal sex (from 3 months after vaginoplasty).
Compared to water-based lubricants, oil gives a little resistance but will not need to be removed by using a vaginal douche. While water-based lubricants should be removed.
Are you also having penetrative vaginal sex (from 3 months after the vaginoplasty)? Then it is best to use condoms that can withstand oil. Ordinary or latex condoms are affected by the oil and can therefore become torn or break, in which case you would no longer be protected against STDs or the HIV virus.
Dilation technique
Dilation following penile inversion vaginoplasty
Following vaginoplasty using the penile inversion technique, dilation is necessary to maintain the depth and width of the vagina. Most healthcare facilities in the Netherlands follow a schedule whereby you dilate for half an hour at least twice a day during the first year.
During dilation, you apply gentle pressure with the dilator to the deepest point of the vagina for half an hour. During your first dilation session, a few days after the operation, you will be given instructions on the best position to adopt and which sizes to use.
Dilation following colovaginoplasty
In the case of a colovaginoplasty, dilation is primarily necessary to keep the transition between the skin and the intestine sufficiently wide and supple. Most healthcare facilities in the Netherlands follow a schedule requiring you to dilate for half an hour at least twice a day during the first year. After the first year, it is often no longer necessary to dilate. You will decide this together with your healthcare professional. The dilator must be inserted beyond the transition between the penile skin and the intestine, and you should then make a gentle, rotating movement. This gradually stretches the transition. During your first dilation session, 2 to 3 weeks after the operation, you will be given instructions on the best position to adopt whilst dilating and which sizes to use.
Rinsing after dilation
It is important to rinse the vagina thoroughly after dilation to ensure no lubricant remains inside. It is recommended that you use a solution of Betadine and tap water for the first 3–4 weeks. After, you can switch to using tap water alone. The outside (vulva) can be rinsed clean in the shower. The dilator set must also be cleaned thoroughly after use with lukewarm water and, if necessary, mild soap. Do not use bleach, alcohol or other cleaning products.
Dilation schedule
An example of a dilation and rinsing schedule from Amsterdam UMC can be found here.
Advice on dilation
A few tips and advice on dilation:
- Try to think of dilation as part of your daily routine to achieve the best possible result.
- Allow plenty of time for dilation: the dilation itself takes half an hour each time, but including preparation and rinsing afterwards, it can take a total of 45 minutes or longer.
- Be patient: the appearance and sensation of the vagina will change during recovery. It may take some time for the area to heal properly.
- For practical advice, contact the pelvic floor physiotherapist at your healthcare centre.
Having trouble with dilation?
Not everyone finds dilating easy. If you’re having trouble dilating, it’s better to do an extra session with a smaller size, but whatever you do, don’t quit. It’s important to keep your vagina open and minimise the risk of complications. If you stop dilating, part of the vagina may narrow. You will then be at greater risk of infections, which can be dangerous. Are you still unable to dilate despite these tips? If so, it is best to contact a pelvic floor physiotherapist.
This text was edited on 3-11-2026
Next Step
We recommend that you go through all the information chapters step by step to get a complete picture of the various treatment options and the process involved!We strive to keep this information up to date. Do you have any additions or comments regarding the information above? Please email us at [email protected]
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Where will you have the operation?
On this page, you can read about the different healthcare facilities that provide genital surgery and how to get there.
