Dilation
dilation is an afterthought if you choose to have a vaginaplasty. But what exactly does it involve? You can read it on this page.
About dilation
Dilation is necessary, in order to keep your new vagina open (both depth and width) after vaginoplasty. How often and for how long you need to dilate depends on the healthcare facility where you had surgery and the surgical technique used to create the vagina. In addition, this is influenced by personal factors such as your lifestyle and how long ago the surgery was performed.
It is also important that you learn to properly control your pelvic floor muscles, as they affect urination, defecation, sexual activity and dilation. You will learn how to do this from the pelvic floor physical therapist, in the period before and after surgery. Information about the pelvic floor muscles, what they do and how you can train them is provided below. Furthermore, additional information about pevic floor muscles and dilation can be found in the animation video from Amsterdam UMC.
What is the pelvic floor?
The pelvic floor consists of muscles and ligaments that seal the lower part of the pelvis. These muscles contain openings for the urethra, vagina and bowel (see figure above). Blood vessels and nerves also run through the pelvic floor.
Tensing your pelvic floor muscles allows you to hold up your urination and defecation. Conversely, these muscles need to relax in order to urinate and defecate.
The pelvic floor muscles also frequently tighten during sexual activity, like during orgasm. On the other hand, these muscles should relax to allow for penetration and dilation.
Tight pelvic floor muscles
If you are unable to relax your pelvic floor muscles or unconsciously tighten them too much, this may narrow the gaps for the urethra, vagina and rectum. Possible causes include stress, holding urine/faeces for too long or too often, negative feelings about your genitals or negative sexual experience.
Tight pelvic floor muscles may cause you to:- Have trouble urinating and defecating
- Have dilation-related problems
- Experience sexually related issues (e.g. pain or lack of arousal)
- Experience pain
- Improve bladder emptying and eases bowel motion
- Create more room for dilation
- Contribute to good blood circulation (promoting wound healing)
Equipment
You will need certain equipment to ensure effective dilation.
The dilator set
You must purchase a dilator set and bring it with you when you go to hospital for your vaginoplasty surgery. If you have any doubts about which set to purchase you can contact the institution where the surgery is taking place. It is most convenient to have a set with different diameters and, if possible, equal lengths. See the image above for an example of a dilator set.
Mirror
It is helpful to purchase a hand mirror or mirror with stand that you can put between your legs so you can see clearly what you are doing.
Lubricants
In order to dilate smoothly, you will need some type of lubricant. Preferably choose an odourless product without silicones, such as almond oil or a water-based lubricant, available from your pharmacy.
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 in case of penile inversion and bowel vaginoplasty
Dilation in case of penile inversion vaginoplasty
In the case of the penile inversion technique, the dilation serves to maintain the depth and width of the vagina. The size of dilator you start with will be determined during the first dilation after surgery. When the swelling in the surgical area decreases and the wound healing is going well try dilating with a larger one.
After inserting the dilator try to apply pressure to the deepest point of the vagina for 30 minutes; this should not hurt.
Most healthcare facilities in the Netherlands have a schedule that requires you to dilate at least twice a day for half an hour during the first year. After a vaginoplasty it is best to assume that regular dilation will remain necessary for life. The frequency differs per person.
Dilation in case of bowel vaginoplasty
With bowel vaginoplasty, the dilation mainly serves to keep the area between skin and intestine sufficiently wide and smooth. You start with a small dilator size. Bring the dilator just past the transition area between penis skin and intestine and make rotating/stirring movements. This stretches the transition area gradually. Same as for a penile inversion vaginoplasty, intensive dilation is necessary.
Vaginal douche after dilation
After dilating, rinse the vagina using a vaginal douche and clean the dilator set thoroughly, ensuring no lubricant or oil remains. It is advised to use a solution of betadine and water for the first 3-4 weeks. After this, you can switch to tap water.
Dilation schedule
The dilation schedule depends on the method used and at which clinic you were operated. An example of a dilation and vaginal douche schedule can be found here.
Dilation advice
Below you will find a number of tips and some advice regarding dilation:
- Try to think about dilation as a daily routine, needed to achieve the best possible result, so that you will not feel apprehensive about it.
- Be patient; the vagina does not need to look perfect straight away and it may take a while before the vagina will function optimally.
- Take ample time for your dilation routine: dilating takes half an hour, but with preparation and rinsing afterwards, it often takes you up to 45 minutes in total.
- For practical advice, please contact your pelvic floor physical therapist.
Dilation problems
Not everyone finds dilation easy. If you are having problems, try dilating more often but with a smaller dilator. Whatever you do, do not stop dilation. Try to let go of feelings of tension, worry and doubt. If, after having tried this, you are still unable to dilate, then please consult the pelvic floor physical therapist.
This text was edited on 7-10-2022
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