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 narrowing, 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!
"All I wanted to do was sleep, but I couldn't sleep since I had to wake up and dilate endlessly. It was so much dilation that I would dream about it many nights."
— Autumn Asphodel
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.
"So, there are four dilator sizes I have. The first one is 1?", the second one is 1¼", the third is 1?", and the largest one is 1½". I don't use the first one at all anymore. But, I have to start with the second one and then work up to the largest one. I can't just use the third or fourth one without working up to it. UHHHHH, I hate the largest one so much. It tears me up, literally. I just wanna throw it out the window. [Glass break]"
— Autumn Asphodel
Dilation Isn't Fun But It's Worth It
"The only part in my vagina self-care regimen that differs from a natal vagina is that I have to dilate. When I first came out of surgery, my body naturally registered my neo vagina as a wound and, because of that, it wanted to heal and close up. No thank you!"
— Maddy McKenna
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 is] very important. Very important. Can't say that enough. Your vagina will close up if you don't dilate. I did have a patient who didn't dilate for two weeks. She went back to the doctor, and she had closed up. And they couldn't reverse back. So, it's very important. Not to scare you, but just do it."
— JD Davids
Dilation Tips
Follow your surgeon's dilation guidelines!
Find ways that help make the process go by faster.
"I dilated a lot to TV shows. They tell you to dilate for 20 minutes a day. But you're so scared that it's going to close up that you probably dilate -- well, I dilated till like an hour. I would watch the Atlanta Housewives, and I would get in my bathtub. Because at first it was the only place that I could dilate. So, I would get my pillow. I would sit in my tub. I would have my iPad, and I would watch The Real Housewives of Atlanta while I was dilating. I'd watch the whole episode. Then I was done."
— Nyala Moon
Use a lot of lube. (Water-based, not silicone.)
Stretch before and after dilating.
"All that dilating made my hip get out of place because it's an uncomfortable position to be in multiple times a day. So, it's always best to stretch before and after."
— Autumn Asphodel
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.
More dilation tips at Transgender Map »
WATCH: Dr. Gabriel Del Corral's Dilation Instructional Video (sign-in required)
"The average canal can be anywhere between four and six and a half, seven inches. Certainly with good discipline using the dilators, you'd be able to accommodate a regular sized penis. It just takes work after a Vaginoplasty. It takes a lot of discipline. And it takes a lot of time to be able to dilate three times a day for the first couple months post-surgery." — Dr. Gabriel Del Corral
WATCH: Dr. Heidi Wittenberg on Basic Equipment & Positioning to Optimize Dilation
Where to Buy Dilators
You should receive everything you need to dilate before you leave the hospital or recovery facility, from your surgeon. You will use several dilators of different lengths and widths during your recovery and beyond.
Dr. Rumer provides a Dilator Kit for patients, which includes dilators made specifically for trans women by Soul Source. $40-55 each.
Note on materials: Some believe that dilators shouldn't be made out of silicone or other soft materials. Dilators should be rigid and hard enough to provide the rigidity necessary to stretch forming scar tissue.
This section contains affiliate links.
BioMoi's Silicone Vaginal Trainers with BioCote Protection (Full Set)
The "best quality" vaginal dilators on the market, made of US Platinum silicone. $129.99.
VuVa Smooth
Set of 5 dilators made of medical grade polycarbonate plastic, with Instructions and pouch. Made in the USA.
VWell
Set of 5 dilators made of silky smooth medical grade silicone, BPA and paraben-free.
Amielle Care Set of Vaginal Dilators
Set of 4 graduated dilators with a universal handle to make insertion and removal easier, lubricant and a discreet bag.
Vaginal Trainer Set
These dilators are smooth and comfortable, easy to control, light-weight, latex-free, washable and safe.
6 gradual sizes plus an ergonomic solid-lock handle. HopeandHer.com
Expandable Dilators
Milli - Gradual expansion from from 15mm to 40mm, with 25mm total achievable expansion. Optional vibration, charging case. $395.
ZSI 200 NS Expander - In?atable cylinder made of biocompatible silicone. Lengths available: 90 mm & 120mm. Diameter: 40mm. No retail sales, must be purchased by a surgeon.
Last updated: 02/04/21