Vaginas often require a lot of work to maintain- beyond shaving. Dilator therapy is a holistic therapy used to assist in maintaining the function and pliability of the vagina. This is also true for those with a neo-vagina, or a vagina made of other tissues, intestines, or done during gender reassignment surgeries, called a vaginoplasty. Those who have a neo-vagina have them for many different reasons, and they could be female, male, or transgender.
Post-operative vaginal dilation therapy plays a vital role in the surgical process and towards the regular maintenance of a person’s neo-vagina. Typically, dilation therapy begins a few days out from surgery and once you have been cleared by your doctor, and this standard becomes a part of regular “care” of the neo-vagina. When dilation is skipped, the skin grafts and surgical work in the vagina begins to contract, which then leads to the closure and shortening of the neo-vagina. Unfortunately, this is an irreversible result as the depth of the neo-vagina is dependent on this repeated therapy being done regularly.
Dilation may not be pleasant at first, but it is important that you follow your surgeon’s dilation protocols to prevent loss of depth in your new vagina.
The Importance of Dilation
The reason for dilator therapy is to help maintain the depth of the newly created neo-vagina. Dilation helps to prevent the contraction of the skin graft inside of the vagina “canal” and improves the elasticity of the vaginal wall to eventually accommodate penetrative sex acts.
Dilation involves using a lubricated dilator and inserting it into the vaginal canal for a predetermined amount of time. The size or girth of the dilator and how long you will practice this therapy will vary from person to person, and surgeon to surgeon depending on their patient’s situation. Your surgical team should inform you on how often you should practice, how long, and what types of devices are best for this therapy.
At first, you will be dilating up to 2.5 hours per day, with the length and frequency decreasing slowly as you reach 18 to 24 months post-op. Dilation is not always enjoyable, but the benefits are entirely worth it.
Choosing Not to Dilate
If you choose not to dilate, or not to follow your doctors’ recommendations, the skin graft inside of the neo-vagina can contract and close- which leads to the shortening, and potentially closing, of the neo-vagina. Once this happens, a revision procedure may need to be done.
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 neo-vaginal 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!!!” (NIH Studies).
Neo-Vaginal Dilation Suggestions
Be sure you are not starting your dilation therapy prior to getting the approval and okay from your doctor or surgeon. The dilators you use should be firm, yet soft to the touch, to help avoid skin tears and lacerations. Dilators should always be used with lubrication with more accessible when needed.
- Clean all dilators being used with warm water and Dawn dish detergent, Dial soap, or use a specialized sexual device cleaner. Many are listed on our website.
- Begin with the largest size dilator that is comfortable for your needs. This is often the smallest dilator in the kit. It is best to begin with the smallest size you are comfortable with, as you will then move up to the next size with each shift. You may need to begin with the mid-sized dilator and move up from there. This is different for every neo-vagina owner. Many specialists and doctors still push hard plastic dilators for neo-vaginal therapy. There are many “hard” dilators that also feature skin-safe materials that are medical grade silicone that prevent skin tears and issues, also making the process more comfortable and smoother.
- Enter each therapy session with a positive mindset and open mind. If you need to have distraction while practicing, try the TV, radio, or invite your partner in for a conversation.
- To prevent muscle spasms and pain, stretch your body for five to ten minutes before beginning your dilation therapy.
- Use lubrication! LOTS of it! Typically, water-based lubrication is best, as it is gentle on the skin, provides a thin friction barrier and helps with skin moisture. Others may need a thicker friction barrier, and silicone-hybrid lubrication may be your best bet. Silicone-hybrid lubrications, like Sliquid Naturals or System Jo, offer a thicker, longer lasting lubrication that is also skin and therapeutic device safe. Ensuring that you are using lubrication made from natural ingredients is also very important for overall skin health and healing.
- Dilation therapy can be a wet, messy adventure. You may need towels, absorbent pads (even puppy pads), or a special bed cover to sit on while you complete your therapy. Doing this will help to prevent any unwanted mess and makes things simple to clean up.
- Use the restroom and empty your bladder and bowels before every therapy session. Doing this can help to keep things relaxed and pain-free during your therapy session.
- If your surgeon approves, you can take an over-the-counter painkiller (or prescribed, with a prescription) AFTER your dilation therapy session. It is not advised to take painkillers before this therapy, as it can increase numbness in the area, which increases your chance of causing injury or pain unintentionally.
How to Position for Neo-Vaginal Dilator Therapy
- Use a pillow, or more if needed, under your lower back to help the pelvic floor muscles and genitals relax.
- Sit or lay down on the bed or chair, with one knee raised and bent, and the other leg straight, but slightly to the side;
- Lay with both legs out, slightly bent, with toes facing outwards. Do not clench the abdomen while in this position;
- Place pillows underneath your calves and lay comfortable in bed;
- Rest your legs over the arm of your couch and lay comfortably there.
- The duration of dilator therapy is typically done for 2 to 3 hours per day, divided into sessions of 20 to 30 minutes each time for the first year and a half. As time goes on, these sessions decrease, although your surgeon and medical team would have the final say.
- If dilation is painful, do not stop doing it! Use more lubrication, alter your positioning, or move to a smaller dilator. If this does not work to lessen the pain, meet with your doctor to discuss.
Tips & Suggestions from Other Neo-vaginal Patients
These suggestions, notes, thoughts, and tips are from other Neo-vaginal owners who have been through the surgical process.
- “Try not to sneeze with the dilator inserted. If you feel a sneeze coming on, quickly and comfortably remove the dilator and wait.” MH
- “Dilation therapy requires discipline and a routine. Failing to do this regularly will result in more surgeries and reconstructions.” NN
- “Bring pads or underwear liners to wear after your therapy ends. This will help to catch any flowing lubrication or fluids and help to keep your cleaner.” LH
- “If your pubic hair is pulling or getting caught in the insertion of the dilator, be sure to pull the flesh open a bit, gently, before inserting the dilator. Also, putting lubrication on the pubic hair itself helped it to not become stuck.” JJ
- “If thicker “jelly-like” lubrications are causing you issue (becoming too sticky, almost holding the dilator in place) change to using a more liquid lubrication, like Reclaiming Intimacy’s Lustrous or Flourish.” WU
- “If you notice your skin is changing or feels bumpy with the use of jelly-like lubrications often prescribed (like KY), stop the use and bring this up with your surgeon. Certain jelly-like lubrications can cause tissue granulation and for some people, use is not advisable.” SD
- “If you experience trouble with insertion, reach out for help to learn the proper way to insert. My surgeon was very helpful with this, as was my primary care doctor when I asked. I also experienced a bit of discomfort when passing this inside near my prostate, which is normal.” LK
- “There was a point when my neo-vagina seemed tight, even with dilation. I contacted my doctor and increased my dilation therapy times per day. This helped to get things going again and relieved some pain that had begun.” HG
Citations:
Center for Disease Control
National LGBT Cancer Network