FOLX Copywriter Adryan is spearheading a new recurring column in the Library—Ask a Clinician! In this series, I dive into commonly asked questions from our community and beyond related to virtual healthcare topics and much more especially as they relate to the queer and transgender communities. Any information in this column is purely educational and is not to be used as medical advice.
For our second installment, I interviewed FOLX clinician Andie (she/her), FNP drawing upon her prior experience working in gender-affirming genital surgery. Particularly, we discussed the importance of vaginal dilation for those who’ve undergone gender affirmation surgery, specifically vaginoplasty.
What is dilating in the context of bottom surgery?
Following the surgical creation of a vaginal canal, dilation is part of the post-op healing process to help maintain the length and width of the canal.
Vaginal openings can be created by using skin grafts (penile and often scrotal skin), a piece of the colon (large intestine), or a section of the peritoneum (sack that surrounds abdominal organs). After these types of tissue are used to create the vaginal canal, they have to be cared for to ensure that the tissue will survive. All types of vaginoplasty where a canal is made require dilation.
Dilation prevents the vaginal walls of the canal from sticking to each other and prevents stenosis, or the canal from becoming too narrow and tight for penetration. If not dilated, the buildup of discharge and graft tissue that doesn’t survive can lead to an infection. Dilation also helps stretch the pelvic muscles around the canal to maintain width/girth and minimize pain with penetration.
What are the benefits of dilating after bottom surgery?
Dilating helps to ensure that the canal will maintain the vaginal depth and width created at the time of surgery. Keeping up with a dilation routine can also help maintain the functionality of the canal for sex and avoid pain with penetration.
Dilation doesn't make the canal longer or wider than it was when created. The full depth of your opening is determined at the time of surgery. It’s important to note that it’s not medically safe to try and "stretch" it with devices larger than the dilators provided.
How long do you have to dilate after bottom surgery?
After vaginoplasty, dilation is a lifelong commitment, even beyond your first year after surgery. However, the amount of time you have to dilate at each session and the number of times per week will decrease the farther you get out from surgery but will still be needed at regular intervals for the long haul. It’s recommended to maintain a consistent dilation schedule to keep yourself on track.
Stopping dilation can result in narrowing or shortening of the canal and loss of depth as well as the tightening of the pelvic floor. Without dilating, the tissue that lines the canal may not survive and may need to be replaced with a new surgery. Some say that penetrative sex is a substitution for dilating, but dilation involves holding a dilator that is the size of your canal in place for a particular period of time, which isn’t similar to the kind of penetration that happens with sex. Dilation is also a great post-surgery tool to help penetrative sex be more comfortable.
What are some tips for those recovering from bottom surgery?
For some people, the process of dilation can go from feeling exhilarating and affirming to being frustrating, uncomfortable and time-consuming and back again! Being super patient with your body is so important, and over time, sessions will be less frequent and feel more comfortable and routine.
Having a ritual can help your body relax and make dilation easier. Light candles and play relaxing music. Keep the room warm and comfortable. Maybe incorporate reading something relaxing and light, like a magazine or book. A bath with warm water can also be great after you have been cleared by your surgeon for tub baths.
Don't forget to pay attention to your body posture. Being curled up or angling your hips to be able to see can make insertion harder. Having a nice big mirror and a comfortable place to lay with supportive pillows behind your head can really help muscles relax and avoid getting back and neck pain.
Anything else you’d like to add?
If you’re ever unable to insert your dilators, notify your surgeon's office right away. Don't wait until your next visit or stop dilating without communicating with your surgeon. They can also be a helpful resource if you have questions regarding appropriate pain medication.
Use lots of water-based lubricants when dilating. Other types of silicone or oil based lube are difficult to wash out. Be sure to follow routine douching instructions provided by your surgeon closely as well. Remember to urinate after dilation and sex to avoid urinary tract infections.
Additionally, if you’re experiencing significant post-op pain in your genital/pelvic area, it might be worthwhile to explore pelvic floor therapy, a type of physical therapy specialized in healing the pelvic floor following all kinds of gender-affirming bottom surgery. (People who haven’t undergone bottom surgery also seek out pelvic floor therapy to heal from chronic pelvic pain and more.) If you’re a FOLX member and need assistance with finding a gender-affirming physical therapist that specializes in pelvic floor therapy, please contact Member Support at firstname.lastname@example.org to get connected with FOLX’s referral network.
We want to hear about your LGBTQ+ health questions! If you have a question you’d like to be considered for a future installment of Ask a Clinician, email email@example.com. If you’re a FOLX member with specific questions, feel free to schedule an appointment or message them in your Athena Patient Portal.