For many trans women, undergoing gender affirmation surgery to achieve an aesthetically pleasing and functional vagina is an important step. There are different techniques: penile inversion vaginoplasty, colovaginoplasty and vaginoplasty involving skin grafts. It is the medical team that will decide which technique is best suited to your medical history and to your personal characteristics and circumstances. To achieve the best results, a woman must agree to undertake certain treatment procedures, including vaginal dilatations after vaginoplasty.
In other posts we have talked about surgery, so what are the treatment procedures to be undertaken after vaginoplasty? At IM GENDER we have a treatment guide that is given to all vaginoplasty patients to provide them with detailed information about the whole process, and about the treatment procedures they need to undertake before and after surgery. One of these procedures is vaginal dilatation.
What is vaginal dilatation after vaginoplasty?
Vaginal dilatations form a very important part of the postoperative treatment after vaginoplasty. They should be carried out consistently and methodically for at least the first three months after vaginoplasty, whether this takes the form of penile inversion or colovaginoplasty. After this time period, sexual intercourse can begin, and natural penetration will now be able to replace mechanical dilatation.
When should vaginal dilatations start? While you are in hospital, between the fifth and seventh day after the operation, the genital area is uncovered. From the seventh day onwards, if confirmed by the attending doctor, daily washings and dilatations should begin.
The IM GENDER team will guide you during the first dilatation so that you can learn how to do them, and once you have returned home, you will need to perform them several times a day. There are two types of dilators available for vaginal dilatations, one smaller in diameter and the other larger. Start with the smaller one and after a month, when you are more confident and your muscles are more used to it, you can move on to the wider one.
How is vaginal dilatation performed?
At IM GENDER, all trans women who have undergone vaginoplasty are provided with a treatment guide and a dilatation kit. In this kit you will find all the elements needed for washing and dilatation:
- A syringe with a cannula, for washing prior to genital dilatation.
- Serum and Betadine, which when mixed together will be used to wash the genital area by means of the syringe with its cannula before dilatations.
- Two dilators of different sizes, one narrower and one wider. The first dilatations, which you will perform during the first month, will be carried out using the dilator with the smaller diameter. In this way all the muscles of the pelvis will become accustomed to the dilation process. From the second month after the vaginoplasty, once patients have had more time to practise the process and the pelvis has developed a greater degree of flexibility, patients can start to perform vaginal dilatations using the wider dilator.
- Lubricating gel and Betadine gel, to be used in conjunction with dilators. The lubricant will make it easier to insert the dilator into the vagina. The Betadine will help any wounds to heal.
In this video, Dr Trinidad Labanca, a specialist in gender affirmation surgery at IM GENDER, explains more about the contents of the Dilatation Kit.
How often should I perform vaginal dilatations?
During the first month, unless your doctor recommends another frequency, it is usual to perform them three times a day, for about 12 minutes each time, using the smaller dilator. From the second month onwards, the vaginal dilatation can be performed once or twice a day, for about 12 minutes each time, using the larger dilator.
What are the consequences of not doing the dilatations?
The main negative consequence of not following the dilatation guidelines is that this will affect the outcome of the vaginoplasty. In other words, if dilatations are not carried out regularly, this will affect the flexibility of the pelvic floor and its diameter.
Further treatment after vaginoplasty
You will need to rest while you are in the hospital. You will be admitted to hospital for at least one week so that the IM GENDER Gender Unit medical team can monitor you on a daily basis. On the last day of your hospitalisation, the first vaginal dilatation will be performed and the treatment procedures to follow will be explained to you so that you can perform the recommended dilatations at home.
You will also leave the hospital with a bladder catheter, which will need to remain inserted until periurethral swelling becomes minimal. At home, in addition to the vaginal dilatation, you will need to continue with the rest of the recommended treatment process.
During the postoperative period after vaginoplasty, you should consult your endocrinologist about your hormone treatment in order to restart it after the first four weeks and readjust the dose required.
In addition, you should avoid any kind of sporting activity until the medical team advises you otherwise. However, this does not mean that you have to stay in bed all day. It is advisable to go for short walks, which will gradually become longer and give you more freedom of movement.
If you have any further questions about vaginal dilatations or vaginoplasty surgery, please do not hesitate to contact IM GENDER.
If you have more questions about what phalloplasty involves, make an appointment with the IM GENDER team and we will inform you.