Sex Reassignment Surgery (SRS) also referred to as gender affirming surgery, is the process of transforming the genitals to match a person’s sexual identity. When transitioning from male to female (MtF) a procedure known as vaginoplasty is performed to create a neo-vagina, and vaginal dilation is an essential part of post-surgical care to prevent the new vaginal canal from shortening or narrowing.
While surgeons and their care team will typically provide patients with a dilation schedule after surgery, many people considering vaginoplasty wonder if they will have to dilate forever after SRS. Keep reading to learn more about dilating after sex reassignment surgery, how long you will have to dilate, and why some dilators are better for transgender patients than others.
Also referred to as Genital Reassignment Surgery (GRS) or Gender Confirmation Surgery (GCS), male to female Sexual Reassignment Surgery (SRS) involves reconfiguring the male genitalia to create a vaginal canal between the rectum and urethra, and the vaginal lining from penile and scrotal skin. The labia majora are also formed from scrotal skin and the clitoris is shaped from the rounded head of the penis, known as the glans penis.
Vaginal dilators are tube-shaped medical devices that are designed to stretch the vaginal tissues, relieve discomfort during penetration, alleviate pain during sex, and maintain the vaginal canal post surgery. When used after SRS, their function is to prevent the new vaginal canal from tightening or shrinking and prepare the vaginal walls for comfortable penetration, as well as enjoyable sex.
If regular and consistent dilation is not practiced after SRS, neo-vaginas are known to narrow and shrink. As one surgeon puts it, if you don’t use it, you lose it. Neo-vaginas are similar to a wound from pierced ears – if they are not used, they will close. And once the vaginal canal has contracted after SRS it cannot be reversed by re-starting dilation. This means SRS patients could be confronted with painful penetration and ongoing discomfort during sex, or undergo a revision surgery.
To achieve the most successful outcome from SRS, it helps to understand that the patient’s role is just as important as the surgeon’s. The surgeon’s responsibility, for example, is to perform the procedure and offer advice on post-surgical care. The patient’s responsibility is to follow the post-surgical care instructions and accept that consistent dilation is essential to the continued function of the neo-vagina.
Dilating daily according to the vaginal dilation schedule that your surgeon provides will prevent the development of scar tissue, maintain the depth and width of the vagina, and improve blood flow & elasticity in the vaginal walls to allow for a more enjoyable sexual experience.
After SRS, the neo-vagina is essentially a wound that is healing, and the more care and time you can contribute to your recovery the more successful you can expect the outcome to be. For this reason, a member of your surgeon’s care team will typically perform your first dilation within a day or two after surgery.
To maintain the quality and capacity of the neo-vagina, your surgeon’s care team will incrementally increase the dilation time in the week following surgery. They will also show you how to dilate at home with a strict vaginal dilation schedule to follow.
Patients who do not follow the dilation schedule run the risk of scar tissue forming within the new vagina, losing flexibility in the vaginal walls, and developing a condition known as vaginal stenosis, where the vagina narrows and shortens. In addition to reducing the size of the vaginal canal, a lack of dilation can also result in thinner and dryer vaginal walls, which ultimately leads to pain during sex.
Before being discharged after GRS, MtF transgender patients typically receive a set of vaginal dilators from their surgeon in varying sizes and diameters to perform their vaginal dilation schedule. Generally made from hard plastic, some patients can accept the rigidity of the dilators provided by their surgeon, however, many prefer the softer, smoother, and more life-like feel of medical-grade silicone dilators.
Although a little softer, the still firm form of medical-grade silicone dilators provides the perfect amount of pressure to improve blood flow and flexibility of the vaginal walls, as well as maintain the capacity of the neo-vagina, without placing too much force against the already sensitive vaginal skin. For these reasons, silicone are the top dilators of choice.
At the end of the day, the choice of which dilators to use is a personal one. What’s important is that your dilation practice after GRS is regular and consistent, so if the harder dilators from your surgeon are causing pain to the point that you are skipping dilation, consider buying dilators made from medical-grade silicone.
If you decide to change from plastic to silicone dilators, it is important to check with your surgeon to ensure you are using the correct size and dilating for the right amount of time.
When it comes to silicone dilators, not all brands that produce them use medical-grade silicone so it is important to check for FDA registration before purchasing. Dilators made from silicone that is not medical-grade standard will feel sticky once lubrication is applied, and stickiness is not a sensation that feels comfortable or soothing against sensitive neo-vaginal skin.
Designed by a pelvic health rehabilitation specialist, Intimate Rose Silicone Dilators are not only made from medical-grade, body-safe silicone that is FDA-registered, but transgender patients have confirmed that their human-like feel is more sensitive to neo-vaginal healing. As an extra recovery aid, Intimate Rose Silicone dilators can also be chilled to reduce and relieve post-surgical inflammation, and they come in sets of 8 varying sizes.
Although softer than plastic dilators, GRS patients continually confirm that Intimate Rose dilators are strong enough to apply the perfect amount of pressure for gently stretching the neo-vaginal tissues without causing too much pain. This perfect balance of gentle stretching without too much pain appears to be a deciding factor in encouraging GRS patients to continue with consistent dilation and achieve the best results after surgery.
A day or two after your gender reassignment surgery, dilation is typically performed by a nurse or member of the surgeon’s care team. A member of the care team will continue to perform dilation twice or three times per day for the next few days while you recover from surgery. Before you are discharged a member of the care team will show you how to continue dilation at home with clear instructions on which dilator to begin with, and for how long you should dilate each day.
The at-home vaginal dilation schedule and recommended length of dilating sessions will vary for each patient as well as the recommendations of each surgeon. For the first three months, patients are generally advised to dilate three to six times per day for a total of 120 minutes. However, depending on the patient and the surgeon, some patients are directed to dilate three times per day for as little as ten minutes each session.
To maintain the integrity of the neo-vagina, many surgeons suggest dilating regularly for up to two years at regular intervals throughout the day. That said, the duration of dilation sessions could drop after three months to once a day as soon as patients have comfortably enjoyed intercourse. Nine months after SRS, dilation regularity can drop to two or three times per week for some patients, and once per week after a year.
Essentially, everyone heals at a different rate, so the exact guidelines for your recovery journey will be communicated to you by your surgeon and it is highly advisable to follow them for the best outcome.
Yes, after SRS you can expect to dilate for the rest of your life, but less frequently than during your post-surgery recovery. Some patients might be advised to dilate two or three times per week to preserve the capacity and comfort of the neo-vagina, while once per week, or once per month might suffice for others.
Gender affirming surgery is a life-changing decision that requires aftercare in the form of vaginal dilation to prevent the neo-vagina from shrinking. Although frequent and consistent dilation is vital after surgery, dilation sessions will become less frequent as intercourse commences and time passes.
Even though hard plastic dilators are often provided for dilation after SRS, many transgender patients opt for a gentler dilation experience by using medical-grade silicone dilators instead. To ensure you are purchasing silicone dilators made from medical-grade silicone always check the product description for FDA approval and registration.
References
My Cleveland Clinic – Vaginoplasty - https://my.clevelandclinic.org/health/treatments/21572-vaginoplasty
MTF Surgery - Use It or Lose It: The Importance of Dilation Following Vaginoplasty - https://www.mtfsurgery.net/dilation.htm
Women’s College Hospital - Post-Operative Vaginoplasty Guide to the First Year - https://www.womenscollegehospital.ca/wp-content/uploads/2022/09/PatientHandoverDocument.pdf
Medical News Today - Sex and sexual health tips for transgender women after gender-affirming surgery - https://www.medicalnewstoday.com/articles/transgender-women-after-surgery
