Vaginal dilation program after sex reassignment surgery.

If the surgeon puts his art at the service of the patient in order to achieve a vagina with functional depth, it is the duty of the patient to apply and follow the guidelines of the vaginal dilation program in order to maintain this functional depth. original.

Vaginal dilation stretching force is intended to prevent contraction of the graft inside the vagina and also provide good elasticity of the vaginal wall to accommodate penetrations regardless of size.

Without adequate and correct vaginal dilation, the graft in the vagina tends to shrink or contract, and this can lead to an irreversible reduction in the depth and diameter of the vagina.

The daily program of vaginal dilation takes place over the total duration of two hours and thirty minutes.

During the first year after surgery, it is recommended to do vaginal dilation 3 times a day for 50 minutes in the morning, 50 minutes in the afternoon and 50 minutes before going to bed. This frequency is preferable to twice a day: 100 minutes in the morning and 100 minutes before going to bed.

It is recommended to obtain a set of five dilators with different diameters: dilator n° 0 measures 20 mm in diameter, that of dilator n° 1 is 23 mm, that of dilator n° 2 is 26 mm, that of dilator no. 3 is 29 mm and that of dilator no. 4 is 32 mm.

The length of each dilator is plus or minus 21.5 cm.

The first vaginal dilation is always performed by a surgical nurse for a few minutes. Your original vaginal depth will be confirmed by the measuring scale on the dilator shaft at the point of the vaginal orifice.

During the first week after surgery, your dilation will be performed under the close supervision of a nurse. Never attempt to perform dilation without supervision.

When the nurse considers that the patient is qualified enough to perform this very important and very delicate procedure, she will authorize her to do it herself.

Hands and dilators should be washed before and after each vaginal dilation using mild soap and water. The use of water-based lubricating gel is mandatory whenever dilation is done, to prevent any tearing of the delicate skin inside the vagina.

A lubricating gel must be applied abundantly to the entire dilator and also to the skin of the vaginal opening before the start of the dilation. This makes it easier to insert the dilator inside the vagina. During expansion, if necessary, lubricating gel can be reapplied.

The ideal body position for dilation is the same as that taken during the pelvic exam: lying on your back in a semi-prone position with your legs bent. Next, the lubricated dilator is placed against the vaginal opening located below the opening to the urethra. The tip of the dilator should be slid slowly into the area just below the urethra. The dilator can be twisted around to help widen the vaginal opening. The dilator is advanced slowly, with a downward angle from the spine or tailbone, until it occupies the full depth of the vagina. CThis depth should be checked frequently on the dilator scale using a mirror to ensure that the bottom of the vagina is reached at least using dilator #1.

Light and constant pressure is needed to stretch the skin graft deep inside the vagina, to maintain the original vaginal depth. Do not attempt to push or force the vaginal dilator against the fundus of the vagina in order to increase the existing vaginal depth because this could cause a tear in the vaginal wall which would result in bleeding or vaginal fistula.

As long as you do not feel comfortable with the size of the dilator used, do not go to the next size even if it is planned in the dilation program. When you manage to do the dilation with the larger sizes, you should not try to push the dilator to the bottom of the vagina the first time. You have to go gradually and be patient and persevering.

Vaginal Dilation Process Chart

First day :

The nurse will do the vaginal dilation for you. However, you will need to observe and focus on how the nurse applies the lubricating gel into the vagina. When she reaches the depth of 14 centimeters, she will teach you how to hold the dilator in place for 30 minutes. After completing the 30 minute dilation time, she will show you how to carefully remove it and gently clean the vaginal opening.

The second day :

The nurse will do the vaginal dilation for you. However, you will need to observe and focus on how the nurse applies the lubricating gel into the vagina. When she reaches the depth of 14 centimeters, she will teach you how to hold the dilator in place for 60 minutes. After 45 minutes, you will need to remove the dilator yourself.

The third day :

The nurse will insert the dilator for you up to 7 to 10 centimeters deep and remove it. Then you will start the dilation again on your own under the close supervision of the nurse. When you reach 14 centimeters deep, you will need to hold the dilator in place for 90 minutes. You will need to check the marker on the dilator often throughout the process to make sure you are keeping it 14 centimeters deep.

The fourth day :

Please wait for the nurse before starting your vaginal dilation as you must do the whole process under her supervision. When you reach the depth of 15 centimeters, you must hold the dilator in place for 120 minutes.

After the fourth day, the total time for vaginal dilation should be constant: 150 minutes per day. This is the time required. It is recommended to divide the total dilation time of the day into three sessions of 50 minutes each

You must check with the nurse on the morning of the fifth day if you are allowed to start doing vaginal dilation on your own in the afternoon and at bedtime.

Please follow the recommended combination of dilator sizes :

size #1 = 23mm - size #2 = 26mm - size #3 = 29mm - size #4 = 32mm for the specific dates in the expansion progress chart on the next page.