Dilation after Gender-Affirming Surgery: Types, Timeline, and Complications

Millions of people around the world are dealing with depression and anxiety due to the mismatch between their physical sex and their true gender identity. Hormonal problems, genital abnormalities, and psychological issues are the main reasons for getting transgender surgery. Once the reproductive organs are replaced, the patients must use dilators until the size, shape, and depth of their vagina become natural. If you don’t know how and why dilation after gender-affirming surgery is done, or what happens if you stop doing it, read this article to the end.

What Is Dilation after Gender-Affirming Surgery?

One of the main challenges for people undergoing male-to-female transition surgery is “vaginal stenosis.” This happens when the vaginal canal gradually tightens or even fully closes after gender reassignment surgery. Fortunately, the dilation procedure is done to prevent such problems. The MTF patients (trans men) may also face penile blockage; therefore, they should use narrow dilatators to widen the penile canal and prevent urethral blockage.

Why Is Dilation after Bottom Surgery Important?

If you want to maintain the results of your bottom surgery, you must dilate your vaginal canal several times a day with a proper dilator. The important point is that the dilators should be the right size to keep the vaginal canal and urethra open without damaging the tissues. Skipping dilation, especially in the first few weeks after surgery, can lead to complete blockage of these canals and cause other serious complications. 

Using dilators during the recovery period prevents urination problems and helps you have pleasurable sex without any pain, tearing, or bleeding. Note that if you stop dilation, the internal vaginal skin shrinks, and the vaginal canal loses its depth. Unfortunately, this change is permanent and cannot be reversed, not even with surgery.

Types of Dilators and How to Choose the Right One

The main difference between dilators (both for males and females) is their thickness. For the first days after the surgery, the smallest size of dilator is used until the vagina gets used to it. Then, it is replaced by a thicker one until the vaginal canal is fully stretched. The surgeons or healthcare staff usually give the patient the first dilator (with the right size) and explain how to use it properly.

How to Do Dilation after Gender-Affirming Surgery

Right after the surgery, the surgeon places a bandage or a stent inside the vagina, which should not be removed for several days. After pulling out the stents, the first dilator is inserted and should stay there for at least 15 minutes. Depending on the doctor’s instructions, this procedure must be repeated two or three times a day. After some time, larger dilators will be used to stretch the vaginal muscles more.

Trans men should also use dilators to keep the urethral canal open. The dilator is first inserted into the tube, and once it is in the right position, it’s gently rotated. Over time, larger dilators are used to prevent urethral adhesion and blockage.

Dilation after Gender-Affirming Surgery Timeline

There is no single, standard timeline for dilation after GAS, as each body is unique and responds to the surgery in its own way. However, most patients follow this timeline after the surgery. 

Note: Sometimes, the MTF patients must use dilators for the rest of their lives. So, ask your surgeon for clear instructions.

5 Tips for Dilation after Gender-Affirming Surgery

For the first few weeks after the surgery, the genital area is delicate, swollen, and stiff. So, the doctors recommend the following 5 tips to minimize the discomfort.

• Apply lubricant to both the dilator and the vagina to prevent tearing of the skin.
• Start with small dilators and be gentle when inserting and rotating them.
• When using dilators, apply pressure gradually to give the vagina the required depth.
• Pay attention to the size of the dilator and avoid pushing it too far. This can cause tearing, bleeding, or the formation of a vaginal fistula.
• Visit your doctor regularly, and contact them if you notice anything unusual. 

How to Reduce Pain When Using Vaginal Dilators

If you feel severe pain when using dilators, you’d better follow these steps.

• Lie on your back or in a semi-reclined position. Then, bend your knees and spread them slightly.
• Choose the right size of dilator (based on the table above) and apply lubricant to it.
• Find the right angle and insert the dilator gently. Once the dilator is inside the canal, push it slowly until it reaches the end of the vagina.
• Use a handheld mirror and rotate the dilator gently to avoid applying extra pressure and tearing up the vaginal canal.

The techniques we mentioned here help you feel less pain and pressure in the vagina, pelvis, and groin, especially during the first two weeks.

What Happens If You Stop Dilating?

Dilation after gender-affirming surgery is as important as the surgery itself. Not using the dilators can cause the following complications:

• Vaginal stenosis
• Minimizing the vaginal depth
• Pain or trouble when having sex
• Need for corrective surgery
• Anxiety and dissatisfaction with the results

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Dilation is one of the essential care after genital surgeries in the gender reassignment process, which is used to maintain the depth and diameter of the new vagina (neovagina) or to prevent blockage of the created canals. This process is started with dilator instruments from the first days after the operation and must be continued according to a strict schedule to prevent irreversible stenosis, infection, or the need for corrective surgery. Compliance with hygiene principles, appropriate lubricant, and medical follow-up are very important for the correct performance of dilation.

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FAQs

1. How long after bottom surgery should I do dilation?

Trans women (MTF) have to do the dilation for the rest of their lives. However, they might need to do it less frequently over time.

2. How many times a day should I use dilators?

Depending on your doctor’s instructions, you should dilate 2 or 3 times a day. After about a year, this is reduced to once a week.

3. What dilator size should I start with?

All patients should begin with size zero. After some time, they should use larger, thicker dilators to stretch the vaginal skin more.

4. How should I clean the dilator?

Right after the dilation, wash the dilator with warm, soapy water to disinfect it. Then, place it in a dry, clean box or bag. Remember that the dilator shouldn’t have any cracks or impurities, so check it before using it again.

5. I have so much pain when dilating; can I stop doing it?

No. Dilation must be done exactly as instructed; otherwise, you will not get the results you expect and face serious problems. Remember that pain and discomfort when dilating are normal and aren’t a good reason to stop doing it.