“Skin likes to heal in the path of least resistance,” says Dr. Emma Kaeser, PT, DPT and one of the physical therapists at Origin, “If you’ve ever had a bad cut, you may have noticed it healing in a jagged or uneven way — this is the skin knitting itself back together as quickly as possible to keep you safe. After a vaginoplasty, we have to be aware of this same principle and be proactive in maintaining the size and shape of the skin grafted vagina post-operatively.”
Enter the vaginal dilator — an oblong mold in the shape of a vaginal canal that is often used to gently lengthen the pelvic floor muscles and vaginal tissues. Although there are many different varieties of dilators, including the silicone dilators we often use at Origin when treating things like vaginismus, it’s important to use specifically designed rigid, plastic dilators after a vaginoplasty procedure because silicone may be too flexible or the wrong size for this task.
“The plastic dilators are made to maintain (and eventually expand) the size of the new vaginal canal,” says Dr. Kaeser. “You want that healing grafted tissue to retain the same shape post-op and essentially make sure that the walls don’t just adhere together.”
Patients are often given multiple sizes of dilators (⅞-of-an-inch up to 1 ¼-inches) by their surgeon or told which products to purchase along with instructions on how to use them.
“Not everyone’s vagina is the same size,” says Dr. Kaeser. “Whether you’re cis or trans, it’s important to use dilators that are the right size for you and only insert them until a comfortable depth.”
For the first three months, it’s common to use dilators for 15-20 mins, multiple times per day. After a check-in with your surgeon (when your tissues have healed, says Dr. Kaeser), you’ll likely decrease to 1-2 times per day. Eventually, you will be able to decrease to several times per week.
“It’s important to be comfortable,” says Dr. Kaeser, “You want to make sure your pelvic floor muscles are fully relaxed because it will make inserting the dilator easier and more comfortable.”
She instructs her clients to lay down with a mirror in hand (helpful to guide the insertion process), a few pillows under their head and their knees propped up on pillows in butterfly position. “Take a few deep breaths and imagine your pelvic floor lengthening on each inhale.”
Then, start with the smallest dilator and size your way up, Dr. Kaeser instructs. Be sure to have a water-based lube on hand (we recommend Slippery Stuff) and when ready slowly insert your dilator at a 45 degree angle until it clears the pubic bone, then angle upwards until inserted to full depth. Feeling easy to insert your current size? Try using the smallest dilator for the first 10-15 mins of your session. Then, try to insert the next size in the pack as far as you can for the last 5 minutes of your dilating session. When you are able to fully insert that one, you can begin using it as your primary dilator and repeat the process for sizing up when you’re ready. In terms of depth, there are dots at the end of the handles — always check that you’re inserting to the same dot to ensure that you’re maintaining full length.
Dr. Kaeser recommends that her patients see a pelvic floor PT pre-operatively as a way to learn how to relax the pelvic floor. “If you are already tight going into surgery, your muscles will be more guarded and shortened at baseline. It can be hard or uncomfortable to progress with the dilators as quickly as you’d like because the muscle tension becomes a limiting factor.”
Just like with any operation, pelvic floor PT can be really helpful after-the-fact. In addition to pelvic floor work and dilator help, your PT will also be able to work with you on scar mobility and tissue healing. “It might feel intimidating to tackle this healing process alone,” says Dr. Kaeser, “but at Origin we’ll be there for you every step of the way.”