Both the patient and the surgeon share a key responsibility in achieving the best surgical outcome and maintaining functional vaginal depth following gender confirmation surgery (GCS). During your procedure, your surgeon utilises the penile and scrotal flaps safely to create the maximum depth of the vaginal canal and form the internal lining of the vagina.

As the patient, it is your responsibility to ensure you strictly follow the Vaginal Dilation Schedule to maintain the depth and calibre of your vagina. The stretching effect from vaginal dilation can prevent wound contraction, in addition to providing optimal elasticity of the vaginal walls to accommodate penetration. Without adequate and consistent dilation, the skin inside the vagina will shrink and contract, which may ultimately lead to shortening and/or narrowing of the vaginal canal; this is known as stenosis.

A shortened vaginal canal resulting from contraction inside the vagina is an irreversible process which means you cannot regain your original vaginal depth by resuming or increasing vaginal dilation.

According to our surgeon’s GCS technique, packing will be used to stabilise the skin flaps inside the vagina, which is then removed at approximately 5 days post-operation. When the vaginal pack is removed, a speculum is inserted into the vagina to examine the healing of the skin flaps.

Following this, your first vaginal dilation will be demonstrated by your surgeon or a senior member of the clinical team. Your vaginal depth will be confirmed by the measurement scale on the dilator shaft; this is measured at the point of the vaginal opening.

You will be provided with a set of vaginal dilators prior to your discharge from the hospital. These dilators will vary in diameter and you will be advised by your surgeon or a senior member of the clinical team which sized dilators to use during your vaginal dilation. It is recommended that you continue with daily vaginal dilation up to 3 months following your GCS. After 3 months, once a week or alternative weeks as required is acceptable. Once vaginal intercourse is commenced, you may only need to dilate once a month as necessary.

Dilation essentials

Wash your hands and dilators both before and after vaginal dilation using warm water and mild soap. The use of water-based lubricating jelly is mandatory for the first year following your surgery to prevent tearing of the delicate skin inside the vagina. Prior to commencing dilation, plenty of lubricating jelly must be applied to the tip and shaft of the dilator, as well as the vaginal opening to ease insertion. Please re-apply more lubricating jelly during dilation if necessary.

Lie on your back in a semi-recumbent and comfortable position with your knees slightly bent. Position the lubricated dilator against the vaginal opening. Slowly push the dilator at an angle toward your lower back or tailbone until it occupies the full depth of your vagina. Whilst inserting the dilator, slow and gentle rotation can help expand the vaginal opening.

Gentle and constant pressure is required in order to sufficiently stretch the skin and maintain vaginal depth. You should frequently check the measurement scale on the shaft of the dilator to ensure you are maintaining depth with at least the smallest size dilator supplied. You must not attempt to push or force the vaginal dilator against the end of your vaginal canal to increase existing depth; this can result in tearing of the vaginal wall, bleeding, or a vaginal fistula.

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