NeoVaginal Dilation Therapy

Neovaginal Dilation Therapy


Dilator therapy is used to help maintain the function and pliability of the vagina, whether natural, or a neovagina. A “neovagina” is the creation of a new vagina out of other tissues, intestines, or done during gender reassignment surgery, often called vaginoplasty. Many people have a neovagina for various reasons, and these folks can be female, male, or transgender. Post-operative vaginal dilation is an integral part of the initial surgery recovery and the regular maintenance of a person's neo-vagina.

Usually, dilation begins a few days after surgery (once cleared by your doctor or surgeon) and is almost always required for life. Without proper dilation, the skin graft inside the vagina tends to contract which leads to shortening or closure of the neo-vagina. This is an irreversible result; one cannot regain the original vaginal depth by simply resuming or doing more dilation. Dilation may not be pleasant, but it is essential to follow your surgeon's dilation protocol in order to prevent loss of depth of your new vagina.


Why is Dilation so Important?

The purpose of dilation is to maintain the depth of the neo-vagina. Dilation helps prevent contraction of the skin graft inside vagina and also improves the elasticity of vaginal wall in order to comfortably accommodate penetrative sex.

 Dilation involves inserting a lubricated dilator into the neo-vagina and keeping it in there for a specified amount of time. The size of dilator and the length of dilation time varies depending on the surgeon's protocol and patient's needs. Your surgeon will advise about the proper use and frequency of post-op dilation and it's important to follow their advice above all as it may be specific to your case.

Initially, one can expect dilation to take up to 2-2.5 hours per day, with the time and frequency decreasing after you reach 18-24 months post-op. Dilation may not always be fun or enjoyable, but it is necessary and worth it!


What happens if I do not Dilate?

When dilation is not done according to the recommended routine, the skin graft inside the vagina can contract and close up which leads to the shortening, and even closure, of the neo-vagina. Unfortunately, once this happens it cannot be fixed by simply resuming or doing more dilation. A revision surgery is usually necessary.

 A 2015 study concluded that the most common complication from Vaginoplasty was narrowing of the vagina. A more recent study that was presented at WPATH 2018 by urologists from Hahnemann University Hospital reported an overall incidence of revision surgery after Vaginoplasty was 7.9% in 240 patients of Dr. Kathy Rumer, and that the second most common reason for revision was neovaginal stenosis (2.1%). Researchers concluded that not following the dilation regimen was significantly associated with increased risk of complications or revision.

 "Vaginal openings are similar to pierced ears in that if you don't use earrings regularly, the piercings will eventually close," says Dr. Rumer. "So, we always say, 'DILATE!!! DILATE!!! DILATE!!!'"


Tips for NeoVaginal Dilation

It is best to follow your surgeon’s directions for your dilation plan, and not to begin until you have to go- ahead. The dilators you use should be firm, but soft to the touch to avoid skin tears and lacerations.

Dilators should ALWAYS be used with lubrication.

  • Clean all dilators with warm, soapy water or with a gentle therapeutic aid cleaner like Reclaiming Intimacy’s Clean.
  • Begin with the largest size dilator that is comfortable to you. For many, this is often the smallest dilator in the kit. It is best to begin with the smallest size you are comfortable with, as you will then move up to the next size with each shift. For others, you may need to begin with the mid-sized dilator and move up from there. This is different for every neo-vagina owner. Many specialists still push hard plastic dilators for neovaginal therapy. There are many “hard” dilators that also feature skin-safe materials that are medical grade silicone that prevent skin tears and issues. Please reach out to our staff if you have questions or need direction on these dilators.
  • Before you begin your dilation therapy each time, be sure your mindset is positive, and you have something to occupy your mind, if needed. For some, this might be watching TV shows, or doing a craft.
  • Stretch your body for five to ten minutes before beginning your dilation therapy.
  • Use a lot of lubrication. Typically, water-based lubrication is best, as it is gentle on the skin, provides a thin friction barrier and helps with skin moisture. Others may need a thicker friction barrier, and a silicone-hybrid lubrication may be your best bet. Silicone-hybrid lubrications, like Reclaiming Intimacy’s Satin, offer a thicker, longer lasting lubrication that is also skin and therapeutic aid safe. Ensuring that you are using a lubrication made from natural ingredients is also very important for overall skin health and healing.
  • You may need towels or absorbent pads to sit on while you complete your neovaginal dilator therapy. This can be a very messy therapy with body fluids and lubrication, and this helps to prevent any unwanted mess, and makes things simple to clean up.
  • Take a trip to the bathroom before each session of dilation therapy. This includes both bladder and bowel movements. Doing this can help to keep things comfortable during your therapy session.
  • If your surgeon approves, you can take a painkiller AFTER your dilation therapy session. We do not advise taking painkillers before this therapy, because this can increase numbness in the area, and increases your chance to cause pain or hurting yourself unintentionally.
  • Positioning for Dilation Therapy:

               o Placing a pillow or pillows under the low back can help the genital        muscles to relax.

               o Sitting or lying down with one knee up, bent, and the other leg out straight.

               o Both legs out, slightly bent, with toes facing outwards. Do not clench abdomen while in this position.

               o Placing pillows underneath the calves and laying comfortably in bed; or resting your legs over the arm of your couch and lying comfortably there.

  • Duration of dilator therapy: To begin, typically neovaginal dilator therapy is done for 2 to 3 hours per day, broken in to sessions of 20-30 minutes each time for the first 18-24 months. As time goes on, this becomes less frequent, but still requires a consistent routine of therapy. Although, your surgeon and doctor may have a different plan for you, and you should follow your treatment plan with your doctor.
  • If dilation is painful, do not stop doing it! Use more lubrication, alter your positioning, or move to a smaller dilator. If this does not work to lessen the pain, meet with your doctor to discuss.


Notes from Neovaginal Patients:

These are notes, tips, and tricks from patients who have or are going through neovaginal dilation therapy.

  • “Try not to sneeze with the dilator inserted. If you feel a sneeze coming on, quickly and comfortably remove the dilator and wait.” MH
  • “Dilation therapy requires discipline and a routine. Failing to do this regularly will result in more surgeries and reconstructions.” NN
  • “Bring pads or underwear liners to wear after your therapy ends. This will help to catch any flowing lubrication or fluids and help to keep your cleaner.” LH
  • “If your pubic hair is pulling or getting caught in the insertion of the dilator, be sure to pull the flesh open a bit, gently, before inserting the dilator. Also, putting lubrication on the pubic hair itself helped it to not become stuck.” JJ
  • “If thicker “jelly-like” lubrications are causing you issue (becoming too sticky, almost holding the dilator in place) change to using a more liquid lubrication, like Reclaiming Intimacy’s Lustrous or Flourish.” WU
  • “If you notice your skin is changing or feels bumpy with the use of jelly-like lubrications often prescribed (like KY), stop the use and bring this up with your surgeon. Certain jelly-like lubrications can cause tissue granulation and for some people, use is not advisable.” SD
  • “If you experience trouble with insertion, reach out for help to learn the proper way to insert. My surgeon was very helpful with this, as was my primary care doctor when I asked. I also experienced a bit of discomfort when passing this inside near my prostate, which is normal.” LK
  • “There was a point when my neovagina seemed tight, even with dilation. I contacted my doctor and increased my dilation therapy times per day. This helped to get things going again and relieved some pain that had begun.” HG


Resources Used:

Reclaiming Intimacy



National LGBT Cancer Network

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