Dilation Protocol
Dilation is one of the most important factors that determines the success of SRS surgery. Regular dilation prevents skin graft contraction and improves the vaginal wall’s elasticity. Failure to dilate responsibly will result in shortening and shrinking of neovagina. Once the vaginal wall shrinks or contracts, it can not be corrected by simply resuming regular dilation. Failure to dilate properly may also result in serious injury. Therefore, it is imperative that dilation protocol is followed in order to achieve and maintain maximum the depth of the neovagina.
The Dilation Program provides guidelines for dilation starting from the first week after vaginal packing is removed. The total time required for dilations begins with 30 minutes per day and will change over time.
Dilation Schedule for Non-Sigmoid Patients
For patients who undergo non-Sigmoid Vaginoplasty, dilation will start on day 1 after vaginal stent removal. Dilation during the recovery period at the hospital will be done by nursing staff who will explain dilation in detail and ensure that the patient understands the dilation protocol.
Day 1 – Day 3
Size of dilator used: small dilator
Number of times: 2 times/day (morning and evening)
Duration of each dilation: 15 minutes
Day 3 – 3 months
Size of dilator used: small, medium, and large dilators
Number of times: 2 times/day (morning and evening)
Duration of each dilation: 45 minutes (small dilator for 15 minutes, followed by next size for another 15 minutes, followed by the next size for the last 15 minutes)
*The depth of the neovagina should be maintained at approximately 6 inches. If the depth decreases, the patient will need to repeat Day 3 – 3 month schedule which requires both small, medium, and large dilators.
3 months onwards
Size of dilator used: large dilator
Number of times: 2 times/day or 1 time/day
Duration of each dilation: 15 to 30 minutes
*The depth of the neovagina should be maintained at approximately 5 inches. If the depth decreases, the patient will need to repeat Day 7 – 3 month schedule which requires both small and large dilators. Procedures for SRS Surgeries
Dilation Schedule for Sigmoid Graft Vaginoplasty Patients
For patients who undergo colonvaginoplasty, vaginal packing will be removed on day 5. Dilation during the recovery period will start between day 10 to 12 after surgery. The first dilation will be done by a nurse staff who will instruct dilation in detail to ensure that the patients will be able to dilate properly after leaving the hospital.
For patients who undergo colonvaginoplasty, vaginal packing will be removed on day 5. Dilation during the recovery period will start between day 10 to 12 after surgery. The first dilation will be done by the surgeon who will instruct dilation in detail to ensure that the patients will be able to dilate properly after leaving the hospital.
Once the patient is dilated by the surgeon, the patient will consider the next day, “day 1” and proceed with the following protocol:
Day 1 – Day 3
Size of dilator used: small dilator
Number of times: 2 times/day (morning and evening)
Duration of each dilation: 15 minutes
Day 3 – 3 months
Size of dilator used: small, medium, and large dilators
Number of times: 2 times/day (morning and evening)
Duration of each dilation: 45 minutes (small dilator for 15 minutes, followed by next size for another 15 minutes, followed by the next size for the last 15 minutes.
Dilation Instructions
Patients who undergo both non-sigmoid and sigmoid vaginoplasty will need to follow dilation instruction below during each dilation:
Before dilation
- Urinate before dilation
- Each dilation takes considerable amount of time and may stimulate the feeling to urinate.
- Prepare necessary dilation kits and put them within easy reach. All the kits should be kept together.
- Wash hands thoroughly before and afterwards
- Prepare TV or music to watch or listen to during dilation for entertainment
- Put the blue pad sheet on the bed, placing a cushion under the buttocks might make it easier for patients to dilate. Procedures for SRS Surgeries
Dilation instructions
- Before starting dilation, relax your body.
- Put a condom on a dilator (only during the first 6 weeks).
- Apply K-Y jelly over the tip and shaft of the dilator and your vaginal opening.
- Lie on your back in semi recumbent position with your knees in semi flexible position.
- Both sides of your knees should not be extended too much as it will be more difficult to dilate.
- Slowly and gently insert the lubricated dilator inside the vagina at 30-degree angle, while inserting rotate the dilator left and right (quarter or half length of the dilator’s circumference) to expand the vaginal opening.
- After half of the length of the dilator is inserted inside the vagina, adjust the dilator at 60- degree angle
- Push the dilator towards your lower back until it reaches the end of the vagina
- Remember that applying constant and gentle pressure at the bottom of the vaginal wall is vital to maintaining the depth of the neovagina.
- Regularly use a mirror to see the scale on the dilator which indicates whether you reach the end of your vagina.
- Leave the dilator inside the vagina as indicated by the schedule. Use your fingers to push the dilator inside. During this time, patients can readjust their position and relax. They can lie down and stretch their legs which will also allow the dilator to go deeper.
- Take note of the depth of vagina so that you can maintain the same depth during the next dilation.
- After leaving the dilator inside the vagina according to the schedule, move your legs back to an earlier position.
- Gently remove the dilator.
Procedures for SRS Surgeries
Repeat the above process with larger dilator (if indicated by the schedule)
- Clean the dilator with soap or antiseptic solution.
- Rinse out lubricant and clean your vagina.
- Douche the wound. (see below)
Procedures for SRS Surgeries
Please note:
If you find it difficult to insert the dilator into the vagina due to insufficient amount of lubricant, you may apply more lubricant on condom and use a syringe to inject lubricant into the vagina before starting dilation again
After the wound is completely healed, patients may not have to use condoms during dilation.
Sometimes, the dilator cannot be inserted because of muscle contraction. In such cases, patients should slowly push the dilator while rotating it left and right and take a deep breath. If the dilator still can not be pushed further inside, remove it and try to relax your muscle before attempting to dilate again. In this case, the patient should also contact the doctor. Procedures for SRS Surgeries
Caution
Do not skip any dilation according to the schedule even if it is painful. Failure to strictly follow the schedule will result in partial or total contraction of the vaginal wall.
You must not push the dilator too hard in an attempt to increase the depth of the vagina. Such an attempt might lead to injury or discomfort.
Procedures for SRS Surgeries