Dilation After SRS: When Do You Really Need It?

In the realm of surgical reconstructive surgery (SRS) for trans women, one of the primary concerns is the need to maintain the newly formed vagina through regular dilation. However, the extensive use of dilation devices is often questioned and can be a point of confusion for many patients. This article aims to clarify the necessity and frequency of dilation post-SRS, focusing on the experiences of individuals who have undergone the procedure and have lived the post-operative life.

My Experience: Not Dilating Forever

The common belief is that dilation is required indefinitely to maintain the newly formed vagina. However, based on personal experience, this perception is not accurate. After surgery, dilation for about six months is sufficient. After that, if sexual intercourse is regular, no further dilation is necessary. In my own case, I have not dilated for more than 25 years, and my experience is that it is a rare activity, occurring less than once every couple of months.

The Role of Dilation in Post-Operative Care

During the six-month period following surgery, regular dilation is used to ensure that the vaginal canal does not shorten or narrow. My routine involved using a specific 1.25" x 6" dilator, and I noticed that my vaginal depth would fluctuate slightly—dropping from 6" to 5". However, I could restore it with a few minutes of gentle insertion. Using a hydrocortisone cream occasionally after showering also helped manage any vaginal discomfort.

Importance of Post-Operative Douching

For the first few weeks after my surgery, my surgeon directed me to use a Betadine/water solution for douching. This solution, while effective for preventing infection, can also lead to drying of the vagina. The use of such solutions can be drying, and the use of a hydrocortisone cream helped alleviate any associated symptoms.

Sexual Intercourse and Dilation Habits

The frequency and need for dilation can vary based on an individual's sexual activity. Those who lead an active sex life may find that regular sexual intercourse serves the same purpose as a vaginal dilator. If sexual penetration is frequent, the vagina naturally retains its elasticity and shape. However, if there is no penetration, the body may not require as much maintenance through dilation.

Other Factors Influencing Dilation Needs

Another factor to consider is the use of hormonal therapies. My experience shows that the use of progesterone (200 mg/day) may help retain vaginal elasticity. Additionally, personal sensations of bodily changes can vary. For instance, being well-lubricated naturally and frequently without additional lubricants is something many individuals report as post-SRS.

Personal Insights from Other Post-Op Trans Women

Conversations with other post-op trans women reveal that their experiences vary greatly. It is not universally true that every individual requires regular dilation. Some individuals find that they can maintain the shape and function of their newly formed vagina with less frequent interventions. The variability in these experiences underscores the importance of a personalized approach to post-SRS care.

General Recommendations for Post-SRS Care

The answers to dilation questions from surgical teams often hinge on theoretical considerations rather than practical ones. For individuals with active sex lives, the practical response might be less clear-cut. The incidental use of a dildo or penis for sexual intercourse often serves the same purpose as a dilator and can provide sufficient stimulation. As one progresses into later decades, physical challenges such as arthritis may make dilation or intercourse more difficult.

Conclusion

In conclusion, the necessity and frequency of dilation post-SRS are highly individual and depend on various factors, including personal sexual habits and the use of hormonal therapies. While many doctors may recommend continued dilation, the reality can vary widely. Regular sexual activity often serves as a similar function. Personal experiences, such as mine, highlight that dilation may not be as necessary as commonly believed and can be conducted less frequently.