Vaginal dilation routine after
Gender Affirming Surgery
Dr. Chettawut’s skin graft technique for gender affirming surgery
Dr. Chettawut’s recommended dilation routine
Vaginal dilation after sex reassignment surgery
The patient and the surgeon share responsibility to achieve the best surgical
outcome and maintain a good function of vaginal depth after sex reassignment surgery.
For the surgeon’s part, Dr. Chettawut safely creates the maximum depth of the vaginal tunnel and then utilize the best quality of skin graft to form the entire lining of the vagina.
For the Patient’s part, it is your responsibility to strictly follow Dr. Chettawut’s vaginal dilation program in order to maintain the original depth of vagina.
The stretching force from vaginal dilation can prevent skin graft contraction inside vagina and also provide good elasticity of vaginal wall to accommodate penetration regardless of size.
Without adequate and correct vaginal dilation, the skin inside the vagina tends to shrink or contract which may lead to the shortening of the vagina.
Shortened vagina resulting from skin graft contraction inside the vagina is an irreversible process which means you cannot regain your original vaginal depth by resuming or doing more vaginal dilation.
The vaginal dilation program focuses on the total time of your everyday dilation requirement which is around 2-2.5 hours per day.
During the first year after SRS, we recommend you to do vaginal dilation 3 times per day (50 minutes in the morning – 50 minutes in the afternoon – 50 minutes before bedtime), which is considered better than 2 times per day (100 minutes in the morning – 100 minutes before bed time).
Dr.Chettawut’s vaginal dilator set will be provided for all his SRS patients and the cost is already included in the SRS package price.
The provided dilators vary in different diameter (5 sizes) which comprised of dilator no.0 with 20 mm diameter, dilator no.1 with 23 mm diameter, dilator no.2 with 26 mm diameter, dilator no.3 with 29 mm diameter and the biggest no.4 with 32 mm diameter.
The length of each dilator is approximately 8.5 inches.
According to Dr. Chettawut’s SRS technique, the gauze packing (formed like a tube) will be used to stabilize the skin graft inside vagina around 7 days.
When the gauze packing inside vagina is gently removed, the speculum is inserted into the vagina for examination of the skin graft.
Your first vaginal dilation will be demonstrated by Dr. Chettawut’s surgical nurse for a couple of minutes. Your original vaginal depth will be confirmed by the measurement scale on dilator shaft at the point of the vaginal opening.
During the first week after SRS, your dilation will be carried out under the close supervision of our nurse. Do not attempt to perform dilation whilst unsupervised.
When the nurse considers you to be sufficiently skilled in performing this most important and delicate procedure, she will allow you to do it by yourself. ** (Please see Revise in the paper)
You should wash your hands and dilator(s) before and after vaginal dilation by using water and mild soap.
The use of water based lubricant jelly is mandatory for every time you do dilation or have sexual intercourse in order to prevent tearing of the delicate skin inside the vagina.
A plenty of lubricant jelly must be applied over the tip and shaft of your dilator and also at the skin of vaginal opening before dilation to ease insertion of the dilator that will be put inside vagina. Re-apply more lubricant jelly during dilation if necessary.
Lie on your back in semi recumbent position with your legs bent (the same body position during pelvic examination), and then position the lubricated dilator against the vaginal opening located below the urethral opening.
While inserting the vaginal dilator, you should slowly slide the tip of the dilator in the area right under your urethra. The dilator can be rotated in circles to help expand the opening of the vagina.
Slowly push forward your dilator at an angle toward your lower back or tail bone until it occupies the full depth of your vagina.
You should frequently check the scale number on the dilator (by using the provided mirror) to ensure that you can reach the bottom of vagina with at least the smallest size of dilator (dilator no.1).
Gentle and constant pressure is needed for stretching the skin graft at the bottom of vagina in order to maintain your original vaginal depth.
You must not attempt to push or force vaginal dilator against the bottom of vagina in order to increase your existing vaginal depth because it may cause a tear of vaginal wall which may lead to bleeding or vaginal fistula.
According to the steps of increasing the size of dilator in our program, it is possible to postpone if you still feel uncomfortable with the current size of dilator.
When you are starting to use the bigger dilator, it is common that it cannot be push forward into full vaginal depth as the smaller dilator.
We can assure you that the bigger dilators (no. 3 & no. 4) can gradually go deeper inside vagina and finally reach the bottom of vagina with your diligent dilation.
During the first year of your dilation routine, you should maintain the use of dilator no. 1 & 2 even though you can accommodate dilator no. 3 and/ or no. 4 already.