Vaginal dilation is a critical part of postoperative care following gender-affirming surgery (GAS) at WIH Hospital
Without regular dilation, the neovagina can naturally shrink over time, leading to a loss of both depth and width. Daily dilation is essential to maintain the surgical results and ensure long-term function and comfort.
After surgery, vaginal dilation must be performed every day for the first 1–2 years to preserve the depth and width of the neovagina. Consistent dilation prevents tissue contraction and helps maintain optimal surgical outcomes.
Dilation involves gently inserting a dilator to the maximum depth of the neovagina, typically around 6–7 inches. The dilator should be held in place with steady pressure for the recommended duration. This regular practice prevents the neovaginal canal from narrowing or shortening over time.
Gradual progression to larger dilator sizes helps expand the neovaginal width. Similar to the process of stretching an ear piercing, transitioning to larger dilators over time improves flexibility and ensures the neovagina remains open and functional.
At WIH Hospital, patient education and postoperative support are fundamental to achieving the best possible outcomes.
Proper vaginal dilation is vital for maintaining neovaginal health, maximizing surgical success, and enhancing overall quality of life after gender-affirming surgery.
The use of a WIH medical-grade dilator set helps maintain the flexibility, width, and depth of the neovagina, preparing the body for future sexual activity.
The standard dilator set includes five progressively sized dilators, with each size increasing gradually by 3 mm in diameter to ensure comfort and ease of use during progression.
Each dilator has a consistent length of 8.5 inches (approximately 21.5 cm) to help maintain the full depth of the neovagina during dilation.
The primary goal is to progress to Size 4, which ensures the neovagina is wide and flexible enough for typical sexual activity.
Statistically, 95% of male partners have a penile size that is equal to or smaller than the width corresponding to Size 4, making it an optimal target size for readiness.
For patients who feel comfortable with Size 4 and wish to continue expansion, an optional Size 5 dilator (35 mm) is available for purchase. However, sizes larger than Size 4 are generally not necessary for maintaining neovaginal health unless specifically recommended.
It is important to note that medical dilators are specifically designed to maintain the neovaginal structure after surgery.
Dildos or sex toys are not substitutes for medical dilators, as they are manufactured for different purposes—pleasure rather than postoperative maintenance.
Patients are encouraged to follow the structured dilation program provided to maintain optimal surgical outcomes and support long-term neovaginal health.
Following gender-affirming surgery (GAS), 2 essential practices are required for maintaining neovaginal health:
Water-based lubricants are the recommended choice for both vaginal dilation and sexual activities.
They effectively reduce friction, are easy to clean, and minimize the risk of irritation or residue buildup inside the neovagina.
A generous amount should be used during each session to prevent micro-injuries and maintain tissue flexibility.
Other types of lubricants, such as silicone-based and oil-based, are not recommended because they are harder to clean, may leave residues, and can potentially cause irritation or damage to medical devices like dilators.
Before dilation or sexual activity, it is advisable to apply a water-based lubricant inside the neovagina to a depth of approximately 2–3 inches, ensuring adequate protection and comfort during the procedure.
Lubrication is a critical component in maintaining neovaginal health following gender-affirming surgery (GAS). Proper application of lubricant not only enhances comfort but also protects the delicate neovaginal tissue from friction, injury, and irritation during both vaginal dilation and sexual activity.
When engaging in vaginal dilation or sexual activity, the focus of lubrication should primarily be on the neovaginal tissue rather than the dilator or partner.
During male-to-female intercourse, lubricant should be applied to both partners. However, greater emphasis must be placed on thoroughly lubricating the neovaginal entrance and internal canal, as the body being penetrated is at greater risk of friction and injury.
Approximately 80% of the lubricant should be applied directly to the vaginal entrance and inside the neovaginal canal, with only a small amount applied to the dilator itself. The surface of a medical-grade dilator is already smooth and requires minimal additional lubrication
At WIH Hospital, patients receive personalized, step-by-step training to ensure safe, effective, and confident dilation from the very beginning.
Dilation training begins on the day the vaginal gauze packing is removed. Our nursing team demonstrates the entire process, including gel application, proper dilator insertion, and reaching full neovaginal depth. This session also establishes the patient’s baseline depth, which should be maintained in all future sessions to ensure the canal remains fully open.
Training is provided daily and at no additional cost, continuing until the patient is confident performing the procedure independently.
Patients begin with dilator size 0 and gradually increase dilation time during the first week. In the second week, dilation is performed twice daily using sizes 0 and 1. As healing progresses, patients are guided to advance to larger sizes—typically size 2 by week 3, size 3 by week 5, and size 4 by week 7. In the first year, patients should dilate twice daily for 75 minutes per session. After one year, this can be reduced to twice daily for 60 minutes, and by the third year, dilation can be performed once daily or every other day. For a complete timeline with duration and dilator size progression, please refer to the WIH Hospital Vaginal Dilation Program.
WIH Hospital is committed to providing comprehensive postoperative support throughout each patient’s recovery. Our nursing team remains available for follow-up, guidance, and reassurance to ensure long-term surgical success and neovaginal health.
The key to success is consistency. Patients are encouraged to follow their dilation schedule every day. If a session cannot be completed in full, the remaining time may be compensated during the next session. Staying disciplined and motivated is essential to maintaining neovaginal depth, flexibility, and overall surgical outcomes.
The full routine continues for at least one year, then reduces in frequency gradually over time.
Discomfort is normal at first. It’s okay if larger dilators don’t reach full depth right away.
You can compensate later in the day. Consistency over time is more important than perfection.
Our dilation chart shows time progression and size increase, which can be downloaded below.
No. Vaginal dilation is for depth maintenance post-vaginoplasty, while D&C is a gynecological procedure.
