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Dilation: A Critical Follow-up Procedure to Successful

Genital Reassignment Surgery

By Alessa Adamo July 22, 2003

Male to female sexual reassignment surgery is often viewed by the transsexual as the end goal of a long and hard journey toward becoming a fully functioning female. It is true enough that the sexual reassignment surgery will endow you with a nearly perfect vagina and all its associated parts. But the real work of obtaining a healthy and functional vagina and urethra comes after the operation: the procedure of dilating.

Dilation is the process of inserting a series of vaginal stints into the vaginal cavity in order to prevent it from closing up. More importantly, dilation also performs the necessary functions of stretching and flexing the cavity and expanding it so as to eventually be able to accommodate a penis comfortably. The stints used for this procedure usually come in a series of five, each one just a bit wider than the other. The smallest stint is on the order of 3/4" in diameter. The largest is about 1 1/2" in diameter. All the stints are the same length, about 8 to 9 inches which provides plenty of room to be able to handle the base while dilating. Most sexual reassignment surgery vaginas can accommodate 4 to 5 inches in depth depending on many variables; only your surgeon can indicate what your individual results may be. The most important thing to realize, however, is that your successful operation can only be maintained with regular and frequent dilation. Conversely, a successful operation can be ruined if faithful dilation is not adhered to as per your doctor's instructions.

I have known and associated with many post-op transsexual's and I have learned through our conversations that we all share some of the same tendencies when it comes to dilation. The first observation we often make after our operation is that all the stints appear too large to violate our now invaluable new equipment. And there is no way that big, giant one (often called big boy, the chief or Mr. Big) is ever going to get near my vagina. The Chief will wait a few months before using him, but you will need to start dilating with the others the day your vaginal mold is removed, usually 5 days or so after sexual reassignment surgery.

Your first dilating experiences are the easiest. We are so hopped up on drugs those first several weeks that the dilating doesn't really hurt, and that can be good and bad. The tendency during those first few weeks is to overdue the 'forcefulness' of the procedure, thinking to ourselves that we are really going to make sure we have a good size cavity (possibly a carry-over from the remnants of our male psyches that big is better). Being firm but gentle is important in the first several weeks as tissue damage is a possibility if you dilate too vigorously in the beginning. And tissue damage can lead to minor healing complications later. This is not a major problem, but healing complications occur more often than you may think. I endured healing complications myself.

Following the first several weeks of recovery there is a tendency to start 'cheating' on the dilations. Dilating instructions usually follow the general procedure of dilating about a half hour to 45 minutes a session three times a day. We are instructed to follow this procedure for about a period of 6 months. After that, as we graduate to the larger stints, we may go to 2 sessions a day; this would be from the 6 to 9 month period. Then finally to once a day for the remainder of the first year. After one year post-op you will probably be instructed to dilate once a week for life. It is important to note here that I am generalizing. Your instructions may vary from your own surgeon. Follow your own surgeon's schedule. One caveat here: I have read accounts from some transsexuals on the Internet of being instructed not to dilate for one full month after sexual reassignment surgery from a Bangkok surgeon. There are excellent sexual reassignment surgery centers in both Bangkok and Phuket in Thailand but research your surgeons carefully when going out of country. You will have little recourse with an out of country unreputable surgeon. These accounts have described complications and generally failed sexual reassignment surgery. My only comment on these particular complaints is that no reputable surgeon following prescribed procedures, no matter their particular technique, will tell you not to dilate.

OK; back to the point of this whole liturgy&emdash;and, yes, there is a point. As the operation gets further and further behind us, we have a tendency to get lax about our dilating. Dilating is inconvenient, it is sometimes a little painful as we graduate to the larger stints, and it always seems to be interrupting our daily (or nightly) routines. However, if you want a well formed vagina with its associated parts, you must dilate. Dilation not only gives you width and depth, it seems to influence the entire area. The urethra and clitoris take their respective positions wonderfully. You stop spraying yourself sooner when you urinate and everything in the area firms up nicely. Make dilation the most important part of your day, not the least.

A word about healing problems; you may experience what the doctors call crystallization of the skin inside the vagina during the healing process. Crystallization is skin that won't heal completely. This crystallization may occur in more than one area of the vagina. It is readily visible to an experienced doctor and you should visit your gynecologist if you suspect you are having healing issues. Yes, you need to have a gynecologist now&emdash;don't fight it. I know, I know&emdash;the feet in the stirrup thing may bother you. It's just part of being a woman, girls. Anyway, suspect poor healing if you continue to experience unreasonable pain in the vagina, especially while dilating. It may be difficult to tell the difference from the normal, mild pain associated with training your vaginal opening, and the kind of pain on the skin where the wound is not healing, but you should not be feeling internal skin pain after a few months. Discuss the options with your gynecologist if you are experiencing healing problems. The sooner you address these problems, the easier they will be to remedy.

Finally, I will stress one last time that without the added benefit of regular, long term dilation, you will not achieve the full benefit of sexual reassignment surgery. Dilation is a too often neglected part of the overall sexual reassignment surgery procedure. Do not neglect it. Embrace it and you will be rewarded accordingly. To neglect it would be like spending all your hard earned dollars on a new Mercedes vehicle and then never washing, waxing, or maintaining it. Your new car will look shitty and operate poorly. So treat your new 'Mercedes' well, girls.

Alessa Adamo is a post operative transsexual who had her operation in August, 2002 with Dr. P. Brassard in Montreal, Canada. She lives in Pacifica, CA with her transsexual partner, Traci. You may contact her at AlessaAdamo@aol.com.