Sex Reassignment Surgery (SRS) Aftercare
When Rebecca and I were preparing the Transmission Time segment on Post Sex Re-assignment Surgery aftercare we put together a very detailed “script” so there was a logical flow to the discussion, but more importantly not to leave anything important out. What follows is that “script” and while we tried to follow it fairly closely it is by no means an accurate record of the programs content, it is really just a content guide. See also the companion program 391 on SRS Techniques.
The actual program is available from the JOY 94,9 website www.joy.org.au by clicking on the podcast icon and following the Transmission Time links to the podcast. You can access this particular program and our other podcasts directly at http://www.cpod.org.au/page.php?id=87&page_style=joy.css&no_brand=1
Jayne
Topic of the Week > Vaginal Maintenance Dilation
Rebecca
Introduction
Tonight on Transmission Time, Jayne and I are going to cover a subject that I guarantee that you will not hear discussed anywhere else and again we issue a similar warning to last week that if you are a little squeamish, now might me the time to go and have that cuppa.
Last week we talked about the different forms of Sex Reassignment Surgery for Male to Female transgender women. Many people I have spoken to seem to think that Surgery, is like the end of the road for transition not realising that there is a lifetime of, to put it mildly, maintenance associated with that surgery.
Jayne
When most people go into hospital for surgery, they recover and after that forget about the surgery. For instance I have an elderly relation who had his second hip replacement earlier this year. He came home, did his exercises for a few weeks and then went skiing about 5 or 6 months later, totally recovered, not even giving his surgery a second thought.
Now when you have Sex Reassignment Surgery (SRS), the surgery is just the beginning of a life time of what Lauren likes to refer to a “Vaginal Maintenance”.
Before we talk about Vaginal Maintenance, or what is generally referred to as Dilation, let’s first explain why this maintenance is required after Sex Reassignment Surgery and why it is so important.
If you have a cut or wound in your body, the body's defensive mechanism goes to into action and tries to repair any damage done. Its natural tendency is to heal the wound and try to return the site to that existing prior to the wound occurring. It also has the ability to detect “foreign” body material and reject it unless appropriate drugs are taken.
Sex Reassignment Surgery, is just like having a big wound between your legs where the neo-vagina is placed. This “wound” can be anywhere from a few inches up to about 8 inches in depth. Now the body sees this wound as something that should not be there (no matter how much we want it to be) and immediately starts to try and close it. Last week we mentioned a process of granulation where
The tissue typically grows from the base of a wound and is able to fill wounds of almost any size it heals.
This Granulation if left to its own devices it will eventually Quote “heal” Unquote, the wound and the Reassignment Surgery, not to mention the expense, will all be for nought.
Rebecca:
I think an easy way to explain it, is to think of the vaginal opening as like a pierced ear. If you take the earring out, after a while the hole shrinks, and it's a lot harder or impossible to get an earring through it.
Jayne
So how do we overcome the bodies' natural healing process? We use a process of vaginal Mmaintenance called Dilation. Now I am sure you have all heard of the term dilation but probably not in the context in which we are talking. Here Dilation refers to trying to stop the neo-vagina from contracting and counteracting the bodies natural healing process that wants to close our vagina or wound. So what do we do? We have to insert a Dilator into our vagina and stretch the opening to counteract the bodies healing process.
In practice a Dilator is something akin to a Dildo. The medical ones are often made of acrylic, very smooth with parallel sides and a rounded conical shape at their tip. They do not have any phallic markings like some Dildos. Remember these are for medical purposes not sexual ones. Rebecca, what did your surgeon provide you with for your dilation?
Rebecca
The actual dilators I was given are a clear resin, with inch markings on the side, and their diameter marked as well. Mine were provided in Small Medium and Large ranging from 25 to 32mm in diameter.
Having seen other dilators, I've noticed differences in the end shape, and the material used. I would guess the tip shape has more to do with the surgery technique used, so that the dilator "fits like a glove" so to say. One thing that should be noted is, an off the shelf vibrator or dildo doesn't give the same results as the dilators. As much fun as they can be, they really are more for pleasure, and not for keeping everything in showroom condition.
I've personally found using condoms over the top of the dilators helps with the insertion, and also for keeping them a bit cleaner, although I do wash them after use. It also means you have a handy supply of condoms close at hand, should the need arise for other things.
Jayne
Now that we have had a look at why Dilation is so important and it is time to look at how it is done.
Every Surgeon as different recommendations as to what form Dilation should take so we will just talk about a couple of regimes. I have a very close friend who went to Dr Suporn in Thailand and she lent me her after care manual. Unfortunately for us she would not come on and talk of her experiences. The manual goes into great detail about vaginal after care and of course Dilation.
Rebecca
It sounds like you have certainly done your research that we spoke about last week. A special overseas trip at some point in the future Jayne?
Jayne
Well you never know….. but I have found the research interesting.
One thing I found interesting in reading through it was that they talk about two different forms of Dilation, Static and Dynamic.
With Static dilation, you just insert the Dilator and hold it in place for about an hour while exerting inward pressure. This is solely to prevent your “wound” from initially closing up and to maintain depth.
Dynamic or Active Dilation is designed to help soften the internal scar tissue as it starts to contract and harden and to open the entrance to your vagina. The contraction of the scar tissue can be very strong and will close your new vagina if nothing is done. As the name implies, with Dynamic Dilation you have to move the dilator. The Dr Suporn manual says that you insert the dilator and then apply as much pressure a you can take for 10 to 15 seconds. You then relax the pressure and gyrate the dilator in a conical fashion for another 10 to 15 seconds. This is repeated for about 10 to 15 minutes.
Rebecca
We will continue this discussion after this short break, Transmission Time on JOY 94.9
BREAK
Dilation Methods
Jayne
You are listening to Transmission Time and tonight we are talking about aftercare following Sex Reassignment Surgery
Rebecca
Now that we have had a quick look at the dilation methods, let's have a look at how much and how often you need to dilate post SRS surgery. The Dr Suporn manual says that for the first month while in Thailand, you should use only Static Dilation and do it for at least 1 hour, twice a day.
After that you start on the Dynamic dilation. The manual says to do 3 sessions for months 2 and 3 post surgery. For months 4 to 6, it recommends reducing the sessions to twice a day and for the following 6 months down to once a day. After the first year they say that it is then only necessary to 2 to 3 times a week.
Jayne
Even though the manual says to keep up the static dilation for about the first 4 weeks, my friend said that she started her Dynamic Dilation at about 3 weeks on the surgeon's advice.
Rebecca, how do Dr Suporn’s instructions match with what you were given by Dr Preecha?
Rebecca
The type of dilating is a pretty close match. I was told to dilate for half a hour, twice a day to begin with. But the half an hour started when I reached maximum depth, so I would guess it would work out to an hour any way. I also listened to my body, and if I was happy to keep going a bit longer, then I would keep going. Some days it was very painful, like trying to dilate just a few hours after playing sport, so I wouldn't work things as hard. After all, I spent a lot of money on having the car port put in, no point trying to rip it down by doing burnouts on the driveway.
Jayne
My friend said that one very big mistake she made in her Dilation regime was not going up the largest size early enough. Evidently the surgeon said to start using the largest dilator at about 2 or 3 weeks when the lining of her vagina had initially healed. She told me that she was afraid to use the large one as she thought it might tear something so she just stuck with the Small and Medium ones.
She thinks that as she was not stretching things sufficiently, that scar tissue has developed and a smaller that optimal diameter has made Dilation a bit harder that it should be nearly 18 months post surgery.
Rebecca, how did you judge when it was time to reduce your dilation or did you just follow the instructions you were given.
Rebecca
Firstly in terms of changing up though the sizes, when I first started out I thought “There is no way I will ever get the large one in there, it's huge! But I was surprised at how soon after using it, I was wanting something bigger, as it felt loose.”
As for the method, I would have to say it is a bit of a mix of both. Dilating can take over your life a bit, and so found that as I got further away from surgery, finding the time in my day to dilate became harder, because I was getting on with life. I found that if I dilated once a day, there were no issues, but if I left it for a few days, then things would be tight. In general I found that if the need arise, I could skip the odd day, which made planning my life a lot easier to do. These days I really don't dilate as much as I should, but I also have no plans of taking my vagina out on the battlefield any time soon.
Jayne
My friend who gave me the manual said that she developed her own way of determining when to reduce the Dilation. She basically only used the manual as a guide, and started recording her insertion times each time she dilated. Being the person she is, she them put them into an XL spread sheet and graphed them. In this way she could see at a glance how she was progressing. She said that by looking at the graph, she found that her insertion times trended gradually down and flattened out. She also said that her times would maintain at a given level and then suddenly drop. She used this drop as the time to change and reduce the frequency. She said that she actually spent a lot longer at each level that recommended in her manual.
The insertion times are important as they are a guide to how well you are maintaining your vaginal size. She said that she has lost a little depth, but was not willing to say what she started with of how much she lost, though I don't think she lost much.
She said that every time she reduced the number of dilations or the days between, her times went up again and it could be up to 2 weeks before she got back to her starting point.
Rebecca, what was your experience of Dilation?
Rebecca
My experience with dilation has not been a good one, but it hasn't to do with the surgery technique, it has to do with unrelated illness a year after surgery. Going back to the time just post surgery, dilation was a very messy affair. It took me a couple of weeks to work out a system that worked for me, so I didn't end up with a mess everywhere. In the end I found having an old towel under me, tissues to one side, lube to the other, and my head propped up at the right angle that I could still see the television worked well. I went through a lot of lube in the early stages, working out just how much I needed to use, with out there being a big mess to clean up.
Initially post surgery, I started off with the smallest dilator, and wondered just how the hell I would ever fit in the largest dilator. I was told it would take about a month before I could comfortably use the largest one (32mm diam). One thing I didn't think about at the time was the amount of swelling I had internally, and that's why the smallest size was so tight to begin with.
The actual technique of dilation was fairly straight forward. I had to work the dilator with small rotations, and move it back and forth slowly, as I inserted it. This was to help with the lube, to ensure an even coverage. Some days it would take a good ten minutes to get the dilator all the way in, others it slipped straight in. When I reached the maximum depth possible, I had to hold it there with a small amount of pressure, and tilted up slightly. From this point I would hold it in that position for about half an hour. After this, if I felt like it, I could "pleasure" myself with the dilator, which was really just a bit of bonus dilation time.
Jayne
A Canadian friend on mine said that she used to find dilation a bit painful and that she sometimes had to rest for a minute till the pain subsided and then continue. Did you have this problem?
Rebecca
No I had a relatively straight forward experience, though there was usually some blood, although not much and this became less and less as the months went on. As for pain, I find it no more painful than popping a pimple, if any pain.
All up I had to dilate for half an hour, two times a day, for the first six months, then once a day after that. If I was engaging in sexual activity, then I wouldn't have to dilate at all, but that wasn't the case for me.
Jayne
Yes I have heard that from several sources, though I would have thought that using a Human Dilator may not be as effective as the plastic one but at least it might be more pleasurable.
Rebecca
My personal experience with human dilators is very limited, so I can't speak much from personal experience. I mean they are fun and have their uses, but I'd never want to own one myself.
Speaking to people I know who are in a long term relationship with guys, their views range differently. Everything from "We went like rabbits and after a while it didn't hurt as much", through to "I found a guy who is just the right fit for me". I can see how using a human dilator can be useful, if that's the only thing you want to put in your vagina, but I think of the opening like being a hole in your ear. If you don't keep wearing earrings, it becomes tight, or closes up.
We will continue this discussion after this short break, Transmission Time on JOY 94.9
BREAK
A Third Dilation Method
Jayne
So far we have talked about the dilation methods used by a couple of the Thai surgeons which I believe is fairly typical, but it is not the only way. I was talking to a friend the other night and her dilation regime was very different.
She said that her surgeon did not recommend any dilation for the first 6 weeks. At 6 weeks she had to insert a condom containing rolled up foam rubber and leave it in for 24 to 48 hours. At that point she had to change it and keep doing this for a further 6 weeks. After that she had to dilate for about 30 minutes twice a day and like others reduce this over time.
I can understand the surgeons reasoning as it is in this second 6 week period that the body is trying to contract the scar tissue and inserting the foam rubber resists that contraction.
Rebecca
I can see how this would have advantages, as the neo vagina is not contracting as much between dilations. I can only go on personal experience, and at a guess I would say this technique suits the surgical technique. With any dilating, it is better to go by what your doctor says, for the work they have done, rather than listening to what a friend of a friend heard down the pub, off a good mate.
Jayne
Not that this a subject likely to be discussed down at your local pub
Rebecca
I have to say that it wasn't until I had booked my surgery, that I found out about dilating. I had no idea there was a post surgical need for such a thing. Hopefully those who are considering surgery, who are listening to the show, will be wiser of the facts than I was.
Jayne
Cis-women have a natural advantage over trans women as their vagina is basically self cleaning and requires very little maintenance though some companies would like you to believe otherwise and try and sell you lots of products. I did see note in Dr Suporn’s manual that because he uses your Scrotal sack to line the vagina, that there can be a degree of self lubrication related to the absorption and release of oestrogen from taking HRT, though it does say that this varies greatly from individual to individual.
Rebecca, what other post operative care have you found necessary.
Rebecca
The other piece of post operative care, and something I still do regularly is to clean out the vaginal canal with a Betadine solution. This is done while in the shower, using one of those squirtey things (Jayne I think you mean a Douche), just as a way of getting rid of any bacterial growth or foreign objects that may be in there. Initially post surgery I was doing this daily, but these days I do it about once a month. I also wash using a PH balanced wash, of which there are a couple of brands specific for the female anatomy on the market.
As I mentioned before, I did have issues about a year after surgery, when any time I dilated, there was a larger amount of blood than I expected. At first I thought there might have been something torn, but it turns out this was due to the leukaemia I had. As I went through the treatment for that, I couldn't dilate, as my skin was tearing apart and not repairing itself. After I got out of hospital, about six months later, I tried to dilate, but because I was still undergoing chemo, this was pointless. I basically went for a little over two years with out being able to dilate, and the difference is very noticeable these days. I have lost about 35% of the depth, and I do notice the scar tissue, which is more sensitive. These days I don't dilate on a daily basis, but I find about once a week is enough to keep everything from getting too tight down there, but there hasn't been any improvement to the depth unfortunately.
Jayne
One thing that is stressed in the Suporn manual is that once you loose depth it cannot be recovered. When I mentioned this to a local doctor, he said that he thought that depth could be increased, but that it would be very difficult. He did not elaborate as to how much depth could be recovered or how much work it would be.
Several of my friends have said that Dilation virtually ruled their lives for about the first year. Did you find this initially before you were diagnosed with Leukaemia?
Rebecca
For the first few months it did, but then it just became part of my daily life. When I started out, was making sure it happened "on the hour" for fear the flying monkeys would be sent in from the wicked witch. After time I found I could easily work it around being a shift worker, and travelling interstate. I used it as a private time for a bit of meditation, a chance to unwind from the day. This ways didn't see it as a chore, but something that helped my life in general.
Jayne
One thing we haven't talked about is the emotional feelings that go with dilation. The Suporn manual talks about the need to have a positive attitude towards dilation and not to see it a chore that has to be done. How did you feel about your Dilation?
Rebecca
It helps to have a positive attitude. If you are positive about something, you are more relaxed, and you can enjoy the moment more. Some days my dilation is more enjoyable than others, and when that happens, I go with the moment. We are not unlocking a safe here, it's not three clicks to the left, seven to the right, four to the left and clunk, every thing opens. You need to work with your body, not force it to take the dilator, because the manual does not have to be followed to the letter.
Conclusion
Jayne
As you can see from our discussion tonight, having Sex Reassignment Surgery is not the end of the Transition journey and can go on many years after you reached your initial goal. We must stress that what we have discussed tonight are the experiences of Rebecca and a few of our friends and was meant as a general information session.
Rebecca
What was appropriate for me and our friends may not be applicable for you. If you are considering Reassignment Surgery you will need to follow the recommendations of your own surgeon who will have a dilation regime applicable to their surgery.
Jayne
You are listening to Transmission Time with Jayne & Rebecca on JOY 94.9.
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