Author Topic: Any pelvic physical therapy advice for dilation and groin pain at 8 mo post-op?  (Read 1065 times)

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Offline Janna

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I had peritoneal pull-through vaginoplasty March of this year.  Healing was much slower than average but I'm in my 40s so I thought that was maybe normal.  Things were gradually improving but around 6 months I stopped improving and dilation started getting harder instead of easier and pain/swelling are often worse than previously.  So I'm trying to get an appointment for pelvic physical therapy but I wondered if anyone could suggest any types of exercises or techniques to use until I can get an appointment?

Thanks!

Offline Rachel

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Hi, have you reviewed the situation with your surgeon?

My friend had penile inversion and then PPV to extend depth. She had it in March and orange is difficult. Sometime when she dilates there is blood. She has seen her surgeon several times and has an appointment with another surgeon for an opinion. She had surgery in March. She has sex but with average sized guys and no larger.
MTF in need of help link https://www.susans.org/forums/index.php/topic,133631.1980.html
MTF in need of help 2 link https://www.susans.org/forums/index.php/topic,251825.0.html
HRT  5-28-2013
FT   11-13-2015
FFS   9-16-2016 -Spiegel
GCS 11-15-2016 - McGinn
Hair Grafts 3-20-2017 - Cooley
Voice therapy start 3-2017 - Reene Blaker
Labiaplasty 5-15-2017 - McGinn
BA 7-12-2017 - McGinn
Hair grafts 9-25-2017 Dr.Cooley
Sataloff Cricothyroid subluxation and trachea shave12-11-2017
Dr. McGinn labiaplasty, hood repair, scar removal, graph repair and bottom of  vagina finished. urethra repositioned. 4-4-2018
Dr. Sataloff Glottoplasty 5-14-2018
Dr. McGinn vaginal in office procedure 10-22-2018
Dr. McGinn vaginal revision 2 4-3-2019 Bottom of vagina closed off, fat injected into the labia and urethra repositioned.
Dr. Thomas FemLar 10/13/2020
Dr. Thomas laser vocal procedure 2/17/2021

Offline Janna

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Since I live 8+ hours from the surgeon, they can't do much to help in a video visit, nor can they refer me to a physical therapist without physically seeing me (and even then they seem reluctant to refer because they're a specialist instead of a general practitioner).  So I'm waiting to see a GP because the physical therapy place I'm trying to use said they need a referral.

So I'm just asking if anyone has general advice for exercises, stretches, or other things I can do while I wait to see the therapist.  I searched these forums but couldn't find anything.  Also found nothing specific to SRS on youtube or other places.

I did discover today that ice helps a lot when my pain flares up.  I thought I would be well beyond the time of swelling where ice would help but it still helps.

Offline Rachel

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I has 3 operations and 2 procedures for GCS. I had some difficulties.

After the first operation, when my nerves reconnected I had an area that felt pain when pressure was applied. I would massage the area. At some point my vagina was done and the nerve pain went away. I think associating pleasure with the spot helped. Maybe the nerve just needed time to fully heal. I do not know. 

My girlfriend dilates 3 times a day and sometimes skips orange when there is blood from a previous dilation. She had PPV to increase her depth.

I had a consult with RBL due to 2 issues.  1) depth and 2) cosmetics on the lower outside of the vagina. RBL said I had to go to get pelvic floor instruction from a professional and do it 2 times a day.

I go to MAZZOIN and there are thousands of trans in the practice. My NPT-c showed me how to do
pelvic floor exercises. In about a week my hands hurt. It required a lot of force. I was fully healed. I used a sabian for depth and width and it worked very well. I was fully healed and you may not be fully healed. If you are swelling from dilation then I would consult with your surgeon.

Anyhow, I meet with RBL and my depth and diameter is fine. I am about 1/2 inch above orange dot 5 at the lowest wetted point and at the slit with labia. I am 2 inches in diameter. You can not get that from orange.

First things first I highly recommend consulting with the surgeon on their experience with swelling and pain from dilation.  I am not a doctor.

The second issue RBL recommended stretching my labia to the bottom. She said it could split from sex. I have a lot of sex and some of the guys are very large so that option is out.

I may go back to Dr. McGinn for additional vaginoplasty. Last time she injected fat in the top 2/3 of my vagina and it made a huge difference. Si If I have fat injected on the lower 1/3. I think it would be awesome. I am at Papillion next month and I may inquire.




MTF in need of help link https://www.susans.org/forums/index.php/topic,133631.1980.html
MTF in need of help 2 link https://www.susans.org/forums/index.php/topic,251825.0.html
HRT  5-28-2013
FT   11-13-2015
FFS   9-16-2016 -Spiegel
GCS 11-15-2016 - McGinn
Hair Grafts 3-20-2017 - Cooley
Voice therapy start 3-2017 - Reene Blaker
Labiaplasty 5-15-2017 - McGinn
BA 7-12-2017 - McGinn
Hair grafts 9-25-2017 Dr.Cooley
Sataloff Cricothyroid subluxation and trachea shave12-11-2017
Dr. McGinn labiaplasty, hood repair, scar removal, graph repair and bottom of  vagina finished. urethra repositioned. 4-4-2018
Dr. Sataloff Glottoplasty 5-14-2018
Dr. McGinn vaginal in office procedure 10-22-2018
Dr. McGinn vaginal revision 2 4-3-2019 Bottom of vagina closed off, fat injected into the labia and urethra repositioned.
Dr. Thomas FemLar 10/13/2020
Dr. Thomas laser vocal procedure 2/17/2021

Offline Dorit

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I had similar problems and went to a physiotherapist that specializes in pelvic floor problems for women and has experience with transgender women.  She showed me a number of stretch exercises to do that would help, I have  five photos of them. She also brought out a vibrator, showed me how to use it, and recommended it for releasing the muscle tension in my vaginal area.  She also said that I might just enjoy it too! If you would like, I can send you the photos.
I first told a psychiatrist that I wanted to be a girl in 1967 after a psychotic breakdown
Began therapy again with gender specialist 50 years later in September 2017
Began HRT November 2017
Name change with Israel Ministry of Interior March 2018
FFS September 2018
GCS December 2018
Gender change with Israel Ministry of Interior January 2019
BA July 2020
GCS Revision March 2021

Offline Janna

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I had similar problems and went to a physiotherapist that specializes in pelvic floor problems for women and has experience with transgender women.  She showed me a number of stretch exercises to do that would help, I have  five photos of them. She also brought out a vibrator, showed me how to use it, and recommended it for releasing the muscle tension in my vaginal area.  She also said that I might just enjoy it too! If you would like, I can send you the photos.

Hi Dorit,

Please do send me photos and descriptions of the exercises!  I've had a lot of trouble getting PT.  The doc I saw took a week to tell me they couldn't request prior auth for PT because my PCP wasn't in their network even though my PPO plan says I don't need a PCP or PCP permission for referrals.  So it's been a mess and I don't know how much longer it will take to get the auth much less the PT appointment.

I did manage to see a gynecologist who looked in the canal and said the skin looks raw and "needs healing".  This was incredibly depressing to hear at 8+ months.  She made me bleed trying to look with her speculum.  She also said labia skin looked thin and prescribed me estrogen cream to try to thicken the skin of the labia and vaginal canal.  My tightness problems started when I stopped using steroid cream for granulation and I feel like the two are likely related, though the surgeon's assistant thought it was coincidence.  Either way, I can't get the blue dilator in without pain anymore and even the purple one usually hurts now.  Maybe trying to force them in despite the pain is part of my problem, so I've fallen back to the orange one even though I hate losing all my progress.  I plan to use the purple only as deep as it doesn't hurt.

Offline Dorit

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I hope this helps.  They are all stretch positions to maintain for at least 10 seconds. Sets of three each where recommended.






I first told a psychiatrist that I wanted to be a girl in 1967 after a psychotic breakdown
Began therapy again with gender specialist 50 years later in September 2017
Began HRT November 2017
Name change with Israel Ministry of Interior March 2018
FFS September 2018
GCS December 2018
Gender change with Israel Ministry of Interior January 2019
BA July 2020
GCS Revision March 2021

Offline Janna

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Thanks so much for your images!  I did finally see a PT and she said those exercises were good.  She also gave me a few more but I don't seem to have access to attach an image.

I think the exercises help but she also did some rubbing on the scar tissue that probably helped more.  She was pulling on my inner thighs in places I didn't expect would have scar tissue but I think the idea was to make nearby scar tissue stretch and soften over time.  She said I could do similar rubbing at home but to never go too hard or you can reverse your healing progress. She said the same applies to dilation - don't force it or the skin could be injured and tighten rather than loosen.

I also saw the gyn again who was able to get a smaller speculum in without much pain.  She found clumps of hair mashed into the bottom of my canal!  I've never heard anyone even say that was a possible problem.  So I have to squat and take a photo up between my spread labia before each dilation to make sure there's not a hair hidden in there.  I've already found one.  Gyn also did silver nitrate on my granulation.  I had my first almost painless dilation yesterday so things are looking up.

Offline Dorit

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Happy to hear your good report!   This is my three year post-op birthday month!  :)
I first told a psychiatrist that I wanted to be a girl in 1967 after a psychotic breakdown
Began therapy again with gender specialist 50 years later in September 2017
Began HRT November 2017
Name change with Israel Ministry of Interior March 2018
FFS September 2018
GCS December 2018
Gender change with Israel Ministry of Interior January 2019
BA July 2020
GCS Revision March 2021

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