I've posted this elsewhere but it might help Cherrie -
My e-mail to Dr Suporn...
I've reached that difficult stage where dilation gets painful (almost 3-months).
I've tried a few remedies, like changing position, technique, pain killers, all sorts of things - with varying results.
The other night I was talking to a girlfriend of mine, who's had her surgery with an Australian surgeon (Simon Ceber), her dilation routine post-op was very different to my experience with Suporn. Instead of dilating right away, she didn't dilate for most of the first 2-3months, instead she was required to make and insert her own packing, made of medium density foam rubber.
Anyways, we were talking and ended up having a "show and tell" to compare, because the technique, result and post-op care are such a contrast.
Long story short, I explained my process and my girlfriend explained her process, which lead to some experimentation.
I spent the better part of today with, essentially, packing, between dilation - it was less painful and I was able to slide the large dilator in (something that has been difficult for me) and you can go about your day with this inside you sit, stand, whatever.
I thought it may be useful to some of you who have to work and can't get in that extra dilation in the middle of the day.
I made some changes to suit my own needs, and, well here's how you do it -
Take some medium density foam rubber and cut a piece about half an inch less than your maximum depth, experiment with the length (which will actually become the girth)
Roll it up, tight! Then insert into a condom, still keeping it ok he'd but its not so important now
Working from the reservoir tip down, squeeze the air out of the foam and the condom, then twist the end. You should have a weird looking long piece of foam - looking a bit like a ->-bleeped-<-ty hand rolled smoke.
Then you take it and insert it, after dilation (that's how I do it) and unwind the condom end to let the air back in - the foam expands and keeps the vaginal cavity open as the muscles relax.
If possible I would like some feedback from Dr Suporn as to the safety and suitability of this technique. Some have questioned If there a risk that the packing will prevent blood reaching the lining of the vagina? If so it could cause necrosis.
I don't know if it would be an issue as the foam forms and moulds and is quite soft, but I would like some confirmation before I continue to use this technique, so far I have only tried it for one day at home with 5 hours between dilations.
And Sophie's response...
Dear Sarah,
Thank you for your email. If you don't mind, I'll answer it myself, as I am the Clinic's specialist on dilation, rather than Dr Suporn, and that's what I get paid to do on his behalf. He also does not have sufficient command of written English to explain himself the details of what needs to be conveyed, nor perhaps even to understand what you are suggesting.
Firstly, you simply cannot compare the dilation technique of a client who undergoes penile inversion surgery, with recovery from a non-penile inversion procedure done by Dr Suporn. There is almost nothing that's similar during the recovery phase.
Unfortunately, there is no easy way of dealing with the difficulties of dilation with our technique, and the more one tries to seek out a "soft" solution, the more likely it is that one will create far greater difficulties, than one will make them easier.
The reason that we ask you to you dilate - using a hard dilator, is that you need to oppose the force of scar tissue contraction. That point is emphasised in the post-op care guide that you have, and hopefully was also emphasised in the post-op care class you were given. The force is enormous, and the chances of foam exceeding that force is nil - no chance at all, no matter how solidly it's packed into the vagina. It's an unfortunate fact that our clients do experience a more difficult recovery as far as dilation is concerned, but that's the price one needs to pay for generally a much superior overall outcome compared with penile inversion. So, as an alternative to dilating with our hard dilator, the only long term effect you would experience would be a steady erosion of vaginal depth, but a more rapid erosion of vaginal width, to the extent that quite soon you would find it difficult if not impossible to insert a dilator at all, and would invite a high risk of vaginal stenosis occurring. Even a "soft" dilator such as s silicone rubber dildo, is insufficient to deal with the stretching needed.
There is nothing of course to prevent you from using some packing similar to that which you describe as an additional way of keeping the vagina open during the day after dilation as you say you are now doing, but certainly not instead of the hard dilation that we ask you to do. The packing would not cause any problems with the blood supply. As you said yourself, the foam you have used is quite soft. So the force that could be applied at its surface is virtually nothing. To achieve a true expansion effect, you would literally need to ram packing into the vagina form the outside - rather like packing gunpowder into a cannon. I hope that does not sound too dramatic, but that's what would be necessary, and even then the blood supply would not be affected. To all intents and purposes, that's exactly how Dr Suporn inserted the packing into your vagina at the time of your operation, and which stayed in situ for a week afterwards. If you watched him remove that, you will realise it was a strip of bandage, about 30 meters long - and jammed in place very solidly indeed. Basically, if you can insert the condom-filled wad from the outside, then the pressure it will exert on the vaginal wall throughout the day is virtually nothing. However, if you feel it is doing you good, and you have the time to prepare such a thing twice a day, then by all means use it. It will do no harm, but unfortunately not much good, either, as far as actual <dilation> is concerned. One word of caution I'd like to interject with, please. ...you need to be very sure that you can easily get the condom out again. There is a possibility that during the day it would be drawn into the vaginal vault through displacement, and might be embarrassingly difficult to get out again, especially if it settles behind the vaginal opening ring.
I think it would help if I explained a bit more about the key areas you need to concentrate on, in comparison with penile inversion surgery. There is very little real risk of any vaginal narrowing in your case, in the actual vaginal vault behind the ring of scar tissue at the vaginal opening, and the scar tissue at the far end of the vaginal vault. Those are the 2 areas you need to concentrate on. The softer vaginal tissue in between those almost never narrows very much. The following amplifies on a couple of points I the post op guide, which are important to know about, but it highlights the 2 key areas you need to work on - which are not the vaginal vault itself.
The Last Inch
It is often a common misconception that the last inch of dilation is a barrier. It is difficult for every patient, because of simple geometry. This diagram will explain why, and what you can do about it:
In simplistic terms, the end of the vagina comes to a point, where the incision to produce the vagina, terminates. Although that statement is not 100% accurate in surgical terms, for the purposes of this explanation, it is accurate enough. It is at that point where most scar tissue exists, because that is where the body finds it easiest to start healing what it considers to be a "wound".
As you can see, because of the shape of the dilator, as it gets towards the end of the dilator, it meets the vaginal wall before it gets to the end of the vagina.
You can now see that to dilate "The Last Inch", the scar tissue has to be stretched over the rounded end of the dilator. The stretching hurts, so don't be surprised. It would hurt even if there was no scar tissue, but the scar tissue makes it even harder, and hurt more. The whole reason and principle of dilation is to oppose the force of scar tissue contraction - and this diagram should help explain better exactly what that means. For most people it hurts a lot, and they confuse that sensation with it being an impenetrable barrier. It isn't. It just needs relaxation, and some hard work to overcome.
This diagram also helps to explain why the first part of inserting the dilator can also be difficult. If you imagine the scar tissue near the vaginal opening to be like an elastic band, you can see that before you start dilating, the band has to be stretched over the dilator. It hurts to do that, but the more lubricant you put on this area before you start, the better.
Dilator Size
The larger the dilator, the earlier it reaches the vaginal wall at the end, and the narrower the dilator, the further in it can be inserted before touching the vaginal wall. that is why it is harder to dilate to full depth with the large dilator, than the medium, the small dilator is the easiest.
If you find the last inch to be really difficult, move down a size with the dilator you are using. There is no harm at all with that. You will find it much easier to get to depth, and much more quickly. That will make you much more relaxed, which in turn will make dilation a lot easier. This is a positive spiral! It's a "win - win" situation.
Never be afraid to downsize if you need to. Downsizing makes retention of depth much easier, and in real terms does not affect width much at all, providing you dynamically dilate correctly using the "stirring" motion to stretch the vaginal opening. It is very difficult to recover lost depth and - if left too long - can become impossible. However, it is much easier to increase vaginal width at any time.
Withdrawing the dilator
Withdrawing the dilator is also not as easy as some imagine, because of very simple physics. As you withdraw the dilator, the ring of scar tissue wipes off the lubricant, just like a car windshield wiper. That means that the surface of the dilator that goes over the ring, is drier. That makes friction higher, which takes more force to move it - which in turn hurts more. The solution is simply to relax as you withdraw, which reduces tension in the muscles surrounding the scar tissue.
I don't wish to stifle your proposal, and if anyone came up with a genuine way that would make dilation easier for all our clients, I'd be thrilled to hear about it, and would introduce it right away. Unfortunately, what you are proposing is not the answer, though but - as I say - it will do you no harm at all to use as an additional procedure, with the caveat that you must be careful not to lose it inside your vaginal vault while you sit during the day. I hope that helps, but please do not hesitate to ask at any time if you need any further information or guidance.
Best Wishes
Sophie
