Dilate Forever?

[anjaq]

LOL - I would buy one if I ever manage to get to orange and it does not hurt.
But really - do you think for the long term maintenance you still need the dilator profile, or is the shape a bit less critical later on? My doc said it woul dbe fine to masturbate or have sex with a guy weekly or more to have it all stay in shape, but I dont trust him as he did not tell me about dilation directly pre-op either. Probably he assumed I know that already, but gave me the impresison that I just need vibrators or sex now. Well - I see now where that got me now. Dilating painfully 13 years post op ...

[GendrKweer]

I had SRS with Dr Suporn a year and a half ago.... I usually dilate when I feel like it at this point, once a week or once every 10 days... naturally, it takes a few minutes more if I go 10 days, but it isn't bad, and I'm still at 6 inches x 34 mm diameter. Frankly, I enjoy dilating these days.... it's a nice little time to yourself, flop out on the bed, browse on the laptop, listen to some music, tune out... I could do it in 30 min flat, but sometimes an hour just passes by in a nice half doze and I don't mind that at all! Once a day in perpetuity is ludicrous, and I wouldn't believe it.

[Doctorwho?]

I had SRS with Dr Suporn a year and a half ago.... I usually dilate when I feel like it at this point, once a week or once every 10 days... naturally, it takes a few minutes more if I go 10 days, but it isn't bad, and I'm still at 6 inches x 34 mm diameter. Frankly, I enjoy dilating these days.... it's a nice little time to yourself, flop out on the bed, browse on the laptop, listen to some music, tune out... I could do it in 30 min flat, but sometimes an hour just passes by in a nice half doze and I don't mind that at all! Once a day in perpetuity is ludicrous, and I wouldn't believe it.

^^ This! ^^

I have to say that both as an ULTRA longterm (30 years plus) AIS postie - and as a trainee clinician I would say this is 100% spot on!

And yes I think the form does matter... you certainly don't have to use it every day or even every week, but now and again I don't think it's a bad thing to remind your body what shape things should be in.

[Jenna Marie]

Once a day does sound like a lot to do forever! I have to admit, though, I've surprised myself a bit - at the one year mark I went down to four times a week, and while I'm supposed to be slowly reducing to get to once a week (for 15 minutes with the Giant Orange) forever, I'm currently content at this point. 15 minutes every other day isn't so bad right now!

I also do sometimes use a vibrator first, to make it easier to relax if I'm feeling especially tight that day. I figure the dilation requirements are a minimum, and I can add more time/toys on top of that as long as I do get the 15 minutes with orange in.

[mrs izzy]

I wonder if anyone cares what there doctor suggests?

My doctor said after 1 year (from month 6-12 its 1 x a day) to work it down to 1 x week for life. Your doctor might have told you what they suggest.

But what do doctors know anyway.

I really do not see the big deal, but it comes down to you. For me i wish to keep it in the best shape i can. Wish it was easier but a small price to pay.

Izzy

[Jenna Marie]

Izzy : I care, and I do plan to get down to once a week eventually. But the instructions from Brassard (I know you went to him too) actually do leave it up to us after the one-year mark, and I figure "too much" is not going to be a problem anyway.

[Shantel]

This along with the need to eventually replace breast implants if you have them are a couple of the things these surgeons routinely fail to divulge going into it lest they scare a prospective source of income off. Too bad, they should be more forthcoming although none of that should scare off anyone serious about their transition.

[Jenna Marie]

Other surgeons don't tell people about dilation?? I guess I should be grateful Brassard had that information (and schedule) both on his web site and in his informational packet. It didn't come as a surprise to me by that point, but it was still useful to see the precise schedule.

From Brassard's information, in case it helps anyone else :

Post operative dilation and douching instructions

Dilations

Healing after a vaginoplasty lasts one year.  Keep in mind that the
success of this surgery depends on maintaining the length, girth and
depth of your new vagina.  To achieve this, you need a set of 4
dilators and respect the instructions below. Do not stop dilations
without advising your surgeon.  Stopping dilations will cause the loss
of the vaginal canal and is irreversible without further surgery (skin
grafts or bowel transposition).

Relaxing

Relaxing is the key step.  It will make dilations much easier.  Taking
ten slow deep breaths before beginning is one good way to get rid of
tension.

Angle

After you have localized the vaginal opening with a mirror, insertion
should be made for the 2 first inches with a slightly downwards 15°
angle.  Do not go directly towards the rectum.  After that the angle
should be corrected so that the dilator becomes almost parallel to the
bed while trying to aim at the navel.

Pressure

Insertion should always be gentle and slow.  When the dilator is
inside the vagina for the entire length, apply constant not forceful
pressure.  Gaining depth by applying more pressure is not advised.

Dilation instructions

Wash your hands

The first day of your dilations, the attending nurse will show you
every step of the process.

-       Hold dilator #1 like a pen

-       Apply about one teaspoon of lubricant gel on the tip of the dilator

-       Insert at a slight downward angle for the 2 first inches

-       Leave dilator inside 5 minutes; remove slowly

-       Repeat with dilator #2 for 15 minutes

The second day of dilation can be more difficult because of swelling
that sets inside the vagina during the night. It is perfectly normal.
Be patient.

You should gently and frequently wipe out the gel that is coming out
at the bottom of the vagina.

Wait 3 months before having intercourse.



DILATION SCHEDULE

At the residence

You should dilate 4 times per day.

Day of traveling

You should at least dilate once before leaving the residence.  If you
have time, dilate more that once before your departure.  Even if you
have a long day of traveling and you cannot dilate for hours, you
should plan on doing at least one dilation when you arrive at home.
Please be active on the plane.  Walk as much as you can.

Home

Resume your schedule as soon as possible.

At home, you should dilate 4 times per day with, #1, #2 for 5, 15
minutes for one month.

Dilate 3 times per day with #1, #2, #3 for 5, 10, 15 minutes for two months.

Dilate twice a day with #2, #3, #4, for 5, 10, 15 minutes for 3 months

Dilate once a day with #3, #4, for 5, 15 minutes for 6 months.

Slowly increase the interval of time between each dilation until you
reach one dilation per week with #4, for 15 minutes for the rest of
your life.

If you have difficulties with a bigger size dilator, wait before you
are comfortable with this one before using a bigger size.  You can go
back to a smaller size and increase the frequency for a few days.


CARE FOR DILATORS

Wash the dilators after each use with non-abrasive antibacterial soap
in warm water and dry thoroughly.  Do not wash them in the dishwasher
or clean with alcohol.  This could damage them.

While at the convalescence home, the dilators are kept in Hibitane,
Dexidin 4 or  Hiciclens 4  to find in pharmacy.  25ml of solution in
one gallon of demineralised water) Use one or the other solution.
After 2 months, store them in a clean and dry place between dilations.

In two months, stop: vaginal douche, soaking your dilators and sitz bath.

The Polysporin cream is for 10 days.

Maintain at least 2 hours intervals between dilations (from the time
you finish one and the time you do another one, 2 hours minimum.



DOCHING INSTRUCTIONS

Vaginal douches are to remove remains (sloughing) should be done every
morning and evening.  Douche first thing in the morning before your
first dilation and the last thing at night after your last dilation.

-       Re-use same applicator

-       Insert the applicator 2 to 3 inches deep

-       Squeeze hard to give a good spray inside the vaginal cavity

-       Refill the bottle with a solution of ¼ of a cup of vinegar in
1 gallon of demineralised water and fill up your bottle everyday or
use disposable douches.

Douche twice daily for the first two months.  By then the return
should be clear.  After two months, stop douching long term.  Douching
will alter the vaginal natural flora and cause imbalance.  This is why
douching is not recommended as a routine after two months.

After that if you experience an unusual discharge and odor, you can
resume douching twice daily to correct the bacterial imbalance.  If
there is no improvement after a few days, you can try an alternate
solution with Betadine (one part in 3 parts of water), if you are not
allergic to iodine or shellfish.  If it does not correct the problem,
make an appointment with your primary care doctor.


TYPICAL DAY SCHEDULE

8am                        Breakfast

9am                        Shower and vaginal douche

1030am                 1st dilation

Noon                      Lunch

130pm                     2nd dilation

3pm                        1st sitz bath

4pm                        3rd dilation

530pm                        Supper

Evening                 2nd sits bath

                                 4th dilation

Before bedtime: Vaginal douche

It is very important when you are in bed to leave your genital parts air open.

[Shantel]

Other surgeons don't tell people about dilation?? I guess I should be grateful Brassard had that information (and schedule) both on his web site and in his informational packet. It didn't come as a surprise to me by that point, but it was still useful to see the precise schedule.


Slowly increase the interval of time between each dilation until you
reach one dilation per week with #4, for 15 minutes for the rest of
your life.

Unfortunately this part is either not mentioned or not heard. I had a pre-op consultation with Marcie Bowers a long time ago and none of that was mentioned. Perhaps it would have been brought up post-op I don't know, but it should be a big subject of discussion right up front. I hate after thought surprises! Although it stands to reason because genetic males are all muscle and don't have the cavity that genetic females do so obviously it's going to collapse and grow shut. Sometimes in our drive for full transition we only hear and see what we want, it's probably important to ask a lot of questions.

[Jenna Marie]

Shantel : Wow. Again, I'm amazed there are any surgeons who aren't informing people properly. Of course, you're probably also right about people not hearing - I know for a fact that there are women who went to Brassard, signed the same release paperwork I did and had the same "information interview" I did, and still swear they had no idea certain complications were possible. I can only conclude that "informed consent" works best when both parties are participating fully!

I wonder if it also stems from the fact that *some* post-op women are able to give up dilation permanently after enough years have passed, and so some people must hope that's the expected outcome for themselves as well. It clearly is the case for a few women, but it's far from guaranteed, and every surgeon should make that clear. (Unless there really are some who believe dilation isn't lifelong? I don't know of any, but the dilation schedules/plans vary enough that there may be one, I guess.)

Brassard's informed-consent forms include the fact that you will no longer have a penis afterward, so I guess I shouldn't have assumed people will know *anything* about the process going into it, too.

[anjaq]

Other surgeons don't tell people about dilation?? I guess I should be grateful Brassard had that information (and schedule) both on his web site and in his informational packet.

Thanks for the information. I could have needed that back then. Now i have to work with what I can. To be fair, I somehow imagine that my surgeon normally does tell his patients more. For me it was a bit problematic. The main reason was that i was not able or allowed to dilate for 6 months post-op due to severe complications. So the usual procedure of taking out the stent, then giving instructions on how to deal with it all was cut off and I was back on the OP table and in no condition to hear instructions after that if they had been given except that I was actually not supposed to do anything at this point that could increase the complications. I remember that I was told either at that stage or later after the second revision that basically I should do something once a week - either have intercourse or get a vibrator and that it cannot harm if I do it more often and the doc grinned and said "and why wouldnt you, it is fun, right" or something like that. I have a colon graft in addition to the regular inversion procedure as a result, so I suspect somehow that things are a bit different - at least I did have proper depth and width after that second revision even though I did basically not much in the first 6 months and I kind of assumed that this would just keep going like that, but it turns out I was wrong  and not only was 1x a week not enough, he also failed to give instructions on the sizes needed, so I just got a regular vibrator, had fun with it regularly and that was ok, slightly painful at times. But that meant that I got used to that size and not something bigger, which causes me problems now, that I am not sure I can resolve, but I hope I might, given that my body seems to be rather ok with that opening - from what I hear I am supposed to basically have nothing left now after what I did (or did not). Still, I have anxiety and fear and worry a lot, so yeah - just sticking with a good schedule is all worth it..

Although it stands to reason because genetic males are all muscle and don't have the cavity that genetic females do so obviously it's going to collapse and grow shut. Sometimes in our drive for full transition we only hear and see what we want, it's probably important to ask a lot of questions.

Well I think part of what my surgeon did was to create a cavity by burning tissue (which also probably is what caused the complications). So it seems to collapse slower with me, it may also be because of my rather wide pelvis, IDK. But yeah - I guess for me it was a bit that I tried to not be trans and somehow "forgot" that I need to do this once a week at least and not just once every two months.

So again - really - once a week should really be a minimum, unless you actually tried it and found you can stretch the intervals without any effect.

[Jenna Marie]

Anjaq : Wow, that all sounds terrifying!! I'm glad you came through it mostly OK. I do see the colon procedure often touted as requiring no dilation, so maybe that carries over to a hybrid version such as you had? Also Brassard did specify that it's fairly easy to gain/regain width but that depth is generally lost for good. So you may be fortunate if it's primarily a width issue.

(Also, men and women do usually have the "space" in their abdominal cavity; the real issue is that the body treats the new vagina as a wound and tries to heal it. My personal speculation is that just like some people can get ear or body piercings and have them stop trying to heal closed after a few years and some can't, some probably can get away with less dilation than others. It probably depends on how assiduously a given body tries to "fix" things.)

[Shantel]

(Also, men and women do usually have the "space" in their abdominal cavity; the real issue is that the body treats the new vagina as a wound and tries to heal it. My personal speculation is that just like some people can get ear or body piercings and have them stop trying to heal closed after a few years and some can't, some probably can get away with less dilation than others. It probably depends on how assiduously a given body tries to "fix" things.)

That's the best analogy for the problem, you are probably correct!

@ As Anjac commented about wanting to forget being trans, I recently read an article about how occasionally cis women discover that they are unable to accommodate their spouse on their honeymoon and wind up having to dilate, something that was a surprising revelation to me, so this isn't just something relegated to trans women only which may be comforting to know.

[mrs izzy]

Izzy : I care, and I do plan to get down to once a week eventually. But the instructions from Brassard (I know you went to him too) actually do leave it up to us after the one-year mark, and I figure "too much" is not going to be a problem anyway.

"Slowly increase the interval of time between each dilation until you
reach one dilation per week with #4, for 15 minutes for the rest of
your life." Dr. Brassards dilation schedule.

This is why i say it is for me a life time thing. As anything in life it is everyones body and they need to do what they feel is right. so that is my answer to the original OPs question.

I think maybe many do not understand bodies and how things works. In terms that most can undersand it is like having your ears pierced. If you keep something in they stay open, if you stop for a long time they get harder to put things in or at some point they will close back up. The body sees SRS as a wound and nothing more or less and it will do everything in its power to put things back to they way they where before. So that is why we dialate, no other reason. It is one totaly unpleasent, unpersonal act you can think of but it is the price of admission.

Ok my litte rant:
Its funny i knew years ago what all this was about. All the facts of HRT, SRS and after. There has nothing that i have done that has been a suprise. I have accepted that there could be good and bad in this entire transition. I have not ran into it blind, i totaly see the benefis of the gatekeepers and i also can say i never was in a race. Today i see so many who are starting today but what to be finished up tommorrow. I see so many who are so tightly wound they are about to explode. I see also many who are here to learn and try to understand things. I see other who just talk to talk. Oh and there are the do not tell me i know everything. I also see others who are having complications with there SRS and i feel for them. I wish that complications were a thing of the past but they still happen. I hate to tell everyone SRS is a Major, major surgery that requires many, many hours of your time in the healing process. Again the price of admission.

Izzy

Edit. The rant is not personal or a attack on anyone. Just a few of my Observations i have made in my transition life.

[anjaq]

Anjaq : Wow, that all sounds terrifying!! I'm glad you came through it mostly OK. I do see the colon procedure often touted as requiring no dilation, so maybe that carries over to a hybrid version such as you had? Also Brassard did specify that it's fairly easy to gain/regain width but that depth is generally lost for good. So you may be fortunate if it's primarily a width issue.

Yeah thanks. dont wanted to hijack the thread with my story. It was horrifying and seriously impacted me more than I wanted to acknowledge then. Like you know - waking up after SRS and recover, the really great feeling of it being over setting in, and then wham back to the OP table and getting a colon surgery and all that. So I am actually kind of lucky I guess that after 13 years of only rarely dilating I "only" lost an inch of depth plus a certain amount of width. It is presently a pain (literally) to try and get this back. Thats why I say - dont slack on dilating even if it sucks, it sucks even more to get into my situation.

@ As Anjac commented about wanting to forget being trans, I recently read an article about how occasionally cis women discover that they are unable to accommodate their spouse on their honeymoon and wind up having to dilate,

Yeah - the companies selling GRS dilators are also selling vaginal dilators for women that had no GRS but have some issues. For them its a temporary issue though, I believe, nothing lifelong.

Ok my litte rant:
Its funny i knew years ago what all this was about. All the facts of HRT, SRS and after. There has nothing that i have done that has been a suprise. I have accepted that there could be good and bad in this entire transition. I have not ran into it blind, i totaly see the benefis of the gatekeepers and i also can say i never was in a race. Today i see so many who are starting today but what to be finished up tommorrow. I see so many who are so tightly wound they are about to explode. I see also many who are here to learn and try to understand things. I see other who just talk to talk. Oh and there are the do not tell me i know everything. I also see others who are having complications with there SRS and i feel for them. I wish that complications were a thing of the past but..... Hate to tell everyone SRS is a Major, major surgery that requires many, many hours of your time in the healing process. Again the price of admission.

Yeah - I knew the risks and knew I might have them, it still always sucks as of course you always hope you are not among the unlucky few. I paid my "price of admission" and I guess in a way it strengthened my faith in this being still the right thing for me as even though I had all this ->-bleeped-<- happening to me, I did not feel regrets over it, so I am quite sure that I did nothing that was not for me. I even knew about dilating before, but not the details. There were not that many post ops in our TG support group and only some info online (It was the 1990ies). What I heard from others was that you have to dilate, frequently so in the first year and that they got dilators from their surgeons. So I was kind of surprised at what the doc said then, which I basically understood to somehow fit into what I knew but sounded way less strict. So in case this was a bit targeted at me, yes I was in a hurry to get things over with, I personally now think it was because of my transition age which was 23 and which I was told was pretty early for the 1990ies. If you are a bit older I guess things are more planned and a few months more do not matter, at 23 I was kind of impulsive. Still I knew very well the procedures and risks, just some details eluded me and honestly in terms of how to do post op care, I relied on the doc to tell me. That I slacked with it later on was absolutely my own fault and stupidity though, probably if I had stayed at the 2x weekly intercourse schedule that he suggested (He basically assumed that I will at my age certainly find a BF soon and then dilation would be a nonissue if I just made out with him regularly), I probably would not have the issues now.
So I must say in these times now, information is much more available and techniques are much better, so I guess for those transitioning now it is probably easier than 15 years ago.

[K8]

I have always understood that my body would treat the neo-vagina as a wound, and so I would have to dilate to keep it open.  I followed the surgeon's instructions to the letter through the first year.  There were no instructions beyond the first anniversary.  Because I was older – late 60s – I figured that my body would heal more slowly, so I kept going.  I read comments on this forum that mentioned dilating only now and then, a couple times a month, etc.  Whenever I dropped back more than 4 or 5 days I would have problems, so I kept going.

Around my third anniversary, things got easier.  Once started, the dilator would slide in easily, and I wouldn't have to work too much to get the last half inch.  I figured I was soon going to be able to slack off and dilate only twice a week or less, but I wasn't there yet.

Part of my problems are self-inflicted.  (Can we all say that, or is it just many of us?)  Because no SRS surgeon was nearby, and the gynecologists in the area didn't have experience with trans-women, I let it go.  Finally I traveled to see Dr Bowers for a consult.  She assured me that she could fix me up, but I'd have to stay in San Mateo for several weeks or a month.  I wasn't willing to do that.

I went to Dr Nguyen, who is a little closer, but I got a bad feeling about him and was reluctant to go back. 

I think one reason I was getting a bad attitude about having to dilate is that my life as a woman is wonderful.  I am relaxing into it and wanting to put the fact that I am trans behind me.  (Yeah, right.)  But I still have issues with my vagina.  Dilating has always irritated some of the skin at the opening, regardless of how much lubricant I put on.  When my partner touches it, it is either uncomfortable or painful – never pleasurable.  I have always gotten some blood out after dilating.  (The blood stops after a little while.)  Now it is just light spotting, but it just seems that after 3½ years the skin in there should be healed.  With the continued rawness and bleeding, any touching of the area during sex play does not bring pleasure.

Finally today I went to my regular gynecologist.  I had only seen her once before and had the impression then that she had never seen a trans-woman before.  She was wonderful for me today.  I am so glad I finally saw her and got over this feeling that I needed to see an SRS gynecologist.

This woman explained to me that many post-menopausal cis-women have to dilate twice a week if they aren't having an active sex life but want to keep the capability.  That made me feel a lot better.  She also is confident that she can heal the small tears in the vagina and that we can loosen the skin near the opening so that it isn't irritated by the dilator.  (She can do some surgery if need-be but wants to try some other things first.)  I think this woman can help me get to the point where I don't resent dilating.

Thank you so much for this discussion.  Keep the thread going.  I'm finding it very helpful.  This is an aspect of the process that often, in our rush to be whole, we don't talk about.

- Kate

[mrs izzy]

I have always understood that my body would treat the neo-vagina as a wound, and so I would have to dilate to keep it open.  I followed the surgeon's instructions to the letter through the first year.  There were no instructions beyond the first anniversary.  Because I was older – late 60s – I figured that my body would heal more slowly, so I kept going.  I read comments on this forum that mentioned dilating only now and then, a couple times a month, etc.  Whenever I dropped back more than 4 or 5 days I would have problems, so I kept going.

Around my third anniversary, things got easier.  Once started, the dilator would slide in easily, and I wouldn't have to work too much to get the last half inch.  I figured I was soon going to be able to slack off and dilate only twice a week or less, but I wasn't there yet.

Part of my problems are self-inflicted.  (Can we all say that, or is it just many of us?)  Because no SRS surgeon was nearby, and the gynecologists in the area didn't have experience with trans-women, I let it go.  Finally I traveled to see Dr Bowers for a consult.  She assured me that she could fix me up, but I'd have to stay in San Mateo for several weeks or a month.  I wasn't willing to do that.

I went to Dr Nguyen, who is a little closer, but I got a bad feeling about him and was reluctant to go back. 

I think one reason I was getting a bad attitude about having to dilate is that my life as a woman is wonderful.  I am relaxing into it and wanting to put the fact that I am trans behind me.  (Yeah, right.)  But I still have issues with my vagina.  Dilating has always irritated some of the skin at the opening, regardless of how much lubricant I put on.  When my partner touches it, it is either uncomfortable or painful – never pleasurable.  I have always gotten some blood out after dilating.  (The blood stops after a little while.)  Now it is just light spotting, but it just seems that after 3½ years the skin in there should be healed.  With the continued rawness and bleeding, any touching of the area during sex play does not bring pleasure.

Finally today I went to my regular gynecologist.  I had only seen her once before and had the impression then that she had never seen a trans-woman before.  She was wonderful for me today.  I am so glad I finally saw her and got over this feeling that I needed to see an SRS gynecologist.

This woman explained to me that many post-menopausal cis-women have to dilate twice a week if they aren't having an active sex life but want to keep the capability.  That made me feel a lot better.  She also is confident that she can heal the small tears in the vagina and that we can loosen the skin near the opening so that it isn't irritated by the dilator.  (She can do some surgery if need-be but wants to try some other things first.)  I think this woman can help me get to the point where I don't resent dilating.

Thank you so much for this discussion.  Keep the thread going.  I'm finding it very helpful.  This is an aspect of the process that often, in our rush to be whole, we don't talk about.

- Kate

And i thank you for this. I am only at just over my 6 month mark and yes dilations are a part i hate but i know it is whats needed. Now that i only have to do dilations 1 x a day with the green and orange it is better. I have to do things a little slower but i get through them.

I have heard that things get better down there between month 6 to month 9. I am not sure for me if that will hold true. My PC muscle is still so tight and fights back each time.

Please keep us updated on things as they progress. I also have a good GP that i can ask any question i have. Its always good to have that local go to person. (I am a little lucky, i live in Montreal so if i need to see DR. B its just a phone call away.)

Hugs
Izzy

[K8]

UPDATE: I've been working with my gynecologist.  I'm pretty sure that mine is the only neo-vagina she's ever seen, but I've found her very helpful.  I no longer bleed after dilation and don't have to wear a pad.  Dilation is now rarely painful and is actually becoming almost easy.  I'm hopeful she will get me where I want to be. 

A lesson to myself: I don't need to go to a surgeon who specializes in transsexuals but can go to a decent gynecologist like any other woman.

- Kate

[mrs izzy]

UPDATE: I've been working with my gynecologist.  I'm pretty sure that mine is the only neo-vagina she's ever seen, but I've found her very helpful.  I no longer bleed after dilation and don't have to wear a pad.  Dilation is now rarely painful and is actually becoming almost easy.  I'm hopeful she will get me where I want to be. 

A lesson to myself: I don't need to go to a surgeon who specializes in transsexuals but can go to a decent gynecologist like any other woman.

- Kate

Can you kiss and tell. LOL.. Any tips you could share?
Isabell

[K8]

Can you kiss and tell. LOL.. Any tips you could share?
Isabell

Specifics, if you want them:  She is having me dilate daily in the shower - just in as far as it will go and then remove it.  After the shower I put a little estrogen cream on the sore spots at the narrow place where the vagina goes through the pubic bone.  (I'm going to stop doing that now and see how it goes.)  I insert a prescribed amount of the estrogen cream deep into the vagina the night before a regular dilation (the 15-minute kind).

Very helpful to me was that she told me that my needs are not unusual.  She says that many (cis-)women my age who are not having regular penetrative sex need to dilate regularly if they want to maintain the ability for it.

(It took me a while to get comfortable dilating standing in the shower.  I dropped back a size for that until I had the technique figured out.  I use the regular dilator now.)

I hope this helps.
- Kate