Theories about the reason for long-term dilation

[Apple]

Hello,
it seems to me that there is a complete lack of information regarding why do we need to dilate long after everything has healed. Of course, I'm not trying to dispute fact; the reason, however, is not usually given. But perhaps somebody heard something more trustworthy or did their own research...

Well, it is also often said (theory 1 ): "Body treats the neovagina as a wound and tries to close it." I doubt that, long after everything has healed. Moreover, sigmoid neovaginas have a far lower tendency to close up than skin-lined neovaginas.

That brings up the fact that it could be the property of skin as opposed to other tisues. Theory 2: Skin tends to grow or shrink to remain taut a bit (as when gaining or losing weight significantly). In the neovagina, the skin is in fact slack. So it tries get taut again by shrinking, but since nothing resists it except dilation (I think the neovagina is not anchored to anything in the body, isn't it?), it would continue to shrink. This would in my opinion suggest that older people need less dilation than younger, since the skin's ability to adapt gets limited with age. Do you think so?

Regarding theory 2, I also wondered whether the shrinking couldn't be stopped or slowed by something that medicine already knows. For example, burn victims often have problems with the new skin/graft getting tighter and tighter. Perhaps there is some at least partial treatment known among burn doctors but not among srs doctors? Anybody?

And regarding the question whether the neovagina is anchored to something in the body: In case the neovagina is a skin graft (like Suporn) as opposed to a vascularized skin flap, the graft needs to be pushed onto some other tissue to which it will attach ("take") and blood capillaries will grow into the graft from the host tissue. Then the neovagina will surely be attached to something! In theory, this attachement could after healing resist the tendency for shrinking by keeping the neovagina taut. That would imply that people with skin-graft neovaginas (Suporn) would need less dilation long term (despite needing more in short term). Do you think that's true?

It would be also interesting to know long-term dilation requirements from MRKH patients, since their neovaginas are lined with all sorts of tissue - the methods are much more varied than in MtF vaginoplasty.

Do you have your own theory? I'm eager to hear it

[mrs izzy]

http://library.transgenderzone.com/?page_id=611

All the science behind dilutions.

[Jenna Marie]

Brassard's paperwork, as well as other penile-inversion surgeons' stories I've seen, states that the neovagina is anchored to at least a couple of the ligaments which support the uterus in cis women. (The same is done to anchor the vagina during a hysterectomy, and evidently at least some of the abdominal and peritoneal ligaments do double duty such that they are also present in "male" bodies.)

http://www.goldjournal.net/article/S0090-4295%2807%2901307-6/abstract?cc=y That's a description of doing so correctively, but my understanding is that the technique has now been adopted pre-emptively by some surgeons.

Personally, although I am not doing more than speculating myself, I would think it has something to do with the PC muscle - this theory based both on the fact that the muscle does seem to resist dilation/contract the neovagina and that the same happens in cis women to some degree. However, it's also worth noting that some people's ear piercings do continue to try to heal closed for years and years, and that decades-old lip and nose piercings will often heal over within hours, so the body clearly does have a broad spectrum of how long "attempts to heal a wound" will go on.

My impression is that sigmoid vaginoplasty doesn't require dilation of the colon portion because the colon is already "accustomed" to being an open tube of that size, and it's merely been rearranged to a new location.

[Apple]

One more thing that intrigues me is this: once, I haven't had an erection for months; yet the penile skin did not shrink at all despite not being "dilated" for such a long time! And that's the same tube-like piece of skin that would be used for a neovagina in PI...

[PinkCloud]

Penile skin and especially foreskin is a different type of skin, then let's say, skin on your arms. This skin is known for it's unique properties to stretch beyond what it normally would. Scrotal tissue, however, has the tendency of fusion. It is a different type of skin, and if you look closely you can see the line where it fused together. I notice it's fusion capabilities in the labia minora, which is made out of it. It wants to fuse when it gets a chance. Normal skin on the arms or belly, is completely different. This skin can stretch, but when it is stretched it will remain in a stretched state. (a plus for skin grafts then?) In obese people who lost a lot of weight, their skin needs to be surgically removed. Because it doesn't shrink. So I guess dilation is needed with penile/scrotal because or despite it's unique stretching capabilities? Just a couple of quick thoughts on the get go...

[Jenna Marie]

And yet quite a few people with penises report that the skin *does* shrink... so maybe you're just lucky, Apple.

[Apple]

PinkCloud, it is very intersting what you pointed out, that there might be a significant difference between scrotal and penile skin with regards to tendency to fusion. I have read that many baby girls and prepubertal girls suffer from labial fusion, which is usually resolved with estrogens (either applied or own in puberty). But I don't know if it's labia minora or labia majora that fuse in these girls.

I notice it's fusion capabilities in the labia minora, which is made out of it. It wants to fuse when it gets a chance.

Do I understand correctly that your surgeon made your labia minora out of scrotal skin and you see a tendency for fusion on your own labia minora? I just wanted to make sure...

[PinkCloud]

Do I understand correctly that your surgeon made your labia minora out of scrotal skin and you see a tendency for fusion on your own labia minora? I just wanted to make sure...

The labia minora is constructed from penile (inner skin) and scrotal (outer skin).  The surgeon seems to fold this skin and stitch it to create a labia minora. I am not sure which part wants to fuse, but I think it is the scrotal tissue...

[Apple]

So this means that besides dilation, you also have to take care of your labia to prevent them from fusing?

[suzifrommd]

The labia minora is constructed from penile (inner skin) and scrotal (outer skin).  The surgeon seems to fold this skin and stitch it to create a labia minora. I am not sure which part wants to fuse, but I think it is the scrotal tissue...

My understanding is that it's the muscle tissue that fuses. The neovagina bores through layers of muscle that will tend to fuse together over time if not forcibly separated. This will cause a loss of depth and width. Of course I'm not a doctor, so I may be totally off base.

[Apple]

Suzifrommd, that sounds reasonable, but it is said that with sigmoid neovaginas, there is no need for dilation past the initial healing phase.

[Nicolette]

I've heard some anecdotes where some have experienced difficulty dilating through the ring of scar tissue where the segment of colon joins the vulva, due to the ring of scar tissue contracting. But I'm not sure if that's due to neglecting dilation or other complications.

[Apple]

My understanding is that it's the muscle tissue that fuses. The neovagina bores through layers of muscle that will tend to fuse together over time if not forcibly separated.

I've read that many surgeons (maybe all?) make the neovaginal cavity with their fingers only, without any sharp tools. That would imply that they are not making a hole in any muscle. They might need to tear some muscle groups apart from each other, though.