Why do transgender women have to dilate?

[Girl Beyond Doubt]

While the body is healing after the surgery, several mechanisms are activated that involve creation and contraction of scar tissue. This affects mainly the diameter, but also the length of the vagina, and works quite efficiently during the first few months. Without dilation, diameter would be lost very quickly.
After a few months, the body is no longer creating or contracting scar tissue, and partial conversion of the scar tissue into other tissue keeps going on, but this process does not cause contraction any more.

Another reason for the need to dilate is that the inner end of the surgically created vagina is not attached to an uterus, which in turn would be supported and held in place by ligaments. The pressure in the pelvic cavity would tend to push it out very slowly, and we need to counteract that until the connective tissue around it settles into a state where it gives enough support, and dilation may become less frequent.

What I am writing here is just what I remember from reading one or two books a long time ago, and it may all be completely wrong. Use it at your own risk.

[suzifrommd]

I hate to contradict anyone, but the answers provided here are incomplete.

According to my surgeon, dilation allows the inside of the penile or scrotal skin to adhere to the tissue surrounding the opening. Without it, the skin will not heal onto the underlying tissue, and prolapse, where the skin falls out of the vagina, is possible.

[Girl Beyond Doubt]

I stand corrected.

[Rejennyrated]

I hate to contradict anyone, but the answers provided here are incomplete.

According to my surgeon, dilation allows the inside of the penile or scrotal skin to adhere to the tissue surrounding the opening. Without it, the skin will not heal onto the underlying tissue, and prolapse, where the skin falls out of the vagina, is possible.

Actually that's what the pack is mainly for - the pack comes out on day 5 - by which time one hopes that primary graft adhesion should have already taken place, although I don't disagree that gentle dilation may help to maintain it. I just didnt want to start getting over complicated with my answer.

[JamesV]

Thanks everyone you've been a big help!

[Becca131306]

Thank you James for taking the time to educate yourself on something you weren't aware of before. At a guess only 1 in 4 or 5 people actually take the time. Thus why people are so clueless as to how real gender disphoria is. Here is hoping that recent publicity leads to more general knowledge and acceptance so that those needing support might have an easier time finding it. God bless you sir.

Sent from my SAMSUNG-SM-G870A using Tapatalk

[Micah (Alecia)]

Good Morning James,

Well first of all its incorrect to say that ALL transwomen have to dilate. All do have to dilate while the healing process is taking place to avoid stenosis - but after a time, which varies from one woman to another dilation becomes somewhat optional. I'm over 30 years post-operative and I havent dilated in many many decades, yet I still have my full depth and capacity.

As a medical student I can answer your question as to why... the neovagina is created surgically from a pouch in the body, by extensive skin grafting. This means that there is a lot of healing being activated - and the tendency with healing is for the body to fill a cavity which is not yet lined with endothelial tissue... so until the cells of the graft undergo metaplastic change and become a psuedo-epithelium the cavity will tend to close over. Another problem is that in the early days the graft tissue may become hypertrophic and odematous - that is swollen - the pressure of the dilator helps to reverse this, and thus aids healthy healing.

However over time the body will learn that this cavity is permissable, and thus the dilation process - with frequent stretching and pressure eventually the whole structure settles and further dilation becomes unnecessary because the normal sexual activities that the woman is engaged in are more than sufficient to do the job.

I am not overly sexualy active, but even the occasional activity that I enjoy is more than sufficient to maintain everything and thus dilation is not a requirement.

Thank you so much for this, I have just recently joined this site and have been struggling with my gid for a long time and this helps so much. I identify as gender fluid/bi-gender currently I was born male but I may become female full time in the future after I see a therapist

[Venus]

Well first of all its incorrect to say that ALL transwomen have to dilate. All do have to dilate while the healing process is taking place to avoid stenosis - but after a time, which varies from one woman to another dilation becomes somewhat optional. I'm over 30 years post-operative and I havent dilated in many many decades, yet I still have my full depth and capacity.

As a medical student I can answer your question as to why... the neovagina is created surgically from a pouch in the body, by extensive skin grafting. This means that there is a lot of healing being activated - and the tendency with healing is for the body to fill a cavity which is not yet lined with endothelial tissue... so until the cells of the graft undergo metaplastic change and become a psuedo-epithelium the cavity will tend to close over. Another problem is that in the early days the graft tissue may become hypertrophic and odematous - that is swollen - the pressure of the dilator helps to reverse this, and thus aids healthy healing.

However over time the body will learn that this cavity is permissable, and thus the dilation process - with frequent stretching and pressure eventually the whole structure settles and further dilation becomes unnecessary because the normal sexual activities that the woman is engaged in are more than sufficient to do the job.

I am not overly sexualy active, but even the occasional activity that I enjoy is more than sufficient to maintain everything and thus dilation is not a requirement.

While the body is healing after the surgery, several mechanisms are activated that involve creation and contraction of scar tissue. This affects mainly the diameter, but also the length of the vagina, and works quite efficiently during the first few months. Without dilation, diameter would be lost very quickly.
After a few months, the body is no longer creating or contracting scar tissue, and partial conversion of the scar tissue into other tissue keeps going on, but this process does not cause contraction any more.

Another reason for the need to dilate is that the inner end of the surgically created vagina is not attached to an uterus, which in turn would be supported and held in place by ligaments. The pressure in the pelvic cavity would tend to push it out very slowly, and we need to counteract that until the connective tissue around it settles into a state where it gives enough support, and dilation may become less frequent.

According to my surgeon, dilation allows the inside of the penile or scrotal skin to adhere to the tissue surrounding the opening. Without it, the skin will not heal onto the underlying tissue, and prolapse, where the skin falls out of the vagina, is possible.

These posts were really useful, thanks. I've actually been worried about dilation a bit myself because it was my understanding that you have to do it forever and it's really unpleasant. It's nice to hear that you could actually stop at some point, and the medical reason why it's actually necessary.

[Dena]

These posts were really useful, thanks. I've actually been worried about dilation a bit myself because it was my understanding that you have to do it forever and it's really unpleasant. It's nice to hear that you could actually stop at some point, and the medical reason why it's actually necessary.

After it healed, a bit, it's not really that pleasant. From start to finish it's only about half an hour and no pain is involved. The thing most people are unhappy about is that is boring but you could watch TV or read a book while you are doing it. In addition, once every week or two should be enough to maintain what you have if you don't engage in sex but I went far longer without permanently losing what I had. I do admit I was a bit sore afterward when I restarted dilation.

[suzifrommd]

These posts were really useful, thanks. I've actually been worried about dilation a bit myself because it was my understanding that you have to do it forever and it's really unpleasant.

I do not find it at all unpleasant, other than the few seconds when the dilator goes in, and even then it's just pressure and doesn't really hurt.

I read, listen to music, or just sit back and enjoy a few minutes of reclining before I start my crazy day. One of the better parts of my day.

[Jenna Marie]

I don't find it unpleasant either, just boring. And I do read a book or watch TV to make the time go faster.

After a year, I was supposed to taper down to once a week for 15 minutes, and did so. At about three years post-op... well, I'm supposed to continue at the once weekly schedule forever, but in reality I've had times where I forgot or had to go on a business trip or something, and I've gone as long as 3 weeks between sessions with no problems at all. I suspect that by, say, 5 years post I'll be cheerfully dilating once a month or less.