Susan's Place Transgender Resources

Hello! Thanks so much for all your help, first of all. Dr. Suporn was really awesome to me but it's these little questions that really make things harder.

Anyway, I'm at 8 weeks post-op now and my body is really, _really_ rebelling against dilation. The process is painful to the point that I nearly pass out at every session. The real troublemakers seem to be at the entrance and the last inch of depth before I start my timer; both are incredibly painful. I tend to have a high tolerance for pain so when it's enough to bother me I tend to think "something must be wrong." Yes, Dr. Suporn's staff said that an increase in pain was to be expected as scar tissue formed but this is flat-out ridiculous!

Right now my proceedure involves cleaning the area beforehand, lubing, inserting as far as I can (about an inch), pulling out, relubing, trying again (two inches!), pulling out, relubing, trying again (five inches!), lather, rinse, repeat until I get to my full depth. Part of me is convinced that there has to be an easier way.

Does anybody have any good tips, ideas, or advice for getting through this rough period?

Ok, could this help? I'm not there yet, only next month but one friend had the same painful dilation issues you describe. She then told me, she is now first trying to "get off" after having read some medical information about vaginismus (pelvic floor muscle cramping for various reasons, with GGs. BTW they also in need of dilation, same as us).
It has helped my friend and it be interesting to see how you'd do. Might learn something to come handy to know for myself next month?
Essentially if you not enough relaxed expecting pain, and/or pain get too much your PC muscle just cramps and closes up vaginal entrance. Same happens with GGs... that suffer from vaginismus.
Axelle

First thing to do is relax, if you are not everything will tense up.  From reading your post I feel this could be a big part of the issue, you are tensing up worrying about what is going to happen.  You also haven't mentioned what size dilator you start with.  At your stage start with the smallest and work up through the sizes.  Scar tissue will cause problems however you have to work through this or have problems later on.  Keep at it and things will come good in time.

Best of luck.

If you're doing it right, it's supposed to hurt really bad. Make sure though if you are using the small dilator that you are only using it to prepare yourself for the medium dilator because if you rely exclusively on the small one then it might not be effective.

Dàwkbua is absolutely right; you should only be using the smallest dilator in cases where the medium one is too large to fit. I think that if you are finding that relubing and reinserting is getting you a little further each time, then the issue is one of dryness. I had this problem too and still find it difficult to dilate if I don't lube first.

Try lubing up using one or two fingers before you start dilation. Just apply a little to the tip of your fingers and try to get it as deep as possible. Do this five-ten times and when you insert the dilator it should go in much more smoothly. Before insertion, try using your thumb to press down gently on the entrance and massage the area (not so forcefully that you feel pain, but enough that you are feeling resistance), this will help relax the opening and make insertion much easier. Make sure the dilator is completely coated from the tip up to whatever point you feel is your full depth.

The last inch is always difficult and takes at least a few minutes of work to achieve (I'm nearing two years post-op from Suporn and still need to work to get that last inch). I find that the best way is to insert as deep as you can and, once you begin to feel resistance, pull the dilator out completely and reinsert to depth (this helps push the lubricant up to that last hard-to-reach inch) and start using the active dilation techniques (alternating stirring and pushing every 10 - 20 seconds) but DON'T count this as part of your timed dilation session, just keep using the active method until you reach depth, then begin timing. This always gets me to depth faster than pushing alone.

I find it much easier to relax if I'm watching a film or listening to music. I bring my laptop onto my bed and play a film, using the timer on the media player to determine when I need to switch between pushing and stirring. I find the process feels much easier when I have that distraction.

Oh, and always listen to the advice of the clinic staff. When they say that trouble dilating is solved by pushing harder and dilating for an extra five minutes (or even an extra session per day) they are totally right. Plus, the harder you work at it in the initial stages, the easier it will be to dilate in the coming months.

One thing that kept me going was knowing that there are thousands of women who have come before me and have managed to overcome that difficult stage, and if they can do it then so can I, and so can YOU!  :D

Hang in there! It will be so much easier in a few months (and the relief you will feel after a year has past and you can finally reduce to once every couple of days is so incredibly liberating!)

I hope that helps a little. :)

Yep, I agree with what has been said.

I'm not a suporn girl but I was blessed with super depth (over 6 inches). The challenge is always getting enough lube into the last inch or so.

Like you I have a high pain threshold - and I mean really high. I went through the entire hospital stay taking nothing stronger than paracetamol, but getting to that last inch is always difficult.

Here are a couple of techniques I use. 1. like you I used to relube about three times - but I also used to use the tips of my fingers to make sure the lube was evenly distributed around the dilator.

2. I got hold of a small vaginal applicator syringe of the type used for spermicidal foam and using this I used to squirt a shot of lube up directly inside.

3. After dilation I always flush. If the surgeon doesn't recommend douching then just use a weak saline solution - a teaspoon full of salt in some warm water - but believe me old dried out lube is like glue - and if enough of it accumulates up there that alone can make things difficult.

Bottom line - if you want to keep the depth then you do have to work at it, and yes it will be uncomfortable. If you are hitting bone - or you are hitting an internal organ then believe me you will know it because it feels different to the discomfort of dilating. If this is just things tightening up then the only way is to persist. Far too many girls spoil themselves and lose the depth by the paranoia that "something must be wrong if it hurts." Keep working at it. For me it took over 18 months to get to the point where I could really say that it was easy and I didn't need to dilate regularly.

This might be an off topic question and for that I apologize but I've been dilating without lube so far.  I'm finding I naturally lube enough.  Is that normal?

Teresa

Theresa,
apparently it is possible having had "inversion" and being on good size E per day.
"Colon-section" Colovaginoplasty has never issue with self-lub (often too much). It has other issues as I know first hand.
So if you are more "regular" girl with inversion GRS you seem to proof a point that some claiming colon-section being only one with self-lub like to deny.
Great! Happy for you to hear it. Something to look foreward to for self?
Was this right from the start or only after some time later, be interesting to know.
Thank,
Axelle

Axelle,

I guess it was right from the start.  I didn't notice at first the most of the lube I was putting on the dilator stayed on the dilator and when I noticed this I tried it without and it slipped right in without a problem.  Mind you this was with the dilator coming out of a bath of water and bacterial soap.  After I made the statement above I tried dilating with a dry dilator and it wasn't as easy but it lubed up right away for the second and third dilator.  At the end of the second month I stop the soap solution (and douching and sitz baths).

My surgery was by Dr Brassard and used the inversion method and my E is most likely less than most as I have heart disease as my endo is reluctant to prescribe much more than the minimum.  I'm also told by other former patients of Dr Brassard that they lubricate well too.

The biggest suggestion I can give is don't give up. I went through a hard time with dilation at first, and I think it's pretty common. I had some complications and after my revision I was so small they had to find a size 0 dilator. :o 

I recommend patience. this too shall pass (into your neo-vagina hopefully :P). relaxing is important. so is going slow and easy. finally it helps me to imagine my vagina relaxing to accept the dilator rather than to focus on my hand pushing it in.

I am six months post op, and I have gone slowly from having pain with size 0 to being able to use size 3 pretty easily, so it does get better. Best luck.

Hi Theresa,
seems you found one of those smart docs that use part of urethra for vestibule (vaginal floor) and/or Cowper's gland which produces pre-come, that clear stuff.

Is my best guess if on very low E and still doing so well. Reason to get jealous reading all those pain stories?

Lucky girl, take good care. (also, dilator with "attached support mechanism" still be best, acc. to Val)
Axelle

this issue is exactly what I've been going through, but I've felt that once I past the 2 months it's gotten better, maybe from my technique that I now use. This is about the third time I've changed my technique just to make it possible! pain sucks.

Set everything up around you, spread your legs just enough to get the dilator in without touching your legs. I know that time is of the essence for you but clear at least a total of two hours for set-up, dilation and clean up. Lay still with your eyes closed for at least 5-10mins.. don't flex leg muscles etc.

Cover stent with lube up to five inches and stand up on bedside table, put lube on the index finger of the hand with your glove on (non-writing hand) and put about 3-6 finger fulls of lube in the opening.. each time go further in and push a finger inside and pull up moving from side to side, rest, pull up and move from side to side... the longer you do this the easier it will be to insert.

I grab the stent and add a second layer of lube to the first three inches, then hold it down ready and with the other hand (glove hand) put my finger back inside to pull up one last time.. then as you pull the finger out go straight in with the stent ...slloowwllyyyy....... it will only go in maybe an inch or two and feel like it pushes the muscle inside... rest it as far as you can handle and just hold it there for five mins. IT will slowly stretch the skin over the stent a little, you can pull it out a tiny bit to feel the skin pull back a little once it's over the stent. After five mins pull out and push the lube back down to the tip of the stent.

Re-insert as quickly as possible and you should get to around three-five inches, at three inches hold it for five mins and then pull it out slightly and rotate gently to begin with, if that hurts just pull out push down the lube and try again. Rotating downward and up around the sides is most comfortable, in the shape of a smile then progressing to a full circle. Don't just go in one direction but every two-three circles go the opposite direction, otherwise it feels like you are twisting the skin around in side.

By the time you get to five inches pull out and push the lube back down the stent, I wipe the drips from below with my finger and put them back on the stent. I use an alcohol free wipe in that area before starting so it's clean. saves on lube, if there are still dry spots then I add more as needed. having what seems like two layers worth of lube on really helps!

I lube the stent now to six and a quart and push back in, you wanna re-lube as quick as possible as lube will flow out of the cavity and you don't want that, keep it in there! also it should go in quite easy by now... it takes me 30 mins to get to six inches.
I don't lube up the stent completely at first because it's hard to hold and reach down with it, having that extra inch to hold for the first 30mins stops you tensing up as much. When I pull it out I hold it between my fingers like a cigarette and just as it reaches the end I twist my fingers around so I can grab it as it comes out!

The last inch is nasty but once at six inches I rest with it in for around five mins, pull out slightly rotate and push in and try and get more depth. The last inch can take between 15-30mins.. re-lubing can make you go from six and a quart back to six but you get the quart and more back quicker than the first time. I re-lube quite a bit during the last inch but it helps so much, it takes the burning feeling away which is the majority of the pain. The resting without applying pressure for five minutes helps to stretch the skin.. time helps here the more time it's sitting there stretching the easier it gets. So if it still hurts hold it in where ever it is for longer until it stretches/adapts.

Once I finally get to seven I hold for five mins and then pull out, re-lube/back in. when working up to full depth I don't do the 15 secs of hold and 15 secs of rotate but more like 30-60secs of hold and 5-10 secs of rotate. Once I get to seven I will go the standard 15sec and 15sec. but as the lube dries towards the end of the 15mins of full depth I go back to closer to a min of hold. Once at full depth it's comfortable enough to really give it a good wide rotate as well compared to time reaching depth I only do gentle circles.

I've read that douching with just warm water before a session can help battle dryness. Also if you have extra time to spare then do an extra 15mins at full depth, I extend the hold out to around 2mins with 15sec rotate for that. Also I don't douche after my night time dilation, I figure it will be a little lubey still in the morning but not sure if it's safe so yeah.. but I think it helps :P

You are a week behind me and I feel like last week was my toughest period so far, the last week has been better. So if we are as similar as I think then it will get better during next week! ;)

key words: RE-LUBE! :P

For all pre ops going for surgery, once they remove the packing and they do the first dilation, run back IMMEDIATELY to your room and dilate right away.  As soon as they take the packing out, your vagina is open BUT it closes almost immediately.  They dilated me and it ran RIGHT in as if I had 2 babies before but when i got  back to the hotel an hr and a half lata, that sucka closed shut.  Now my first dilation myself, didnt HURT  but it was uncomfortable due to the surprise that it didnt run right up in me like when the nurse did it an hr prior to.  So I called the office and they told me to RELAX and take it easy and I sat in my hotel room the rest of the day with the heavy lube INSIDE of me and I just did it as much as possible and within 2 weeks i was at the largest one almost 7 inches.  Now dont get me wrong, it DIDNT JUST SLIDE IN as it does now but within 3 mins i was at bottom.  When u DO get it in and you have NOTHING to do, just put in a movie and leave it there, periodically turning to make sure it stays loose because it will lock up on you but RELAXING is the MAIN thing.  If anyone of us was having anal sex prior to, the key was RELAXING and thinking of something calm.  Once you get past this, that muscle down there can choke a mule. 

DONT GIVE UP PLEASE, because once this is behind you (and it will  be) you will have the most PLEASURABLE moments of your LIFE!

TRUST ME you will.

I am pre op but I have to wonder how much has to do with the width of the pelvis?  Some of us have more than others...?  Comments?

Also do you post ops at 4 mo who have intercourse have trouble getting the mans penis in?
Thanks
Amelia

I dont think the width of the pelvis matters that much.

I found my toughest period was between day 48 and day 66 which is like two and a half weeks. Still hurts (discomfort) now but nowhere near the same. The muscle at the opening is much more willing now so I can reach depth much quicker but the last inch still takes at least 15mins. I think it will still be a few weeks before I can bust out mr big though xP

I've had a lot of trouble dilating and it was painful for a long time.  I finally purchased a very small soft vibrator that is 1/2" by 3.5 or a little bigger.  I forgot the name but it's blue.  I also purchased a couple other vibrators up to the size of the dilators.  I have found that using a very low vibration relaxes the muscle and allows me to easily in a few minutes get up to full size.

That's interesting about the vibration. I tried a similar approach to numb the area and dull the pain (indeed I found I could get in more easily with less pain using vibration) but my surgeon's clinic told me not to do that as it might sensitize the nerves or something. But if it does work then it's probably worth doing.

OMG. I could never do that. I'd be bucking and....
Never mind.

Vibration would drive me nuts. Really  :)

alternatively you could just tap on the stent with your finger while applying pressure, it's enough to massage/signal the muscles to get outta the way! I'm getting to six inches in 15mins now with tapping.. then once at six I start rotating to get the last inch which is taking 30mins.. sometimes when I push myself I can do it in 15mins but I had some random bleeding/pain the other day so I backed off again >__<

I can't understand why so many people are having trouble dilating.  Is there anyone here other than myself who hasn't?

people that don't have issues are less likely to post about it? Those that do have issues are more likely to seek help and understanding?

I visited a second surgeon yesterday and he was thrilled that the little vibrator works to calm the muscle down.  I asked about over stimulation of nerves.  His answer was that for the length of time that I use the vibrator, that there couldn't possibly be any harm done to nerves.  (It's like getting a massage on your feet every couple days.  Your feet don't quit :) )  And.... It is MORE pleasureful.

Quote from: Kristyn on June 01, 2011, 09:29:39 PM
I can't understand why so many people are having trouble dilating.  Is there anyone here other than myself who hasn't?

Count me as one...but I'm only about 2 1/2 months post so who knows? I was fully expecting and mentally prepared to have more difficulty due to some of the stories here. Yes it can be uncomfortable at times and can take a few minutes to reach full depth with each size but it isn't painful or incredibly challenging. I went to Brassard also. Maybe it's the surgeon/technique? Straight vs. curved dilators?

Quote from: Kristyn on June 01, 2011, 09:29:39 PM
I can't understand why so many people are having trouble dilating.  Is there anyone here other than myself who hasn't?

I didn't really have trouble until 1.5-2 months in or so.

Good news everyone! Apparently I just needed to wait a few more days. The scarring and pain have come down to a manageable level and I'm able to get to depth pretty quickly. A few tips:

-GENTLE twisting (never more than 15 degrees at a shot!) seems to help when getting through the rough spots at both the entrance and the last half inch. I'm a suporn girl so I do the twist on my "push" intervals. I gain about a quarter inch on each push using this method.

-When I hit a rough spot I pull out and relube the stent. It's a little time consuming at first but it makes the whole process faster in the long run. I have to do this relube process about three times.

-Prep work seems to take a lot of the trouble in the beginning out of the equation. I lube with a finger, then two fingers, for about 3-5 minutes before I insert the stent.

-When they say "the solution to hard dilation is more dilation," they aren't kidding. Tried it and had immediate results.

Overall I think the key is that my pain level went down almost immediately upon hitting month #3. Now if only I can get past this three-times-a-day regimen...

Just thought everyone would like an update!

Quote from: Kristyn on June 01, 2011, 09:29:39 PM
I can't understand why so many people are having trouble dilating.  Is there anyone here other than myself who hasn't?

I've also not had any issues dilating.

For some reason calling a dilator a "stent" somehow seems incorrect to me.  A stent is a hollow tube you put into an artery to keep it from clogging up.

Quote from: AubreyRenee on June 07, 2011, 10:42:02 AM-GENTLE twisting (never more than 15 degrees at a shot!) seems to help when getting through the rough spots at both the entrance and the last half inch. I'm a suporn girl so I do the twist on my "push" intervals. I gain about a quarter inch on each push using this method.

They told me never to twist. I wonder what's up with that. ???

Quote from: Dàwkbua on June 07, 2011, 11:03:59 AM
They told me never to twist. I wonder what's up with that. ???

Slight not fast back and forth twisting is perfectly acceptable and recommended by some surgeons.  What's up with that is it actually does help.

Quote from: AubreyRenee on June 07, 2011, 10:42:02 AM
Good news everyone! Apparently I just needed to wait a few more days. The scarring and pain have come down to a manageable level and I'm able to get to depth pretty quickly. A few tips:

-GENTLE twisting (never more than 15 degrees at a shot!) seems to help when getting through the rough spots at both the entrance and the last half inch. I'm a suporn girl so I do the twist on my "push" intervals. I gain about a quarter inch on each push using this method.

-When I hit a rough spot I pull out and relube the stent. It's a little time consuming at first but it makes the whole process faster in the long run. I have to do this relube process about three times.

-Prep work seems to take a lot of the trouble in the beginning out of the equation. I lube with a finger, then two fingers, for about 3-5 minutes before I insert the stent.

-When they say "the solution to hard dilation is more dilation," they aren't kidding. Tried it and had immediate results.

Overall I think the key is that my pain level went down almost immediately upon hitting month #3. Now if only I can get past this three-times-a-day regimen...

Just thought everyone would like an update!

All good things and I've learned some of these help as well. I do need to prelube more..I have only tried that a couple times...otherwise I just try to go slow and go in a little bit more each time and then back out and sometimes slight twists if I have to.

Kristen I too have had no prob. At all with dialation , I start with mum 3 and reach full depth right away for 5 to 10 mins and mum 4 goes in smoothly ,as for the twisting I was told not to in the beginning so that the graft can heal after my 1 month visit I believe I was told its okay to now twist slightly as  if checking to see if a door is open