Dilation Schedule & Strategy

During my research into SRS, I have come across different charts that are provided by different surgeons to their patients on how to dilate. These schedules go week by week telling the patient what to do. Unfortunately when it comes to Mount Sinai hospital, I was not provided any schedule and simply go by what I'm told by the doctors at my follow-up appointments. Leveling up in dilator size  is at this point "as tolerated" and depends entirely on how I feel. Well that didn't help much now that I'm in a transition period between using the smaller purple dilator and the larger blue dilator. I accidentally ripped the vaginal canal trying to insert the blue dilator all the way in. I didn't even know I had torn anything. It was very minor and only noticed when I removed the blue dilator when I was done and saw blood on it. So I think it might be helpful to others seeking surgery to share how I go about dilating.

For those who don't know what dilating is, please go back to older blog posts about dilation. Here's a link to a photo of my vaginal dilators: https://i.imgur.com/ndD8v1V.jpg

Dilating is an all day thing basically. Once you get up to having to do it three or four times a day, it almost feels tedious. A typical dilation session will last 30-50 minutes from preparation to clean up. I've put together a dilation bag which contains all the supplies I'll need for dilating. It keeps things simple having it all together in one place to just grab, lay down and set it all up. Dilation can be messy. The dilator begins to feel a bit more loose in the vagina after about four or five days after beginning the next size up. The initial skin tightness relaxes.

Dilation requires:
-Tissues or toilet paper
-Paper towels
-A bath towel (optional)
-Water-based plain lubricant (KY or WET is recommended)
-Dilator set
-A good sized hand-held mirror
-A flashlight (optional)

A bath towel can help keep your bed sheets protected from any spilled lubes, blood or fluids. Layering up a bunch of paper towels and sitting on them to catch stuff is good too. A flashlight is something I like having to inspect myself at least once day while I'm healing to make sure there are no signs of infection, irritation, cuts or other problems. Being proactive in your recovery can save you a lot of trouble in the future by catching complications early. The mirror helps you see what you're doing during self inspection and during cleanup. Tweezers are also helpful early on to pick out sutures that have dissolved and are falling out.

My Dilation Schedule

Week One:
-No Dilation
-Wound Vac, Foley Catheter & Vaginal Packing are still in

Week Two:
-Purple dilator, full depth (Dot 5)
-Once a day, preferably twice a day
-20 minutes minimum

Week Three:
-Purple dilator, full depth (Dot 4)
-Twice a day (10am, 10pm)
-20 minutes minimum, 30 minutes as tolerated

Week Four:
-Purple dilator, full depth (Dot 4)
-Three times a day (9am, 4pm, 10pm)
-20 minutes minimum, 30 minutes as tolerated

Weeks 5 - 8:
-Purple dilator, full depth (Dot 4)
-Three times a day
-30 minutes

Four Week Long Size-Up Transition Period (Purple To Blue)

Week Nine:
-Three times a day (9am, 4pm, 10pm)
-Purple dilator, full depth for 30 minutes
-Blue dilator, dot 2 to dot 2.5 as tolerated, 10 minutes

Week Ten:
-Three times a day
-Purple dilator, full depth for 20 minutes
-Blue dilator, dot 3 to dot 3.5 as tolerated, 15 minutes

Week Eleven:
-Three times a day
-Purple dilator, full depth for 10 minutes
-Blue dilator, dot 3.5 to full depth as tolerated, 20 minutes

Week Twelve:
-Three times a day
-Purple dilator, full depth for 3-5 minutes (warm-up stretch)
-Blue dilator, full depth, 30 minutes

Blue Dilator

Week Thirteen:
-Three times a day
-Purple dilator, full depth for 3-5 minutes (warm-up stretch)
-Blue dilator, full depth, 30 minutes

Week Fourteen:
-Three times a day
-Purple dilator, full depth for 3-5 minutes (warm-up stretch)
-Blue dilator, full depth, 30 minutes

Weeks 15+:
-Blue dilator, full depth
-Three times a day
-30 minutes

I have updated this as of Week 24. The schedule may change based on my recovery, how I feel and how dilation progresses as a result. I will update this accordingly. This is a very careful, light stress on the vagina type of scheduling. I noticed that already five days into Week Nine's dilation I was at 2.5 to 3 dots and fairly loosened. The first few days in particular the bigger dilator had to be carefully, gently pulled out because of how tight and sticky it was. For at least the first 3 or 4 months post op, it's best to take the safe and gentle route but perhaps later on the dilation progress can speed up.

UPDATE: On Week 20 I began to level up to the next size dilator, the green. After a month, the green dilator has seen little progress as of Week 24. Unlike the blue dilator which reached full depth in less than a month, the green has only progressed mere millimeters. I am unsure if I will be capable of fitting the green dilator and will have to discuss this with the surgeon.

Shooting Down Stupid Memes

I've seen all kinds of myths, fearmongering and general stupidity regarding male to female neo-vaginas, the surgery, the outcome, function, etc. Well, I'll address these memes and disinformation here and update it if I come up with new issues to address or hear some new dumb statements from people who talk out of their rears.


-Pubic hair grows inside the vagina and makes hairballs-

I see the hairball meme all the damn time. It's not true. That is unless the patient went to a sub-par surgeon, never received a hair removal procedure on their genital prior to surgery and the surgeon does not surgically scrape off the follicles in the skin used to create the vaginal canal so hair never grows back. You see, transsexuals undergoing SRS get hair removal, often laser hair removal or electrolysis on the skin on and around the genital area to kill the hair follicles. Hair doesn't grow anymore. This is often compounded by the surgeons themselves during the surgery taking the tissue used to build the vagina and using a scalpel to skin off the hair follicles. This prevents any survivors of the hair removal treatments from ever growing back ever again. It is physically impossible to grow hair inside the vaginal canal if these procedures were done. Transsexuals getting SRS should ask about hair removal with their surgeon, otherwise, yes, you might grow a bush inside your vagina. And that is friggin' gross.

-It's an open wound that bleeds, pusses and gets infected-

Yes and no. It's a surgical site. Your genitalia have just been disassembled and reassembled in a completely new shape. Yeah, it's got cuts, incisions, sutures, bleeding, bruising, swelling, pain, maybe puss, scabs and everything else associated with a healing wound. It even comes with the typical risks of any surgical procedure: infection and even necrosis. For the vast majority of transsexuals who undergo SRS, they do not encounter such complications. The healing process takes approximately three to four weeks. At this point your incisions and sutures should be healed and the stitching dissolving and falling out as it should. There is no more bleeding. There is no puss. There is no infection. If you have excessive bleeding or continuous bleeding passed one month post-op, you should contact your doctor, surgeon or go to the emergency room immediately. If you have signs of infection, you should contact your surgeon or go to the ER immediately. After three to four weeks, it is fully healed skin. The vaginal canal they constructed is also fully healed. It is no longer an "open wound".

-Dilation takes hours a day for the rest of your life to stop the wound from healing-

At first, yes. The vaginal canal the surgeons built is not the same as a real vagina and therefore does not have a lot of the necessary natural features that keep a female's vagina from shrinking or sealing shut. Dilation is necessary on a daily basis for the first year or so after surgery. It can take upwards of three or four times a day, for 30 minutes each time to help maintain the vaginal canal's depth and girth. Over a period of several months, this procedure ramps up from once a day to twice to three or four times and back down to twice and then once a day. Typically by one year post op, most transsexuals will be dilating once or so a week. Dilation becomes necessary once a week for 20 to 30 minutes for the remainder of your life. Is it to stop the wound from healing? No. The internal pressures from your organs and muscles squeeze on the neo-vagina, causing the tissues to smush in. If not dilated, the tissue used to build the vagina will begin to atrophy, basically it gets shorter and tighter. Eventually it would atrophy to the point of no longer being sexually usable or even recoverable via dilation, which would necessitate surgery all over again. Dilation simply keeps the canal open and deep. Over that first year period, the body adjusts to the canal's and the rate of atrophy is significantly reduced. For those with a sex life, dilation may be entirely unnecessary after a year. The act of having sex on a frequent basis doubles as dilation. The rule is simply put: use it or lose it. Addressing pain, no, dilation is not painful forever. The first few weeks of dilation can be hard, especially the first one or two. Pain medication is already necessary as you're healing, so dilation shouldn't be THAT bad, but it is tight, sore and uncomfortable. Dilation should be painless by week three or week four.

-It smells like rotting flesh, feces or other putrid scents-

False. The neo-vagina will smell like nothing, or smell like any other part of the body. It is up to the individual to maintain hygiene standards. Anyone who fails to take showers is going to start to smell. Maintaining good hygiene is important to the healing process anyway. If the vagina does have a strong odor, like in actual women, transsexuals can be prone to infections such as vaginosis, which is notable for the vaginal odor it produces. A normal healthy post-op vagina is largely scentless like any other body part that is clean. There is no rot. There is no smell of feces. If there is rot or necrosis, you should go to the ER immediately. If there is a smell, you might want to go see your doctor. Bacterial Vaginosis is a possibility. Vaginosis infection is particularly higher risk for most post-op transwomen due to the way most post-op vaginas are constructed. Real vaginal canals are a moist excreting membrane. This moisture allows for a particular growth and balance of healthy human bacterial flora to exist. Some of these bacterium are purposed for maintaining vaginal health and reducing the risk of infections. In women with a micro-flora imbalance, they can develop infections such as vaginosis. Transsexual vaginas do not typically have a naturally lubricating moist membrane... not until recently. As a result, transwomen do in fact develop much of the same normal vaginal bacterial micro-flora, however the lack of a proper vaginal environment results in higher risks of infections like vaginosis. The peritoneal graft method of SRS I received provides SRS patients with a naturally moist excreting membrane in the vagina, which may change this. Because the peritoneal method is a recent development, research into how vaginal bacterial micro-flora develop in peritoneal vaginas does not exist. I would assume because the environment has the proper moisture necessary for certain bacterium to grow would allow for a better balance and reduce risks of infections like vaginosis. Sciencey stuff aside, no, post-op vaginas don't smell like rotting death.

-They use colon tissue to make the vagina, so it smells like feces and leaks anal fluids-

The use of colon grafts to create neo-vaginas is an uncommon form of SRS today. Rectosigmoid Vaginoplasty involves to taking of a chunk of the large intestine, also known as the colon, to create a naturally lubricated, moist vaginal canal in transsexuals. The problem with this method is the type of tissue is a mucus membrane. It secretes fluids to help with digestion and moving fecal matter along into the rectum. As the result, these fluids can have a bit of a scent to them and are prone to developing bacterial flora commonly found in the rectum and colon. Because it is an excreting membrane, it constantly produces fluids, which throughout the course of the day, leak. This is the same with the peritoneal graft I received. It too continuously produces peritoneal fluids, although scentless, as self lubrication, resulting in gradual leakage. This necessitates the use of a panty liner to absorb the fluids. The colon graft method of SRS is uncommon in the U.S. and most Western countries. Most surgeons avoid doing these procedures but many do offer the option, usually as a last resort in patients who require vaginal reconstruction after the first surgery suffered severe complications or in cases of patients with micro-penises. Does it smell like poop though? No. Most transsexuals receive a generic penile inversion. The entire vaginal canal is constructed out of the same skin as the penis and part of the scrotum, which is incapable of excreting any fluids.

-Post-op transsexuals cannot orgasm-

I've seen this around a number of times. Oh, yes we can. Really it comes down to the surgeon's skills and potential for complications affecting the nerve endings. Nerve damage can result in numbness or loss of sensation. In the case of the colon graft method mentioned above, the colon has no pleasure sensation. For most transwomen, the surgeons construct the external female genitalia (vulva) and the internal vaginal canal. The clitoris is often fully functional with pleasure sensation and with work, can achieve clitoral orgasm. Part of the penile tissue used in SRS also contains pleasure nerve endings, allowing for penetrative vaginal orgasm. The prostate is also often left in place or moved during the surgery, creating a third spot for sexual pleasure than can induce orgasm with stimulation. Basically we usually have three points of stimulation to induce orgasms. Because I am only two months post-op at the time of writing this, I am limited in my sexual activities. However, I am capable of achieving clitoral orgasm with ease using a vibrator. I've tested the interior for sensation by inserting a dilator and holding my vibrator against it to make the dilator vibrate inside me. My vaginal canal has pleasure sensation and the vibration feels good, but I do not know what I am capable of at this time. Surgeons who do excellent functional work can allow their patients to experience powerful orgasms.

-Post-op transsexuals cannot cum-

Most surgeons leave the prostate intact during the surgery. It's really the only part of the male genitalia left behind and functional. Cum is made up of a number of things. Primarily the sperm cells and some fluids are produced by the testicles and additional fluids from seminal vesicles. While on hormone replacement therapy (HRT), most transwomen's testicles cease functioning which results in infertility. We no longer produce sperm. However the prostate also produces a sizable portion of male ejaculate and this does not stop producing fluids even while on HRT or after an orchiectomy (the surgical removal of the testicles). The prostate produces approximately 0.6mL to 1.5mL of fluids in a healthy male. Post HRT, the production of fluids is decreased, but still present. If you can still cum fluids after long-term HRT use, you will be able to cum fluids after surgery too. Before surgery the amount of cum that came out of me when ejaculating seemed to vary based on how aroused I was at the time. Sometimes a good amount would come out, sometimes very little or almost none. Post-op, I have had only one orgasm so far where I leaked fluids. Because we no longer possess a penis and the muscles and erectile tissue needed to pump and shoot semen, post-op the fluids simply drool out from the urethra instead.

To be expanded...

Dilation: What The Hell Is It?

Few people know much about post-op transsexuals and how it all works, even fewer know about dilation. There is a lot of disinfo out there about it. The surgery involves primarily the construction of a pseudo vaginal canal out of our male genitalia, however it is not a real vagina and therefore does not have some of the important features real vaginas have, particularly what lets them maintain their shape. The vaginal canal that is built is essentially a tunnel of skin or maybe more like a skin cave that goes several inches deep into the body where a vagina would be on a female. However unlike females, the trans vagina has nothing to connect to at the deepest end. In a woman, that would be the cervix, which is the point of entry to the uterus. The average woman's vagina, from the opening to cervix, ranges from 3 to 5 inches and can change size with sexual arousal.

For trannies, most surgeons provide more depth. Some do even better, deeper upwards of 7 or more inches. For me, I have about 5.75" of depth. For the first several months the tissue used to create this tunnel needs to be maintained daily. Like with muscles for example, if you don't use it, you lose it and muscle begins to atrophy away. The vaginal canal will do the same over time. This is combined with the effects of the vaginal canal being squished by the constant pressures of internal organs and muscles that contributes to more rapid tissue atrophy. The first couple months are critical in this process. To maintain the depth and girth of the vaginal canal and stretch it wider and potentially deeper, we use medical devices called dilators.

A dilator is basically a dildo made of medical-grade plastic. It is solid plastic, not floppy or soft. A set of dilators is used over time, each one slightly girthier than the last. We start off with a small dilator, in my case, a purple dilator that is about 1.1 inches (2.75cm) in diameter and 9 inches in total length. The dilator is smeared in lubricant first. Waterbased lube is recommended by the hospital. I use plain waterbased KY jelly. For the first week or two, the hospital provides a prescription lubricant called Metronidazole gel aka MetroGel, which is also a vaginal antibiotic. After the MetroGel runs out, you switch to normal plain lubes. With the dilator lubed up, it is slowly inserted into the vagina until it reaches the end of the tunnel. For me, that's about 5.75 inches. The dilator must remain inside at the full depth and held in place with some slight inward pressure for 20 to 30 minutes. I do 30 minutes. After the time is up, the dilator is slowly removed and you can clean up. I must do this three times a day as of writing this (two months post-op). I was started at twice a day, one week after surgery.

For the first month dilation can be uncomfortable. For the first couple weeks, it's like a chore you just really really do not want to do, but you MUST do it and it is both uncomfortable and slightly painful. I have a decent pain tolerance, so maybe it's not as bad to me, maybe for others it'd be pretty sucky. It is very tight going in at first. After a couple weeks, the vagina is already adapting. The dilation is doing its job loosening it up and stretching it out. Dilation should be pain free after the first month.

Dilation is not as simple as I just made it sound. There's a bit more involved to make it less uncomfortable and to allow for the dilator to slide in more easily. The first week, the doctors recommended laying in bed, on my back, with my legs spread in a "froggy" position. I used pillows to help prop them up a little so they could rest more comfortably. After a month I changed my position as the vagina got looser, making dilation easier. Now, I get into a comfortable laying position on my back, preferably in bed with coffee and Netflix, and sit with my legs up and spread a little... almost like missionary position for sex. I insert the dilator slowly starting at a 90 degree angle to slide in the tip. The dilator is curved inward to a 45 degree angle as it begins to fully enter the vaginal canal. For the first few weeks, this can be tight and somewhat painful as the dilator transitions from 90 degrees to 45 degrees, squeezing around and under the pubic arch (a part of your pelvis), squishing and pinching the swollen urethra and other tissues inbetween against the bone. This was no longer a problem by four weeks post op. Tylenol helps make this less painful. Take it like an hour before dilation. Another issue is learning to relax your muscles. Dilation can make you tense up and all those muscles in your pelvic area are tightening up the vagina. This makes it harder to get the dilator in. However understand that this is not a bad thing later on when you can have sex. Yes, we trannies can tighten our vaginas when having sex, making things feel better for our partners. I had to learn to try and relax those muscles, relax my body, breathe out slow as I insert the dilator to help loosen those muscles and allow it to enter easily. Once the dilator is in, it must remain in for 20 to 30 minutes. It has to be held in with a bit of inward pressure to help things stay stretched. While the dilator is in I have to be sure to control myself if I feel the need to cough or sneeze. That shit sucks. Go ahead and cough and feel your crotch muscles as they spasm. Now a solid dilator is in there when you do it. Ouch. Avoid coughing or sneezing. If you feel a sneeze coming on, try and remove the dilator first.

Link to photo: The dilator set I was provided by the hospital: https://i.imgur.com/ndD8v1V.jpg

Eventually I will have to size up. As I stated, the purple dilator is about 1.1 inches (2.75cm) in diameter. The next size up is the blue dilator at 1.25 inches (3.25cm). Then some months on the green dilator at 1.3 inches (3.5cm) and finally the biggest dilator I was given, the orange at 1.5 inches (3.75cm). By approximately one year post-op, the dilating process will have ramped down from 3 times a day at 30 minutes each time to once a week. What happens if you don't dilate? Well, contrary to internet disinformation and anti-trans memes, it is not meant to keep an open wound from healing closed. The vaginal canal and vulva is fully healed within three to four weeks. It does prevent the skin or tissue used to create the vaginal canal from atrophying. This means that without dilation or neglecting to dilate as scheduled, the vaginal canal will shrink in terms of depth and girth, leaving it shorter and tighter until it is too short and too tight to use sexually and could be so far gone that you cannot regain the loss. This would end up requiring surgery all over again to rebuild the vaginal canal. For about a year the dilation process is necessary to ensure the body adjusts and the vagina won't shrink away. Skipping even a day during the first couple months can result in the next dilation session being tight and uncomfortable. Depth is lost faster than girth and is harder to regain. Initially post-op I had 6 inches of depth, however I dilated once day for the first week instead of twice and dropped to about 5.5 inches. It is important to stick to the dilation schedule. That first week is a bitch, painful, annoying and I really didn't want to do it. But it must be done. Bleeding also only lasts for the first two weeks post-op. The dilator should be coming out clean, except for the lube, by about three weeks.

Does it feel good after the pain is gone? It doesn't really feel like much. I can feel it all the way in, a painless stretching and pulling from the inward pressure as I hold it in. We don't need to move it around except to adjust to get maximum depth. Sometimes if you have gas while dilating you can feel the dilator being pushed as the pressure moves through your intestines and into the rectum. The dilator moves back again after you pass the gas. Kinda funny. If you take a vibrator and hold it tightly against the portion of the dilator that sticks out from the vagina, the dilator will absorb the vibration and begin to vibrate inside. That does feel good. If anything, it's a good diagnostic way to test your nerves and sensation in there while you're still not allowed to have sex.

Currently at two months post-op, dilation is painless and easy to do. I just get comfy in bed and do my thing. The entire process from prep to clean up is maybe 40 minutes. Doing this three times a day now, that's a good two hours of my day just sticking a medical dildo in my vagina, every single day. It is time consuming and for several months, makes certain things harder to do, like school or work. Some surgeons have their patients do this for longer, like 40 minutes and up to four times a day. Things become simple as you near one year post-op and it's only needed once a week. I just can't wait to get this down to at least once a day.

And that is dilation.