If you qualify or have qualified for vaginoplasty, it is important to become aware of your pelvic floor muscles. Problems with dilation can arise when you are not or insufficiently aware of this group of muscles.
Below please find an explanation of what pelvic floor muscles are, what they do and how you can train them so dilation will be a bit easier and more comfortable.
WHAT IS THE PELVIC FLOOR?
The pelvic floor is the bundle of muscles (muscle fibers) that span the area underneath the pelvis. This muscle bundle does not only have blood vessels and nerves; the urethra, the vagina and the rectum are also located here (see figure below).
You can contract or relax your pelvic floor, consciously or as a reflex. This makes it possible to have control of your bladder, bowel and sexual functioning. Relaxing your pelvic floor muscles is essential for a proper dilation of your new vagina.
Control over your pelvic floor muscles is not something you can take for granted. Small movements that are barely perceptible cause the pelvic floor muscles to contract and relax. The pelvic floor muscles are also located in the pelvic cavity where they are not visible. So getting in contact with this part of your body is not a matter of fact.
In addition this part of your body, as mentioned earlier, is personal and intimate: urinating, defecating and sexuality. If you’ve had negative experiences (traumatic or sexual) the pelvic floor area may become a ‘protective shield’ that changes, reduces or blocks your consciousness of this area.
How do complaints occur?
Complaints may occur if you have no or insufficient control over your pelvic floor muscles. As a result you might (unconsciously) contract your pelvic floor muscles too much or not relax the muscles at the right moment. Problems with dilation, urination and defecation may occur after surgery. You may also experience problems during sex because tense pelvic floor muscles hinder sexual pleasure.
Referral to a pelvic floor physiotherapist
If problems with dilating are likely to be caused by a problem with the pelvic floor muscles, we advise you to go see a pelvic floor physiotherapist. He or she can give you insight into how the pelvic floor, the bladder, the bowels and the sexual functions work. The pelvic floor physiotherapist can also advise and assist you until your pelvic floor muscles have improved and/or are repaired.
When you visit a pelvic floor physiotherapist, it is important for you to be receptive to information and advice. It is essential to have a basis of openness and trust in a safe setting when dealing with this (optie: your) intimate area. The pelvic floor physiotherapist is aware of this and will give you all the space and time you need.
You are entitled to one or more sessions with the pelvic floor physiotherapist, depending on your needs.
GENERAL DILATION ADVISE
Nobody likes to dilate. Try to see dilation as something crucial that really needs to be done. The key to successful dilation is relaxation. If you are tense or anxious, dilation will only become more difficult. Be patient. Don’t expect everything to look perfect and function properly right away. Be realistic in your expectations and don’t judge too quickly. Give yourself time for maximum recovery. For best results, here are some tips. We advise you to stick to the following rinsing and dilation schedule.
Dilation and rinsing schedule
During the first year we advise you to dilate on a daily basis. This applies to the penile inversion vaginoplasty as well as the colovaginoplasty. For frequencies and duration of both dilating and rinsing see section dilation. Be aware of the next circumstances;
Make sure you are as comfortable as possible when dilating. It is best to do this in a relaxed environment where you cannot be disturbed. Prepare everything in advance so the supplies are within easy reach. If possible make a checklist so you won’t forget anything.
Take plenty of time to dilate. It doesn’t work if you’re too rushed. Don’t be reluctant to dilate. These thoughts only make it more difficult.
We advise you to dilate after you have urinated or had a bowel movement. This will make it easier for you and you will get results sooner. Relax your body as much as possible. You can do so by lying flat on your back with a pillow under your head. Your abdominal muscles cannot relax properly when you are half-lying half-sitting. This causes problems during dilation. Pull your legs up and let them drop slowly outwards (optie: away from your body).
If possible place a small pillow on the outside of the hips so the legs can relax. Then take a couple of slow, deep breaths.
Dilation is ‘quality time’. Start with your finger first. Apply sufficient lubricant and massage the vaginal opening. Press gently in the direction as indicated (see figure). This allows the pelvic floor muscles to stretch a little bit, which makes them relax.
Next, insert the smallest cylinder by applying light pressure and using small circular motions. If you feel your muscles tighten, release the tension. Continue to apply pressure and insert the cylinder as deep as possible. Then move the cylinder in circular motion, like you’re stirring. If this goes well, remove the cylinder and insert a bigger one. Follow the same procedure until you have inserted the largest possible cylinder.
If you have undergone penile inversion vaginoplasty (possibly in combination with a skin graft) the purpose of dilating is to maintain the depth of the vagina. This is done by applying a sufficient amount of pressure to the cylinder. If you have undergone colovaginoplasty, the purpose of dilating is to keep the transition from skin to intestine wide and smooth enough. To stretch this part sufficiently, it is important that you rotate correctly, like you’re ‘stirring’.
Always start with a small cylinder for five minutes, then use a bigger size. Give yourself time, don’t expect it to work just as well with a larger cylinder. Do not reach for painkillers. This means you are preparing yourself mentally for the pain and you shouldn’t be aiming for that. Relax. Take a couple of deep breaths. Relax the abdomen, buttocks and legs as much as possible and try to continue. Try to dilate for about thirty minutes. Preferably thirty minutes with a slightly smaller cylinder, than not dilating at all.
After completing the dilation, rinse the vagina thoroughly with clean water so no lubricant is left behind. For frequency of rinsing, see section Dilation and rinsing schedule.
WHAT TO DO IF DILATION IS NOT GOING VERY WELL?
Not everyone is comfortable with dilating. What is painful for one person may be unpleasant for someone else. Pain thresholds differ. In any case, do not stop dilating. Let go of stress, worries and doubts. It’s better to dilate more often with a smaller cylinder, than to stop dilating.
Find a relaxed and comfortable position while lying down. Never cross your legs or press your knees tightly together while lying down. This causes excessive muscle tension on the inside of the thighs and increased tension in the pelvic floor muscles. This position is not good for the circulation in the legs or pelvis either.
Always make sure that you don’t draw in your abdomen (optie: that you don’t hold your stomach in) for a long time. This not only causes the transverse abdominal muscles to tighten, the pelvic floor also becomes tense, which can cause a burning sensation in the vagina.
Relax the buttocks, leg and abdominal muscles as much as possible. Take a couple of slow breaths. Start with the smallest cylinder. Apply light pressure and ample lubricant and insert the cylinder a little further using a small circular motion. If it becomes too sensitive, wait a little before you continue. Let your buttocks rest on the foundation. Relax your shoulders and legs. Occasionally move the cylinder somewhat around, apply light pressure and insert a little further. A prolonged gentle stretch feels better, works better and you’ll notice faster results than a short and intense stretch.
Yoga or gentle stretching may be relaxing. You can start doing yoga and stretches again three months after surgery.
An exercise example: when you are sitting, take a look at how you are sitting. Do not sit hunched forward or arched back but sit on top of your sit bones. Then stretch your body completely, moving your arms as high as you can. Return to main position. Sit up straight. Do not slouch. Relax your abdomen and lay your hands on your thighs. Observe your breathing. If you can feel the breathing all the way in the lower abdomen, the pelvic floor will relax.
There is no way to guarantee a good result of the operation without your commitment. For a fully functioning vagina it is important to be aware of the pelvic floor muscles and how to contract and relax them. Give yourself time and relax!