Now we get to the part that seems to worry everyone the most: the dreaded dilation. Let's be honest here. It is time consuming, generally uncomfortable, and sometimes painful. But next to hygiene, it is the single most important thing you can do to insure the success of your surgery. Failure to dilate properly can result in serious injury, or failure to achieve adequate depth and width of the vagina.

Now that you are properly frightened, let me reassure you that with a little guidance from us and some dedication on your part, you can get through this.

Follow your surgeon's instructions regarding the frequency of dilation. The goal is to be able to reach full vaginal depth (this varies according to the individual) without excessive discomfort. As you progress you will be able to judge for yourself when you can reduce the number of daily sessions. Remember, it's better to dilate more frequently than less.

First, gather all of your materials together. You will need your dilators, lubricant jelly, waterproof pad or towel, and a small towel or washcloth. Wash your hands thoroughly Place your pad or towel on the bed, lie down and get comfortable. Sometimes, a small pillow under your hips will help. You want to be able to relax, especially the muscles in the groin and lower abdomen. Relaxing music can be helpful, as can meditation.

You need to be as relaxed as possible to minimize discomfort. A common mistake is to spread your knees as wide as possible. This actually makes insertion more difficult because it tenses the muscles in the thighs and lower abdomen.

Place your feet about the width of your hips apart and bend your knees at about a 45 degree angle. Move your knees apart only enough to get your hand between them.

If you have trouble reaching your vagina, do not pull yourself up with your abdominal muscles. Instead, place pillows behind your shoulders and neck for support.

Now lubricate the dilator you will be starting with. However, when inserting the dilator, much of the lubricant will be scraped off of the dilator as it passes through the vaginal opening. Therefore it is useful to insert some of the lubricant into the vagina prior to inserting the dilator. The lubricant can be applied by finger, or by means of an applicator such as the applicator supplied with product such as Gyne-Moistrin (a vaginal moisturizing jelly) or other lubricant or spermicidal product that provides a re-usable vaginal applicator. Fill the applicator with lubricant (KY or Surgilube), insert the applicator into the vagina, and push the plunger to place the lubricant into the vagina. This will provide extremely good lubrication exactly where you need it. Relax and open your legs to a comfortable position. Insert the nose of the dilator into the vaginal opening. The dilator must be inserted at the proper angle to avoid damaging the vaginal wall. NEVER insert the dilator at a downward angle.

Always insert at a flat or slightly upward angle, as if pointing toward the navel. It may be necessary to put your thumb or finger on the top of the dilator shaft and apply slight pressure so that the nose of the dilator passes under the pubic bone. Never insert the dilator at a downward angle to get it under the pubic bone!

If you are using straight dilators, begin rotating the dilator back and forth about a quarter to a half turn in each direction while applying gentle pressure to ease the dilator into the vagina. Alternatively, you can rotate the dilator in one direction while applying pressure. The rotation will make insertion easier. As the dilator enters the vagina, you may feel the dilator become more difficult to insert or rotate. You are either not far enough below the pubic bone or you are encountering the PC muscle. When the surgeon created the vaginal cavity, he had to make an opening in this muscle for the vagina to pass through. This muscle is not used to having anything poked at or through it, and it may start spasming or cramping. This makes it feel like you can not get the dilator in. Relaxation will help a lot, but you may want to try massaging the PC muscle to help it relax. Reach into your vagina with a clean finger and locate the area where it feels like the dilator stopped. Gently massage the surrounding tissues and try the dilator again. The PC muscle will quickly be "trained" to accept this, and should stop giving you problems relatively quickly. Continue rotating and insert the dilator again, until full vaginal depth is reached. Although the sensation is difficult to describe, you will be able to feel when you have reached full depth. Once at full vaginal depth, continue rotating the dilator and apply gentle inward pressure. The slight friction as the dilator rotates will help stretch the tissues. If rotation becomes difficult, remove the dilator and apply additional lubricant to the nose of the dilator, or use the applicator to apply additional lubrication internally.

Once the dilator is inserted, relax your legs by bringing your knees together and straightening them as much as you can. You may roll over on your side with your knees slightly bent if you wish.

An accurate measurement of vaginal depth can be made immediately following dilation. Remove the dilator and wipe off any remaining lubricant. Insert the dilator to full vaginal depth and rotate it in one direction for 3 or 4 turns. There will be adequate lubricant remaining in the vagina for this. Remove the dilator and measure the part of the dilator that is covered by the lubricant.

After dilating, thoroughly clean the area as described previously. Clean the dilators and applicator with antibacterial dishwashing liquid and water. To relieve post-dilating discomfort, try a warm bath, or apply moist heat to your groin.

One problem that many people encounter is how to maintain the required dilating frequency when they return to work. Some people have made arrangements to use the Infirmary. Others have successfully dilated in a stall in the lady's room. This is a situation that you will have to explore for yourself before surgery, and depends upon your work situation. Sexual Response

This is an area that is very dependent on you, and all we can do is provide some information about what has happened to others. Some people recover sensation quickly, for others, the process can take many months. The best thing to do is to wait, and not worry about it. When it happens, you will know.

One thing that people worry about is whether or not they will have self-lubrication. The surgeons that we know of will tell you that there will be very little, and for some people, this is true. On the other hand, others find that they can produce adequate lubrication for intercourse. The lubrication reportedly comes from two sources: The urethra and the vagina. The urethral secretions probably originate from the remaining glands such as the cowpers gland and the prostate gland. The origin of the vaginal secretions is more of a mystery, but it has been reported. The only way you will find out is to wait and see how you respond. Remember that there are no guarantees about this.

Some of the surgeons have been using a section of urethral tissue as a way to provide additional lubrication. The urethral tissue is mucousal in nature, and will continue to secrete mucous and provide lubrication.

Whether or not they will regain orgasmic function is an important question for many people. As with lubrication, this is very dependent on you, and there are no guarantees. It does happen for many people, so keep a positive attitude and after you are healed, start experimenting. Things are different now and you will have to learn some new tricks, but during the learning process, the practice can be so much fun.

For men, orgasm — usually occurring fairly quickly — is almost a sure thing whenever sexual stimulation is undertaken. For a woman, this may not always happen so it may be more effective to approach the session with the idea that you simply want to experience pleasure without specifically seeking orgasm. Holding out orgasm as the specific goal may create a sort of performance anxiety that leads to further frustration and a cycle of failure.

The physical surroundings may be rather unimportant to men, but for many women it is extremely helpful to find a quiet and relaxing place where you won't be disturbed. "Getting in the mood" with sensual things like music, soft fabrics, a warm bath, muted lighting, etc., can be beneficial. Some discover a heightened sensitivity to fragrances and tactile stimuli like the gentle breeze from a ceiling fan. Anecdotally, it has been suggested that men tend to have a more strongly visual/cognitive component to sexual arousal, while women may find tactile and olfactory stimuli more persuasive.

In your former life, you may have been accustomed to very focal stimulation but now you may want to get your whole body more involved in the process, breasts, abdomen, legs, face, everything.

Some have suggested there is an erotic component to feminization and feminization fantasies that may dissipate for a while or even permanently after vaginoplasty. The extent to which this phenomenon may occur is obviously variable. In some instances, however, an individual may find that her old core fantasies need to be redeveloped, replaced or just discarded.

Genital surgery remaps tissue and nerves, so take some time to gently but thoroughly explore your anatomy. There might be all kinds of stuff going on there you didn't expect.

Another factor in sexual function is your endocrine system. A proper hormone balance is often critical to proper sexual functioning. Both women and men require testosterone for libido and orgasmic ability. After surgery, some women find that their adrenal glands (the other source of testosterone) do not produce enough to provide adequate libido or orgasm. You may require a small amount of supple mental testosterone to regain functioning. The amount required is typically far below the amount that will cause any other unwanted side effects, such as hair growth. Not everyone requires this, but keep in mind that some do.

It is important to be patient and learn about your new body in a playful and joyous way. Don't put expectations on yourself — just revel in who you are. Take your time, and let every part of your body and your mind and your spirit have a role in the experience. Give yourself the freedom to truly love yourself and appreciate your own beauty and unique sensuality. Crummy sex is probably worse than none at all, but good sex, well...

Sexual Response

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