Dilation is a fact of life for post operative transgender women. It’s pretty hard at times & I’ve been thinking about how to make the experience as good as it can be.
It’s worth noting that my surgery was the non-penile inversion method which is quite different to the more common penile inversion method and has more rigorous dilation requirements, but I think a lot of this still has relevance whatever surgery you had.
So here’s my list of ideas for improving the experience:
1. Listen to everyone… then ignore it
If you are newly out of the hospital and are just discovering how much dilation sucks, you will probably have lots of other post op trans women ready to give you advice on dilation. Listen to all of it. They know more than you. They will have figured out a way to develop the mental toughness and the tricks and techniques that work for them. There will be a lot of gold in this advice – learn from these people – they know what you’re going through.
However everyone is different. I’ve seen half a dozen other women dilate and all seem to do it slightly differently. Some sit up more, some are completely flat. Some are more vigorous, some more gentle. Some take pain killers, some don’t. Ultimately you have to live with this burden and you’ll find the way that works for you.
So rule number one is: Listen to and learn from others, but not too much; Figure out what works for you.
2. Routine is your friend
I have a series of rituals that I’ve developed and I follow them almost without deviation, like I’m following a script. After a while it’s second nature. Equipment all goes in specific places at the start and gets moved to different places when used at different stages in the process. In the morning I always make a cup of tea to take a sip of when I reach depth. In the afternoon and evening one I’ll quite often have a small glass of wine as I start to help me relax.
Sticking to the routine has a number of benefits:
- Having this routine helps keep me on the rails and allows me to zone out for long sections.
- Keeping the timings between dilation as evenly spaced and regular as possible means that you’re minimising the chances of encountering a difficult session.
- Some nights when I’m very tired I have gone up to my room and thought “I’m not going to do it tonight, I just need sleep”. Then I think about the consequences and all I have to do is begin the first step (disposable sheet on the bed), then the next one sort of happens and the next and the next and I find myself halfway through doing it.
3. Blood sugar seems to be important
I have found consistently over the last weeks and months that topping up my blood sugar prior to doing this seems to significantly take the edge off. In the mornings it’s just be a single piece of toast with jam, in the afternoon it’s usually hummus and a few crackers and in the evening it might be a square or two of dark chocolate.
I don’t like to eat too much because dilation and bloat is horrid, but it seems to be just a tiny hit of something is all I need to stack the deck in the favour of an easier dilation session.
4. Be empty
Without being too crude about it, the dilator takes up space inside you. If the neighbouring space is also full, then it’s going to make the whole thing harder. So just make sure that your bowels and bladder are empty before you begin.
Also if you’re in the early stages of recovery and are using lots of painkillers, you will be constipated. Laxatives are your friend – if you’re too solid and have to push, you can tear something.
Let’s not dwell on this one eh?
5. Leave work and turmoil at the bedroom door
Sometimes when I come in from work, I’m still stressed or riled about something that just went down. I have a rule with dilation that work thoughts have to stay at the bedroom door.
I am convinced that both blood pressure and an agitated mind make the process harder. When you’re dilating, it has to be about you and your body and all the other stuff can just wait for an hour.
6. Don’t worry about being late
We all have some place to be. Whether you’re trying to make it down to breakfast, to work or to meet friends. Trying to dilate when you have to be out of the door in 32 minutes is just going to make things stressful and hence harder. If you look at the clock and realise you’re running short of time – just text or call ahead and set expectations that your physio is running a few minutes over and you’re going to be a little late. It will take a lot of pressure off and again – get your mind in the right place.
I got a great piece of advice from one of the patient coordinators, Jib, in Thailand. I’d just grumbled about having a hard dilation when I expected it to be easy, then the next one I was down about how hard the last one was I was shocked at how easy it was. She said to me “You must have no preconceptions; Go into it expecting nothing and it will be ok”.
The best dilations I have are ones where I don’t expect too much and am not too fearful of the worst.
8. Chill out for a few minutes
As I mentioned before, I’m convinced that heart rate and blood pressure make a difference. Taking a few minutes to lay in the bed and be calm is a vital part of my ritual. It doesn’t have to be long, just enough to let my body relax. Sometimes I just Facebook for a bit or read a few pages of my book and then when my body has slowed, I can begin.
This seems to be especially important if I’m short of time or conscious of starting late. Counter intuitively, it has been my observation that a few extra minutes at the beginning seems to make the whole thing go a lot quicker.
9. “Your finger is the smallest dilator”
This is a Dr Suporn quote; It was something he said to me on clinic day when telling me how to do dynamic dilation. He was suggesting that I begin with a lubed finger to loosen up the opening for a minute or so rather than just using the dilator. It makes a huge difference for two reasons:
- It is actually a lot smaller… So a few minutes of circular motions can warm up the scar just inside the entrance before stretching it open with the dilators. This seems to make it so much easier.
- Psychologically it’s easier to start exploring gently with our fingers and spreading lube around and venture in slowly rather than stuffing a big glass penis inside yourself without any preparation.
10. Disengage your core
This is more advice that I was given my Dr Suporn when I got my first dilation lesson. He poked my tummy which was a little firm and he says “make it soft, your tummy is hard – you are tense – your vagina will be tense, and this will be harder”.
Occasionally I still test to see if my core muscles are properly relaxed with a poke or a prod. If they’re not I just focus on letting the tension in my tummy go.
11. Be flat(er)
This one seems to be controversial in that I have seen some women sit at a forty five degree angle and swear by it. But for me, the flatter I am, the easier it is and deeper I can go. It’s a trade off, because I’m often watching something, so want to be propped up a little, but if I’m struggling, flatter always seems to help me get to depth.
12. Use plenty of lube
Lube is your friend. If you’re struggling use more. As I mentioned above, I use my finger to spread plenty of lubricant inside myself even before I put any on the dilator. I then make sure the dilator’s surface is covered to about 3/4 of the way to depth. I know a lot of this ends up being expelled and is wasteful, but using less seems to make it worse.
13. There’s no shame in using the small dilators
I have heard some women proudly tell me “my small dilator is still a virgin” and “I only use the largest one”. Who gives a shit?
I now routinely use my small dilator, not to find depth, but as an interim between my finger and the medium. I just use it for maybe 2-3 minutes to further loosen myself up before the medium. When I then step up to the medium it just slides in without any discomfort. I don’t need to do this – I can go straight to the medium or even the large, but I just find it more comfortable to invest the couple of minutes working up.
It is astonishing to me how many women are struggling with really challenging dilation, but never reach for smaller dilators. It’s like there’s some residual macho need to make it hard.
14. Go slow; It’s not a competition
There is this weird phenomenon amongst early post op trans women where they seem to want to compare various metrics – one of which is time taken to reach depth. I get why they do this – we all want to check if we’re normal, but it leads to pressure to get there quickly.
I have now assumed the attitude that it doesn’t matter if it takes me all day to get to depth.I put myself under no pressure to get there within a set time period, I just slowly start working my way there. I always manage it. Sometimes I guess it happens quickly sometimes it seems to take a really long time – but that’s OK because I’m not competing on the “time to depth leaderboard”.
15. Listen to your body…
I have learnt that when pushing for depth I seem to have a series of obstacles. I don’t know if they’re areas of scar tissue or muscle mass, but it doesn’t just slide in. I can feel when I reach one of these areas that I may need to massage it for a while to get it to give up and allow me past. I never force my way through, I just work on that area for a bit and suddenly the difficulty dissipates and I can proceed on.
16. …also don’t listen to your body
There is only one firm rule about dilation: Depth. Time spent at depth is important. If you don’t get regular quality sessions at depth, you will progreeively lose it. It’s that simple. So whilst the previous point is saying – take it slow, don’t push past something that isn’t ready, you do need to get to depth.
From personal experience, I have had a handful of sessions where I’ve not got there and I know others do too, and the odd occurrence is fine, but you need to build up the mental courage and endurance to accept that you are going to find a way past this and get to depth. Your body may be saying “No. Give up. You can’t do this” – but you have to do it.
17. Don’t be afraid to experiment
There’s a lot of variables and as with anything you can get a feel for your preferences.
- Lubricant: There are lots of different consistencies of lubricant. There are lots of different ways you can apply it.
- Positions: Laying flat works for me – more upright may be what you need. Adjust the angle of your legs
- Movement: During dynamic dilation, some people move the dilator, some move their hips.
- Timing: I like evenly spaced dilations: 8am, 4pm, 11pm, but it cuts into sleep. Others like to do their evening one earlier, get more sleep, but have a tougher one in the morning.
The only rule is there are no rules… well apart from spending quality time at depth.
18. Remember it’s not a science
With Dr. Suporn you are given a pretty extensive manual describing how to dilate. There are some things that are laws, some things that are principles and some that are guidelines.
In the case of Suporn he and his staff continually reinforce the importance of dilation and once depth is lost then it is lost forever – that’s a law. But I suspect a lot of the rest of the rules about exact number of minutes to dilate and seconds of stirring vs pushing are principles or guidelines. Likewise the recovery window is just a guideline – don’t firmly count down the days until the manual says dilation will get easier – your body might heal differently – again – have no preconceptions… because it’s not a science.
19. This is about the mind as much as the body
I firmly believe that although dilation is one of the most physical challenges that someone has to endure, the solution lays in the head.
If you dread dilation, it will be bad. If you fear dilation, it will be bad. If you can find a way to be positive – everything will be so much better.
If you think of it as painful, you will experience it as pain. Try to get into the mindset of seeing it as arduous or a task to be done, but not pain to endure.
Remember and repeat the words: “I can do this. I can do this. I can do this. I can do this. I can do this. I can do this. I can do this. I can do this. I can do this. I can do this. I can do this. I can do this. I can do this. I can do this. I can do this. I can do this.”.
When the going is tough, just keep saying this, if you hear the other words, just keep reminding yourself: “I can do this; I will do this”
20. Re-lubing can sometimes help
Sometimes getting to depth can be really heavy going or you can start to feel very sore halfway through your allotted time. If you pull out and reapply lube it can sometimes help just enough to make a difference.
21. Netflix and dilate… or whatever
This is another one about creating rituals and refocussing the experience on enjoyment rather than the arduous nature of the task. I’ve netflixed my way through a number of series during dilation now. What I’ve found is that if I reserve the viewing only for dilation time, I find myself actively looking forward to it.
As an aside: I did however make the mistake of trying to watch Narcos season 2, which I’d forgotten from the first season is almost entirely in Spanish. Twisting to read tiny subtitles while trying to lay flat was hard. Also there are moments where it gets intense and you need to just listen for a few minutes… Again not ideal with subtitles.
For that reason, I’m a huge fan of Audible as audio books don’t need eyes. I know some people that read their kindle, but I find it kind of cumbersome holding it above my head. But same principle applies, I find myself thinking about getting back to the book and dilation seems to not seem like such a chore.
Other times I’ll be into listening to a playlist of music to get lost in. Music is kind of great, because you can keep a vague track of time without clock watching.
The point is it’s about creating a space for entertainment and enjoyment within the routine.
22. Be honest; Be disciplined
I think there are two kinds of dilation session:
- Compliance dilation
- Honest dilation
With compliance dilation, you do your minutes of work, you just about reach your depth and comply with the minimum letter of the guidelines. With honest dilation you ask yourself is there more that I should do? Was that honestly the best and most complete dilation I could have done?
Sometimes I get to the end of my time and I kind of just know that a little more massaging and a little more time is needed. Other times I know I can push for a little more depth. My advice is be honest with yourself – are you genuinely working the scar tissue as much as is beneficial?
If you don’t honestly push for maximum benefit – your recovery will just take longer – it will take more time to be able to start dropping the number of dilations per day.
23. Rewire your brain
OK… this one might be a leap too far, but there is some science behind it. You can rewire your brain to experience pain as pleasure. Stick with me on this one.
Some of dilation can definitely be painful. Excruciating even. But there’s a lot of sensations that you will feel that aren’t pain, just really intense. If you don’t actively filter them, they can just get classified as pain, but if you listen to them and try to experience the intensity as pleasure rather than pain it can make a huge difference. Honestly it works.
Flipping the ‘intense’ sensations into the pleasure category is relatively easy. It simply requires awareness. There are some things you can do to help this. When there is a wave of intensity (rather than pain) make a pleasured moan or breathe as though it feels nice. It feels kind of silly at first, but I’ve notice that acting as though something was pleasurable actually can make it more pleasurable.
Once you’ve mastered that, start working on experiencing the pain as intensity. This is much harder – especially for certain types of pain, but it is possible. This is pretty common practice in the world of kink –
24. Look after your future self
After dilation I always do as much as I can to look after the exhausted, probably emotional woman that will be doing it again in a few hours time: Me.
This is just a series of small things. For example: Making sure my water bottle is refilled or if I finished a tube of lube, making sure there’s a fresh one and the foil has been pierced so it’s ready to go. All the little things just to help my future self out a tiny bit.
I completely get that this saves no time; Do it now or do it later, same chore surely? However if I’m feeling a little demoralised later, removing the friction points in advance, helps me just begin the routine and not procrastinate. Plus doing things to be kind to yourself feels good.
25. You are only competing with yourself – nobody else matters.
And finally the golden rule:
It’s super easy to get drawn into conversations on the message boards, chat or in the post op recovery community about time to reach depth, how many painkillers everyone is taking, how long dilation takes, how their result is, whether they have reached orgasm yet, amount of blood or discharge.
The truth is that what they are going through is completely irrelevant to your recovery. Your body will heal at a different rate to everyone else’s, your pain will be different and your dilation experience will be completely different. The only person you need to measure your progress against is yourself.
I hope this was in some way useful – I’d love to update the list with any thoughts or tips you might have.