3 Tips To Help Reduce Risk of Vaginal Stenosis for Providers and Patients!
Penile inversion vaginoplasty PIV continues to be a relatively safe procedure. While the complication rates are low, vaginal stenosis of the neovagina is one of the common complications transfeminine patients face.
Vaginal stenosis is when the vagina (canal) becomes narrower and shorter, often described as “loss of depth.”
Just how common is vaginal stenosis in post-op transfeminine patients following a PIV procedure? A recent study, “Neovaginal Stenosis in Transfeminine Patients after Gender-Affirming Vaginoplasty Operation,” performed at Mount Sinai Hospital, looked at 560 primary vaginoplasty cases and revealed the following:
out of the total cases, 147 patients underwent a total of 209 revisions
out of the total revisions, 83 patines underwent 100 revisions for vaginal stenosis
of those with vaginal stenosis, 61 patients had experienced difficulty with dilation in the post-op period
with “difficulty to dilate” described by patients as too painful or too difficult to follow up a post-op regiment of 2-3x a day dilation for 20 minutes each with dilator increasing in size
Vaginoplasty, while relatively safe, is still a significant surgery, and as with any surgery, minimizing potential risks is essential.
When it comes to vaginal stenosis, there are things medical providers, as well as patients, can do to help reduce the potential occurrence of this complication.
#1 SETTING EXPECTATIONS OF POST-OP CARE
It is important to start by setting clear expectations of what is expected in the post-op care regimen, including frequency and duration of dilation.
On the provider's end, it is essential to have a post-op package available to give out to patients going through vaginoplasty to set clear guidelines for what’s expected of them.
Discussing the importance of consistent dilation and the potential risks of vaginal stenosis is especially important.
Unfortunately, in cases where medical providers are not offering a post-op care information package, I encourage patients to be active participants in their recovery by advocating for themselves and asking questions about post-op care.
Having realistic expectations of what to expect and a clear understanding of how certain behaviors may lead to vaginal stenosis may help reduce the potential for future revisions.
#2 BEING PSYCHOLOGICALLY PREPARED
It is natural for patients to be excited in anticipation of going through vaginoplasty and finally feel the congruency they seek. And while it is exciting, medical providers seldom discuss potential psychological struggles.
Not all patients will have access to mental health services at the time of the surgery and following the post-op period resulting in being underprepared psychologically for the expectations of surgical outcomes.
While I do not expect providers to take a role of a therapist, it is helpful to discuss and include in the post-op package potential psychological challenges such as:
be prepared that the surgical area may be difficult to look at due to swelling, bruising, stitches, etc.,
provide support in educating patients that it will continue to get better with each day
discuss potential issues to look out for and when to reach out for medical support
discuss potential feelings of depression following surgery and that they may need to reach out to mental health provider
normalize that this experience is hard, challenging, and may feel scary
Potential patines reading this, I encourage you to be mentally mindful of these as well:
make sure you have post-op care support who can assist and be there for you
reach out to your mental health therapist or see if you can set up an appointment with one during this period
reach out to your support network or private groups on FB and other platforms where others can share and offer what their experience was like
Please do not neglect psychological readiness! Even something as simple as knowing how challenging it may be to see your body bruised and swollen as you hold up a mirror to dilate can help prepare you for it. Know that it will and does get better with time.
#3 IDENTIFYING BARRIERS TO POST-OP DILATION
Finally, the biggest challenge I hear from my patients going through post-op recovery are barriers they have to face in regard to dilation.
Often, these barriers are work-related as well as pertaining to their living environment:
lack of privacy at work to follow the regiment
lack of employer support to offer breaks to meet post-op care needs
for patients who are not out at work, fear losing employment if they come out in order to request time off
lack of privacy within their living environment
safety issues/concerns if they are going through post-op care in living quarters shared with others
For medical providers, having discussions with your patients about potential barriers and helping patients explore what options they may have to reduce them will decrease the risk of vaginal stenosis from happening.
Alternatively, while many barriers are outside of the patient's control, I encourage patients to be aware that there may be challenges to post-op care within their environment and to consider what steps they may take.
CITED SOURCES
Kozato, A., Karim, S., Chennareddy, S., Amakiri, U. O., Ting, J., Avanessian, B. K., ... & Pang, J. H. (2021). Neovaginal Stenosis in Transfeminine Patients after Gender-Affirming Vaginoplasty Operation. Journal of the American College of Surgeons, 233(5), S199-S200.