Infant Vaginal Dilatations Continue
Vaginal surgery generally requires a kind of post-operative care called “vaginal dilatation.” After surgery, the tissue tends to get smaller while healing. In order to keep the vaginal opening from closing up, the patient (or her mother or a doctor, in the case of an infant or child) is instructed to insert an object into the vagina, pressing against the scar tissue, on a regular basis.
When performed on a child, vaginal dilitation can be emotionally scarring for both child and parent. This is one reason why many experts recommend that vaginal surgery not be performed on children with DSDs (Disorders of Sex Development) — rather, it should be made available to patients who are at least adolescent, who can understand the reasons for the procedure, and who can do the necessary vaginal dilitations themselves (if the patient is not motivated to do this, then the surgery should obviously not be performed). The surgeon’s argument that vaginoplasty can be completed with a one-stage procedure on an infant has been roundly refuted — follow up surgery will almost always be required as the patient enters adolescence. Avoiding vaginal surgery on infants and children also allows for the patient (as an adolescent or adult) to try manual pressure dilation, which has been quite successful for many women who escaped vaginoplasty.
Cornell University’s Pediatric Urology Department continues to recommend:
The first important issue is the timing of the reconstruction. This has been a controversial area in the past, but presently the standard of care is to perform reconstructive surgery at an early age rather than delaying until adolescence. Reconstruction is generally initiated between the ages of 3 and 6 months old. … The frequency of dilations can be tapered by the six month interval until a once a month schedule is reached. Monthly dilation must be continued into adolescence to prevent any narrowing that may occur during growth and development.
We’re looking forward to more up-to-date recommendations from Cornell soon.
Note on terminology
This sort of vaginal surgery is generally called “vaginoplasty” in medical literature. Vaginal dilatation is sometimes called “vaginal dilation.” The process by which the vagina tends to narrow or close up after surgery is called “stenosis.”
- Care and Counseling of the Patient with Vaginal Agenesis
- AIS Support Group’s page Vaginal Hypoplasia
- The Child with an Intersex Condition: Total Patient Care. In this video Debbie Hartman gives a moving account of her experience as a mother instructed to perform vaginal dilatations on her child.