After surgery, patients will have a vaginal pack in place. The vagina is packed with gauze which is sewn in place using clear supports that sit on each side of the labia. There will be two drains on either side and a Foley catheter. All of this should remain in place for about five or six days.

After five or six days, your packing, supports, catheter, and drains will be removed. Once the packing is out, you will have an exam to check that the skin graft is healing well.

We will teach you how and when to dilate and rinse. We will show you how to lubricate the dilator with KY jelly, and how place it in the vagina. Once the dilator is in place, we will leave you alone to get used to it. We will also send you home with written instructions on how to dilate and rinse.

Dilation

Many patients are worried about learning to do this. It is a new part of your body and it will be a new sensation for you. This fear can cause patients to spasm, bear down, or tighten their perineal muscles. This can make it hard to place the dilator. Make sure you breathe and relax as it is going in.

Steps for Dilation
Patients can perform this on the toilet or on the bed.

  1. Lubricate the dilator well with KY or lubricating jelly.

  2. Gently insert into the vagina at a 45-degree angle. Fit it under the pubic bone, then continue to insert straight back and up. There is a slight bend as the vagina goes around the pubic bone and the prostate. You will have
    some resistance, but it is safe to keep going.

  3. If you feel major resistance or severe pain, stop, and let the plastic surgery team know.

  4. Insert the dilator to its full length.

  5. Once it is in place, rest for about 20 minutes.

  6. After 20 minutes, gently remove the dilator and rinse.

  7. Wash the dilator in the sink with soap and water and put in a safe spot.

How Often to Dilate

  • 0-2 months after surgery: 3 times each day for 20 minutes each time, after the packing is removed.

  • 2-6 months after surgery: 3 times each day for 20 minutes each time

  • More than 6 months after surgery: 1-2 times each day for 10 minutes each time.

If the vagina begins to feel too tight, you may be told to increase the frequency.

Rinses

It is best to do the rinses in the bathroom, in the tub, shower or over the toilet.
Supplies:

  • 2 peri bottles

  • 2 graduated cylinders

  • Red rubber catheter

  • 60cc Tumi syringe

Fill one graduated cylinder with warm soapy water. Use any gentle soap and tap water. Fill the other graduated cylinder with warm water.

Note: If you have well water, boil it and let cool. You can also use distilled water or normal saline.

Steps for External Rinse

  1. Fill one peri bottle with the soapy water and one with the clear water.

  2. Squirt the warm soapy water on the outside and inside the labia, letting it run over the incision lines and wounds. The clitoris is at the top part of the surgical site and can be very sensitive.

  3. Use a warm washcloth or gauze to clean up any dried blood.

  4. If you are showering that day, the shower can count as an external rinse.

Steps for Internal Rinse

  1. Insert the catheter into the vagina. This is like placing the dilator but should go in much easier.

  2. Draw up 60 cc of the plain tap water into the Tumi syringe.

  3. Insert the syringe tip into the end of the catheter and inject, flushing the water through the catheter.

  4. Repeat with warm soapy water, then once more with warm water for rinsing (sequence is clear-soapy-clear).

  5. Once done with the rinse, you can then go on with dilating.

  6. After dilating, flush the vagina again, using steps 1-4.

  7. Pat the tissues dry with a washcloth or gauze.

Tips
You should do the rinses before and after dilations and after any bowel movements. You can also use the peri bottle to rinse after using the bathroom if it is more comfortable.
Some patients like to practice dilating and rinsing before they leave the hospital. It is important for the nurse to be able to answer any questions you may have.

When to Call
A small amount of blood tinged drainage is normal. If there are large amounts of bleeding or it is constant, call the plastic surgery team.