Posted by: jasgreen | July 30, 2009

The dilator/depth debates continues……..

Each day, I’m on a schedule to dilate 4 times a day for at least 10-20 minutes each session. Yet, I dilate 4 times a day for 40 minutes each session because I read how one surgeon suggest that anything less than 2 hours a day is not enough to train my neovagina.

Nevertheless, my surgeon insist that his dilators that he recommends is the best in the world and all other fail. Well, I’ve done my research and I’m no longer in a fight by myself on which dilators are the best to use to train the neovagina but also just how much depth is needed to have a successful sex life with an average sized man.

There is a misconception amongst the HBS/Transsexual women that depth is the all important factor in having a successful sexual life with an average size man. It not uncommon that you will hear girls brag about how much depth their surgeons have given them and how much they have maintained. “I have 6 inches of depth.” And another will say, “Yeah, well, I have 8 inches of depth.” I even read how some girls who kept their surgeons dilation schedules to the tee and still lost depth. Is this even possible with just a skin graft?

I would like to start off by mentioning an article written by Dr. Anne Lawrence.  “Vaginal depth in natal females typically ranges from 7 to 14 cm or about 3 to 5-1/2 inches.” According to Dr. Lawrence and her research results, this is the typical depth that most girls end up with postoperative. She mentions that it is highly unlikely that further depth can be achieved with just the typical skin graft procedure due to the peritoneal reflection (The Douglas Pouch) preventing further dissection. The rectovesicle septum is typically 10 to 12 cm or 4 to 5 inches before the surgeon has to stop dissection or he or she will end up into the peritoneal cavity. There no room for curving upwards or downwards, side to side. Nevertheless, this is well within typical range of natal females. The only time that the peritoneal cavity is entered is when we are talking about colon vaginoplasty. Please read the study for further understanding.

Notes on Genital Dimensions

By Dr. Anne Lawrence

Now, I would like to also draw my sisters attention to women born with missing vagina’s or vagina’s that are completely formed, the condition is otherwise known as MRKH. What do these women have in common with us? Well for one, if they choose to go about the McIndoe vaginoplasty, they pretty much have to endure what we HBS/transsexual women must endure. By the way, 1 in 5,000 women are born with this condition. What are their averages in depth? Well, according to the studies that have been conducted over the years, these women have a cavity length of 10-12cm (4-5 inches) and a diameter of 4-5 cm (1.5-2 inches).  The study showed that 7 women led successful sexual lives after the surgery, 6 of them rating excellent depth and 1 rating good.

McIndoe Vaginoplasty: Revisited


Sanjay Saraf MS, MCh. (Plastic Surgery), DNB (Plastic Surgery), MNAMS


Praveena Saraf MS (Gyn/Obs)

I have learned a lot from these studies and I have taken my healing process from the success rate of these women. There just is no need for me to stress myself out about trying to obtain or maintain a depth grater than 6 inches of depth. I do not wish to have grater than 6 inches nor am I trying to reach depths that are grater than 6 inches. For my sisters that insist that they need to be deeper to have successful sex lives, I encourage them to read the studies. The average female is smaller than the average male.

Now, the next topic focuses on which dilators should be used or what I like to think of it as vaginal trainers or vaginal stents. For women with Vaginal Agenesis who have had the McInode procedure done, there is no dilation schedule such as ours. They simply are fitted with vaginal stents which they wear 24/7 only to take off to clean themselves. We on the other hand are told to not wear our stents 24/7 but to dilate as frequently as possible and less as time passes. There is also the dilator debate which I for one have strong reasons why we should not be using dilators with blunt ends or dilators that curve up, down, side to side or that are not good for creating microtears in our neovagina’s.

Dr. Schrang, before he retired, wrote an article on the importance of dilation and the importance of using the proper dilators. He stress that dilators should not be blunted and that they should be designed in a fashion that would create microtears as well as spread the tissue upon insertion. He stressed that dilation should not be painful, as I’ve been told dilation should be painful, and that dilation should be no more than uncomfortable but not painful. Rather than post his entire article here on this post, I’ll just give you the link;

Dilation dilators in Sex Reasignment Surgery

Why do Post-Op Transsexuals have to dilate


Dr. Eugene Schrang, M.D.

To say the least, I’ve come down to the decision to use only one type of dilator and to take my dilation’s at a much slower pace. I will not use any vaginal stents with blunt ends. I will not use any vaginal stents that cause pain. I will not use any vaginal stents that have bends or folds to them, despite being told that this is how a woman vagina is shaped. A woman’s vagina has no bends to it. It does not curve up and it does not curve down. The natal vagina has an angle that when she stands, it goes up and towards the back. Yet, this does not mean that the vagina has a bend to it at all. The vagina itself is straight with no bends to it. Any dilators that have bends to it is simply not natural and can cause problems in the long term as these dilators must be inserted at an angle and then reposition so that the bend can then be positioned pointing upwards towards the navel. This is clearly an improper way to dilate and stretch the neovaginas skin so that microtears are happening and new cells are forming thus increasing depth.

Again, I cannot stress the importance of learning from the McIndoe procedure on just how are they able to obtain such large numbers of success rate that ends with the woman being able to have a successful sex life despite not being 9 inches in depth and 4 inches in diameter. I was able to find another article on the internet that actually showed the vaginal stent that is to stay in place for at least 6 months. The stent is very similar to the stents that I use now which is the vaginismus dilators. My dilators also go under another name in the U.k., Owen Mumford Amielle vaginal dilators. These dilators are graduated dilators and are similar to the dilators that Dr. Schrang wrote about in his article. Femistent would be even more closer but they are very expensive.

Thus ladies, I say again, don’t be fooled by the depth debate. Your goal shouldn’t be how much depth your vagina has. Your goal should be proper healing and maintaining a depth and diameter that is possible for you to have a successful sex life. You don’t need 9 inches and 4 inches of diameter to have a successful sex life. On average, 4-5 inches of depth and 1.5 to 2 inches of diameter will be more than enough to accommodate the average sized man. You might be concerned that he wont fit and you need more depth and withe. Don’t be. All female at some point go through the fear of being able to accommodate a penis in their vagina’s. With proper dilation with the proper dilator you can be successful. Take your time and allow your body to heal.



  1. Anne Lawrence is not a board certified plastic surgeon. Lawrence’s opinions on surgery are just that — opinions.

    But depth is not the sticking point, it is, and always has been girth. Girth hurts, length stretches.

    Lubrication is everything.

    • Thanks for the comment,

      I always wondered why everyone comes down on her so hard. However, she sites studies not from her own opinion but from studies done by others. Her opinions are just that, her opinions. But we cannot deny what studies have shown. It isn’t an opinion to site that the average female is only 10-12cm in depth when not aroused. This is a given fact, scientifically proven. When sexually aroused the vagina can have as much as 20cm of space but this isn’t because the vagina stretch to this length. It due to the fact that the cervix and uterus pulls up which gives the extra space she may need to accommodate the inserted object.

      My point in posting this topic was that so many doctors focus on depth that they fail to realize that it not about the depth at all. A woman with 12cm vagina can comfortably accommodate the average sized man. Of course there are going to be some men that the woman with a 12cm vagina cannot accommodate. This is only typical of any woman. Some women are small and some are large. My surgeon was so happy he gave me 7-8 inches that he kept stressing the importance of dilating using 9 inch dilators. I kept trying to tell him that all I wanted was to be able to have a comfortable sex life with an average sized male, nothing more and nothing less.

      When I quoted him the research results, he didn’t even want to take them into consideration. He told me basically that that was a different procedure and the result did not apply to my situation. I beg to differ in this case. We aren’t much different and the McIndoe procedure is only so much different in such that the women who have the procedure done don’t need to have a clitoris, labia and urethra formed. That’s the only difference. These women still have to have a vaginal cavity formed. These women still have to have that vaginal cavity lined with skin graft. These women still have to dilate just as we do. The exception is that these women wear a stent for 6-7 months only to take them out for bathing purposes. When I asked my surgeon why we don’t have the same process, he told me that the graft would necroses. If that is the case, then why isn’t it the case with these women? Shouldn’t their graft necroses also?

      Well, I’ve made the decision that I’m going to talk with and learn as much as I can from some of these women. As an intersexed person, I belong to a group where quite a few have had this surgery and they can provide me with some well needed information. I refuse to be set aside and herded amongst a group that is so concerned with depth that they fail to realize the focus should be on functionality. My surgeon is board certified, but I don’t think of him as being the final word. I’m choosing to follow the studies.

  2. Good thinking. Red flags go up for me when someone obsesses about depth the way some people do. It’s the *way* they obsess that is troublesome. It’s one thing to worry about normal function as a woman after surgery, as you are, but quite another to get into a reverse penis measuring contest. Sounds like surgical transvestite talk, and we should avoid those types like the plague.

    As for Anne Lawrence- I can’t believe you don’t know why that person is anathema! lol The original fake “transsexual”, trying to legitimize surgery for transvestites at the expense of HBS women.

    Anne Lawrence is a large part of the colonization of the birth condition by fakes, done to access medical treatment and create political legitimacy for sexual fetishists. It’s actually kind of amusing to see Lawrence “working” with Ray Blanchard. lol! It is going to be a shock when The Anne discovers that Blanchard needed a guinea pig, not a colleague. Get some popcorn…

  3. Thank you for such a well presented piece. I found it very informative and thought provoking.

    As for Dr Anne Lawrence.
    I recently stumbled on several “papers” she presented to the HBIGDA. What disturbed me is that she appeared to be corrupting a clearly defined condition by inserting a concept of autogynephilia against it. Why? A word exists that identifies a defined condition – one that is not and has nothing to do with autogynephilia.

    What motivates Dr Lawrence (and others) to do something like this come from. Hijack a word?
    I suspect it could have something to do with her own internalized phobia and in other quarters a moral based judgment in a scientific/medical domain.

    AIS – is – AIS. Inters-exed is not Transvestism nor is it Transsexualism. AIS individuals don’t lie in order to secure appropriate treatment.
    Intersexed individuals don’t lie either, nor do legitimate Transsexual individuals. According to Anne Lawrence autogynephiliacs do lie – in order to access the treatment afforded to others but for fetishistic purposes. Very disturbing. Very dangerous for genuine sufferers of other specific conditions.

    I thank you Jasgreen and ARIA. If you think my post is somehow irrelevant to this blog then please remove it. My purpose is to lend support. That Anne Lawrence seems motivated to act politically for motives that are hardly medical, hardly even political. Rather she appears to be an attempting to legitimize something she feels shame around or just awkward about, something that’s struggling to find legitimacy and credibility on its own basis.


    • I apologize for not responding sooner to your post, I have be neglectful to my posting lately as I sort out my direction in life.

      As for Dr. Anne Lawerence, I don’t read most of what she writes and I’m not even sure what this autogynephiliacs is all about that she and some others are passing around. I do know that you are not the first to mention how upsetting the term is. From a medical point of view I understand what the term says but from a psychological point of view, it does not describe a true transsexual at all.

      Men who become so fascinated by vagina’s that they begin to think that they would love to have a vagina is not a true transsexual at all. This is an entirely different diagnosis in and of itself. It sound very similar to the man who puts on women clothes and for the moment, he is a woman and becomes sexually aroused. For this man, the female attire is his sex appeal. As for the latter man, he sexual arousal goes beyond just putting on women clothes. It’s the vagina itself that becomes the sex arousal. Another distinction needs to be made here from that of a heterosexual male. Under the definition, autogynephilia can occur among heterosexual males. Yet for most heterosexual males, the vagina is a sexual arousal but only to the point that they become aroused at the taught of how it feels to be sexual with a woman.

      So, I think that Dr. Lawerence is making a completely different statement with this term and if she is trying to rename the true transsexual, I believe that she is far from the truth on this issue. There are individuals out there that are autogynephiliacs and therapist may come across a few that insist that they should be able to have surgery. These individuals could present as true transsexual and therapist need to be mindful of the difference.

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