Individuals may undergo surgical vaginoplasty for various reasons. Individuals may be born with congenital conditions associated with variations in vaginal anatomy, such as congenital adrenal hyperplasia, cloacal exstrophy, vaginal stenosis, and vaginal agenesis, for which patients may undergo vaginoplasty. Transgender individuals may seek vulvovaginoplasty for gender affirmation. Finally, some patients may have acquired issues such as malignancies where cancer or its treatment impacts the natal vagina.1 Types of surgical vaginoplasties may include full vaginal grafting, partial vaginal grafting with use of some natal vaginal tissue, or no grafting with mobilization or dilation of natal vaginal tissue. Across types of surgical vaginoplasty and indication, when performed at an age when patients can participate in postoperative care, dilation is often considered critical to maintaining neovaginal patency postoperatively and reducing the risk of complications such as stenosis and loss of vaginal depth.1 Despite near ubiquity of dilation after vaginoplasty, there is a lack of standardized approaches—either within a type of vaginoplasty or across types.

Depending on the type of vaginoplasty, dilation may be used either to increase the depth and width of the vagina (full vaginal dilation [FVD]) or to maintain the opening created without circumferential stricture (circumscribed vaginal dilation [CVD]). Existing dilation research primarily focuses on comparing outcomes after patient-led dilation alone vs surgery for conditions such as Mayer-Rokitansky-Küster-Hauser [MRKH] syndrome.2,3 Studies evaluating postoperative vaginoplasty outcomes recognize dilation as a component of healing but have not evaluated it explicitly, although there are several studies investigating providers’ approach to dilation techniques for specific conditions.4., 5., 6. Gaps remain in understanding the diversity of dilation approaches and their impact on surgical outcomes. There is also a need to understand how surgical teams approach facets of dilation, including patient counseling and education, age appropriateness, type of dilator used, and frequency of dilation. For example, data are lacking on whether surgeons treat dilation differently for different forms of vaginoplasty or consider potential nuances of dilation between CVD and FVD. This study explores clinician approaches to dilation after vaginoplasty to begin to understand perspectives about, and variables felt to be involved in, dilation.