Qualitative Assessment of Provider Approaches to Dilation after Vaginoplasty

Most surgical vaginoplasties are followed postoperatively, when age appropriate, by patient-led dilation to maintain patency, but there is a lack of both standardized protocols and research comparing dilation practices within and across surgical routes. This study's objective was to determine surgeon attitudes about dilation and learn what protocols they use and endorse to take steps toward addressing the literature gap around dilation practices and outcomes.

We performed semi-structured interviews about dilation practices with 10 providers (9 surgeons, 1 nurse) involved in vaginoplasty at a single tertiary care children's hospital. The interview recordings were transcribed, and thematic analysis was performed using an iterative process of coding, re-coding, and generation of themes.

Three major themes were generated from the analysis. First, interviewees described variable definitions of success regarding dilation after vaginoplasty, describing both patient-centered and anatomically objective outcomes. They also discussed a lack of standardization of techniques, with many echoing confusion or frustration regarding this, both in training and in practice. Finally, they described the ad hoc inclusion of behavioral health as a collaborator for patient dilation education. This was reviewed as something often believed to be necessary to dilation success but not explicitly included in dilation protocols.

This study of clinicians' experiences with dilation after vaginoplasty highlights the diversity of approaches used, the lack of standardization in training, and the gaps in existing research to inform best practices.