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Longitudinal patient-reported outcomes of vaginal dilation after penile inversion vaginoplasty
Diego A Gomez1, Makenna Ley2, Allison C Hu3
1Mayo Clinic Alix School of Medicine, Mayo Clinic, Phoenix, AZ 85054, United States.
Background:
Penile inversion vaginoplasty (PIV) is a commonly performed gender-affirming procedure that requires postoperative dilation to maintain vaginal canal patency.
Aim:
To characterize patient-reported dilation experiences and evaluate temporal trends in postoperative outcomes.
Methods:
Consecutive patients undergoing primary PIV at a single center were prospectively surveyed at 1, 3, 6, 9, and 12 months postoperatively. Surveys were author-developed based on clinical experience and clinical review. Surveys assessed dilation frequency, session duration, depth achieved, and challenges encountered. Univariate analyzes were used to evaluate changes over time.
Outcomes:
The primary outcome was the proportion of patients reporting any dilation-related challenge over time. Secondary outcomes included adherence metrics (frequency, days/week, session duration), depth achieved, and specific challenges.
Results:
Seventeen of 27 patients completed all survey time points (63% response rate). On average, participants dilated 6.6 ± 1.4 days/week and 2.4 ± 0.9 times/day; sessions lasted 38.3 ± 16 minutes. Mean depth achieved was 4.05 ± 1.32 (13 cm standardized dilator set), with no significant decline over time. All patients reported at least one difficulty, most commonly tightness (71%), bleeding (71%), pain (65%), discharge (47%), and logistical barriers (24%). The prevalence of reported challenges declined significantly after six months (P < .05).
Clinical Implications:
Early dilation-related difficulties are nearly universal and should be anticipated with proactive counseling and structured postoperative support, though symptoms improve over time.
Strengths And Limitations:
This is the first prospective, longitudinal study of dilation following PIV, using an author-developed survey instrument to capture patient-reported outcomes. Limitations include modest sample size, potential response bias, and lack of assessment of challenge severity.
Conclusion:
Reported dilation adherence following PIV is high, but most patients experience early challenges that diminish over time, highlighting the need for anticipatory counseling and individualized, symptom-responsive dilation protocols.
