Five months after vaginoplasty and dilation still feels like hitting a wall. Is pelvic floor physio worth asking for?

Some of you will remember my blues thread from the summer. Mood is genuinely much better now, so this is a different thing.

Surgery was mid May, so about four and a half months. Dilation is happening, on schedule, every time. But it is still a fight. There is a point about two thirds of the way in where everything just tightens and I have to stop and breathe and wait and sometimes it gives and sometimes it does not. My follow up said depth looked fine, which makes it more confusing, because if the depth is there why can I not get to it without it feeling like a door slamming?

I also leak a little when I cough now, which I never did before, and I have been too embarrassed to mention it to anyone.

Someone in a group chat said "get a pelvic floor physio" and I did not even know that was a thing for us. Has anyone actually done this? Did it help? How do you even get one?

The door slamming thing. Yes. Mine was a muscle, not the surgery, and it took me an embarrassingly long time to realise I was clenching before I had even started, like bracing for a jab.

I never saw a physio, I learned to breathe out on the way in from a video my surgical team sent, but if someone had offered me a physio I would have bitten their hand off.

I am only a month out so no wisdom on the wall, but my centre actually gave me a leaflet about pelvic floor physio at discharge and I had not opened it until I read your post. It says to ask at the six week review if dilation is "persistently painful or difficult". So it is definitely a thing some places offer. Ask yours.

Rosa, I am so glad to hear the mood has lifted, and thank you for saying the leaking part out loud, because it is far more common than people admit and it is one of the things a physiotherapist works on.

I am not a clinician, and your own team is the one to ask, but I can tell you what I learned when I went down exactly this road in my fourth month. A pelvic floor physiotherapist assesses the muscles at the base of the pelvis, the ones the new canal passes through, and works out whether they are weak, tense or not coordinating well. A wall partway in, when your team says the depth is there, is very often those muscles tightening rather than anything to do with the surgery. They can be taught to let go, which is mostly breathing, positioning and noticing when you clench, rather than squeezing harder.

A published study of a programme that referred everyone found that 42% of people had pelvic floor problems before vaginoplasty, and most of those improved with physio around surgery. It is a small study, but it tells you you are far from unusual. Four appointments did more for me than I expected, and the dilation side of letting those muscles relax is in learning to dilate.

How to get one: ask your surgical team first, because some have a physio attached or a standard referral route. If not, your GP can refer you to a local pelvic health service. Name the operation and the specific problems, the wall and the leak with coughing, so the referral lands with someone who can help. And if they suggest an internal examination, that is always your choice and you can say no or stop.

Jessica Tran said:

very often those muscles tightening rather than anything to do with the surgery

I think I needed someone to say that, because I have been quietly convinced for months that something went wrong in theatre and nobody was telling me.

Emailed the surgical team tonight with both things listed. Kerry-Anne, thank you for reading your leaflet on my behalf.

Update. Surgical team referred me to a pelvic health physio they work with, first appointment was last week. Mostly a long conversation, then some breathing and positions to try, and she said the muscles were "guarding" which is apparently extremely common after this surgery.

One week in and it is not fixed, but twice now I have got past the wall without stopping. That has not happened since July. Leak is on her list for next time.