Qualitative assessment of provider approaches to dilation following vaginoplasty.

Study objective: Most surgical vaginoplasties are followed post-operatively, 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 is to determine surgeon attitudes about dilation and learn what protocols they use and endorse to take steps towards addressing the literature gap around dilation practices and outcomes.

Methods: We performed semi-structured interviews with ten providers (nine surgeons, one nurse) involved in vaginoplasty at a single tertiary care children's hospital about their dilation practices. These recordings were then transcribed, and thematic analysis was performed using an iterative process of coding, re-coding, and generation of themes RESULTS: Three major themes were generated from analysis. First, interviewees described variable definitions of success regarding dilation post-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 felt necessary to dilation success while not explicitly included in dilation protocols.

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