Riley's Story*
Step 1
Riley discovered what mattered
Riley (they/them) is a 28-year-old graphic designer who had been on the waiting list for gender-affirming vaginoplasty for 18 months. While excited about finally aligning their body with their identity, Riley was anxious about recovery, worried about complications and had unanswered questions about what to expect. They'd read conflicting information online about pain, dilation, sexual function and return to work and exercise. Riley felt unprepared and overwhelmed, wishing there was someone who could guide them through the practical aspects of recovery. Hearing this, their psychologist suggested a pelvic health physio. Working with Riley and their healthcare team, we discovered that Riley had reasonable pelvic floor awareness but some anxiety-related tension.
Riley's Pelvic Health Goals:
- Understand exactly what to expect during recovery so I can be fully prepared.
- Learn how to do vaginal dilation correctly and confidently and be able to continue it for as long as needed.
- Return to work within 6-8 weeks and get back to cycling and yoga - they help me feel like myself.
- Eventually experience pleasurable sexual intimacy – alone and with a partner.
- Feel confident and comfortable in my body for the first time in my life.
Step 2
Riley restored what mattered
Pre-Surgery: Understanding the entire process reduced Riley's anxiety significantly. Education about pelvic anatomy, the surgical procedure, and their new anatomy helped them prepare mentally. We started pelvic floor muscle training and Riley was introduced to dilators and how to use them– making the entire recovery much less daunting. Breathing exercises and relaxation techniques gave them tools for managing anxiety and pain.
Post-Surgery: At 2 weeks post-surgery, Riley experienced some granulation tissue, moderate discomfort with dilations and anxiety about whether they were doing everything correctly. We re-assessed healing, checked technique and provided reassurance that recovery was progressing well. Hands-on treatment reduced scar tissue and improved tissue mobility. Progressive dilation training helped build confidence and reduced discomfort, especially using pelvic floor relaxation during these sessions. As healing progressed, we gradually introduced movement practices and specific exercises focussed on returning to yoga and cycling.
Step 3
Riley enjoyed what mattered
After 6 months, dilations had become routine and comfortable, and Riley was back at work, cycling, and yoga. Most significantly, Riley felt at home in their body for the first time. They began dating and had experienced comfortable, pleasurable intimacy. Riley sent us a message after their first yoga class post-surgery: "I cried happy tears in savasana. Not from pain or dysphoria - from joy. This is the body I was meant to have, and you helped me recover so I could fully live in it."