Post-Surgical Care (Disclaimer)

  • Post-surgical instructions
  • Know what to expect after surgery
  • Take good care of your body
  • Beat the post-surgery blues
  • Mindfully return to usual activities

Post-surgical instructions

GSP BC (Vancouver):

Before your surgery, the Gender Surgery Program BC will provide you with a booklet called “Enhanced Recovery After Surgery” for phalloplasty, metoidioplasty or erectile tissue release surgery. This booklet will provide detailed information about what to expect before and after your surgery, and instructions on how to care for yourself when you go home.

Know what to expect after surgery

Below is a description of what generally happens when you wake up from phalloplasty, metoidioplasty and erectile tissue release surgery. This information is provided to help you start imagining what the hospital experience could be like- you will be given more detailed and up-to-date information once you have your surgical consult and meet your surgical team.

Each surgical centre is different and your surgical team will provide you with more detailed information about what to expect when you wake up from surgery.

In general, here is what you may expect: 

After surgery, you will be moved to the Post Anesthesia Care Unit (PACU). You will feel quite drowsy when you wake up -this is normal. It is also normal to feel sick to your stomach (nauseated) or to throw up after surgery.

Erectile Tissue Release & Metoidioplasty

Some people choose to have erectile tissue release surgery without any additional procedures, while others may choose additional procedures. Information about what to expect for each procedure is below:

Medical equipment

You may have some or all of the following:

  • an oxygen mask
  • an IV line
  • calf compressors to prevent blood clots

Erectile tissue release

You may have bruising and swelling in the groin area (abdomen and thighs).

You will have small incisions on each side of the groin, where the ligaments have been cut.

The erectile tissue will be puffy and swollen. This swelling tends to go away in two-to-four weeks, but could take longer for some.

The tissue may feel tender and uncomfortable while it is healing.

If you did not have urethral lengthening, you will not have a catheter in place. You will be able to urinate as you did before the procedure.

Urethral lengthening

If you had urethral lengthening, you may also have a catheter that starts in your bladder and comes out the tip of your penis to help keep your urethra open- this is called a urethral catheter. You may also have a catheter that starts in the bladder and comes out of your lower abdomen, near the pubic bone- this is called a supra pubic catheter.

Your surgical team will let you know when you can start urinating through your new urethra – this generally happens between 1-3 weeks after surgery.

Experiences of having a catheter can vary. For some people, the catheter may be very uncomfortable. It is important to speak with your surgical team if you have any challenges with your catheter.

While you have your catheter, it is very important to drink enough water to make your urine a pale yellow colour.

Scrotoplasty

It is common to have bruising and swelling in the groin area (abdomen and thighs).

You will have several incisions on the scrotum, including along each side and at the mid-line. It is normal for there to be some dried blood and clearish fluid present at the incisions.

You may also have 1-2 drains at the scrotum to help extra fluid leave your body.

If you are getting testicular implants, this procedure tends to take place around six months after your first surgery.

Vaginectomy

You will have an incision at the site of your vaginectomy. These incisions may feel ‘tight’.

You may experience a sense of aching where the internal tissue was removed.

It is normal for there to be some dried blood and clearish fluid present at the incisions.

Other details

Members of your surgical and post-operative team will check on you frequently.

You may be given some breathing, leg, ankle and arm exercises to do throughout the day. You may feel emotional and very tired- these are normal responses to having a big surgery and if you follow your surgeon’s post-operative instructions, your body will recuperate with time.

Phalloplasty

Medical equipment

You may have some or all of the following:

  • an oxygen mask
  • an IV line
  • calf compressors to prevent blood clots

Bruising

It is normal to have bruising in the groin area (abdomen and thighs)

Penis

Your penis will be swollen. It may be supported in a sling to reduce swelling. It will feel numb.

You will have incisions at the point where your penis connects to your body, and along the underside of the shaft. You will also have some incisions on your scrotum and at the vaginectomy site.

You may have a drain in your groin to help fluid drain from your body.

There may be a small device called an “implanted doppler ultrasound” embedded into the skin of your penis to measure blood flow to the area.

If you had urethral lengthening, you may also have a catheter that starts in your bladder and comes out the tip of your penis to help keep your urethra open- this is called a urethral catheter. You may also have a catheter that starts in the bladder and comes out of your lower abdomen, near the pubic bone- this is called a supra pubic catheter.

Penile donor site

Your penile donor site may have a special dressing called a vacuum assisted closure (VAC)  to your penile donor site, which is connected by a drainage tube to a small, portable vacuum pump.

Skin graft donor site

This area can be quite sensitive or painful, as the nerve endings here are exposed to the air as you heal. It may have some drainage and be covered by a bandage.

Other details

  • Members of your surgical and post-operative team will check on you frequently.
  • You will be on bed rest and nurses will help you with all your care needs.
  • You may be given some breathing, ankle and arm exercises to do throughout the day.
  • You may feel emotional and very tired- these are normal responses to having a big surgery and if you follow your surgeon’s post-operative instructions, your body will recuperate with time.

Take good care of your body

It is important to follow your surgeon’s post-operative instructions. The information below is a brief summary and does not replace the information you receive from your surgeon. If there are any differences, you should follow your surgeon’s instructions.

Everybody recovers at a different pace and it can take several months before you feel like you have all your energy back.

Caring for your incisions

Follow your surgeon’s instructions for how to care for your incisions and donor sites. If you have any questions, don’t be shy to ask. This is a new skill to learn and your surgical team wants to support you to feel comfortable and knowledgeable.

Generally speaking, you should contact your surgeon (or go to the Emergency Room) if you experience the following:

  • Increased swelling in the penis
  • Worsening or spreading redness around your incisions
  • Your incisions become red, swollen or hot to the touch
  • Foul-smelling yellow or green discharge
  • Cloudy, smelly urine
  • Chills or a fever over 38.5 degrees Celsius (101.3 Fahrenheit) by mouth
  • An increase in pain or pain that does not go away with pain medication
  • Persistent severe diarrhea

Take care of your catheter

If you had urethral lengthening, you will have a catheter in place to allow urine to drain from your bladder while your new urethra heals. Many people say that having a catheter in place for a prolonged period of time is one of the most challenging aspects of the overall experience. Here are some general tips that can make having a catheter a bit more comfortable:

  • Drink enough water to have clear, light yellow-colored urine. This will likely mean about eight to ten 8-ounce glasses of fluid every day. This will help to reduce bladder spasms and dilute your urine.
  • Avoid spicy, acidic or citrus foods
  • Avoid alcohol
  • Avoid caffeine
  • Follow any other advice from your surgical team

Manage Pain

It is important to manage your pain well so that you can sleep through the night, slowly re-start your usual daily activities, and follow the aftercare instructions from your surgeon.

Wash Hands Frequently

Always wash your hands with soap before and after touching your genitals. This will help prevent infection.

Get Lots of Rest

You may feel very tired after your surgery. Plan to do less activity during the day and allow yourself to nap. Your body needs extra sleep while you are healing. Relaxation techniques can help your body heal from surgery, too. They reduce the effects of stress on your body, letting your body’s systems focus on healing.

Many people share that they were surprised by how exhausted and weak they felt after lower surgery. This is a very complex surgery and it can take 6-8 weeks to recover. Remember that your body does its healing while you are resting. Take naps or rest breaks during the day and trust that you will slowly build up your energy and strength again. 

Walk

Walking helps to relieve pain, improve blood flow and prevent blood clots. It can also be good for your mood. However, it is important to be gentle and not push yourself. Your surgical team will provide you with instructions about when and how you can start walking. Begin with short walks and slowly increase how far you walk. Many people find that using a walker or a cane at first is helpful. If walking is not an option for you, speak with your health care providers about alternative options, like leg and deep breathing or coughing exercises.

Enjoy foods that promote wound healing

Look for foods with protein (meats, eggs and nuts); zinc (whole grains, spinach, nuts); vitamin A (carrots, broccoli, eggs); & Vitamin C (strawberries, peppers). Your body will need extra calories, proteins and nutrients to heal. If you have questions, you may find it helpful to speak with a dietician. You can contact a dietician by calling 8-1-1 (Health Link BC). 

Drink Lots of Water

It is important to drink lots of water (2-3 litres/day) and empty your bladder regularly. This helps to prevent urinary tract infections.

Manage Constipation

Constipation is a common side-effect of pain medication. If you experience this, try increasing the number of walks you take, drinking more water, eating more fruits and vegetables, eating prunes, or taking a stool softener. Get protein from food sources other than dairy. If constipation continues for several days, speak to your healthcare provider.

Avoid Alcohol and Tobacco

Avoid consuming alcohol and tobacco. If you have any questions about this, speak with your surgical team.

Attend Your Check-Ups

GSP BC:

You will be given your post-operative follow up plan before you go home. If you traveled to Vancouver, you will be expected to stay in the Lower Mainland for 3-4 weeks after discharge so you can attend in-person follow up appointments with your surgical team. All your follow up care will be completed by the surgical team at GSP BC.

You may want to arrange to see your NP or GP within a week of going home as well. They will review your post-operative baseline and see how you’re feeling.

Beat the post-surgery blues

The after-effects of medications, surgery and the activity limitations required during recovery can lead to something called ‘post-operative blues.’ This can include feelings of low mood, loss of appetite, difficulty concentrating and even self-doubt. This is a temporary and normal part of the healing period. Here are some suggestions for making it easier.

  • Put your self-care plan from your Surgery Workbook into action. See below.
  • Before surgery, ask yourself:
    • What does it look like when I start to feel low?
    • How will people know that I’m feeling that way?
    • Who can I share this information with in advance?
  • Make lists of things you love and reflect on how you can experience more of what you love while you heal from surgery (eg. lists of activities that bring you joy, ways that you connect with others, ways that you show yourself love, foods you love to eat, smells that calm & refresh you, sounds that inspire you, textures that you love to feel on your skin).
  • Write letters expressing thanks to people who helped you during surgery
  • Keep a journal

Self-Care Planning Exercises

Here are some holistic self-care planning exercises to help you prepare for before and after surgery. These exercises are also included in the Surgery Workbook.

Mindfully return to usual activities

Ask your surgeon when you can resume your usual activities. The information below are some common post-operative recommendations and does not replace the information you receive from your surgeon. If there are any difference, you should follow your surgeon’s instructions.

Driving

Avoid driving until you are no longer taking any opiate pain medication or feeling distracted by pain. Only drive if you are able to:

  • Put pressure on the break quickly and without pain
  • Safely do a shoulder check
  • Wear your seat belt

Start with short trips so as not to put too much pressure on your genitals. If you drive long distances, take frequent stops & pee often.

Lifting, Pulling and Pushing

Avoid lifting objects over ten pounds until 4 to 6 weeks after surgery, including carrying children, pets and groceries.

Work

Plan to take at least 6-8 weeks off work, or longer, depending on type of work and how you are healing.

Exercise

A general rule is to wait until 6-8 weeks after your surgery before participating in intense physical activity. Speak with your surgeon about how you can restart any activity, including exercise.

Rest

Rest is important for your recovery. Your body does its healing while you rest. Take naps or rest breaks during the day.

Sexual Activity

Lots of people have questions about returning to sexual activity after surgery. This can include, but is not limited to, masturbation and sex with other people. As with all other activities, speak with your surgeon about when it is safe for you to be sexually active after surgery.

Exploring how your body feels and responds after surgery is an important step in your healing process. It stimulates the nerve endings, helping them heal and reconnect, and allows you to begin the process of finding where and how you enjoy being touched. It also helps your brain to create a new “map” of your body.

First 10 days after surgery

First 10 days after surgery:

Avoid activities that can lead to elevated blood pressure and the risk of internal bleeding (hematoma).

This includes:

  • Having any kind of sex (alone or with a partner)
  • Having an orgasm
  • Other activities that create risks for bleeding, increase the risk of discomfort or pain or that may disrupt your anatomy while it heals

8 weeks after surgery

  • Your genitals will be numb at this time and your incisions are still vulnerable. It is important to follow all the post-operative instructions and be very gentle with your penis.
  • Do not place anything inside your genitals or rectum beyond what has been recommended by your surgeon(s).
  • Workbook for Phalloplasty, Metoidioplasty and Erectile Tissue Release Surgery in BC for some suggested mindfulness activities.

12 weeks after surgery

12 weeks after surgery:

If you have had metoidioplasty or erectile tissue release surgery, your surgeons will give you customized information about when it is safe to start using a pump for getting erections.

Once your surgical team tells you that you’re ready to use your genitals for sexual activity, here is some general information for returning to sexual activity after surgery:

  • Follow your surgeons’ recommendations regarding return to sexual and other physical activities.
  • Take time to learn your body’s needs and preferences.
  • Ease back into your sexual activities.
  • You may find your sex drive is different from before surgery. It might be lower during your healing period or you might find it’s higher.
  • Everyone is different. It’s important to know that changes to your sex drive are a normal part of your healing journey and will balance out over time.
  • Do not place anything inside your genitals or rectum other than what has been recommended by your surgeon(s).
  • You may find that your endurance or tolerance for different activities and sensations is affected by your surgery or pain medications.
  • Stop or take a break if you feel pain, or you feel anxious or scared.
  • Pay attention to whether your swelling or tenderness increases after sex. If so, you may want to wait until you are a bit further along in your healing before having sex again.
  • Pee before and after sexual activity to reduce the chances of urinary tract infections.
  • Avoid activities that can lead to internal or external bleeding, compromised blood flow, and injury to nerves and healing tissues. This includes:
    • tiring and repetitive movements
    • activities that could affect (stretch/tear) incisions (inner or outer) until your surgeon confirms that your incisions have healed
    • sudden or vigorous movements
    • lifting more than 10-15 lbs
    • strenuous activity (including sex)
    • bondage, suspension, pinching, squeezing, vigorous massage
      flogging, spanking, and paddling buttocks, thighs and other non-genital areas
    • very hot and very cold temperatures until nerves have fully healed
  • It can be helpful to speak with your surgeons before starting any kink activities in the months after surgery. Your surgeon will likely welcome these questions. If you are shy, you can be creative and ask about returning to full contact sports, swinging a tennis racket, receiving vigorous massage, riding a horse, using a heating pad or wearing restrictive or body-shaping clothing.

A note on safer sex and STI screening

Many people find that they are better able to relax and enjoy sex with others if they have spoken with their partner(s) about sexual health and STI screening.

It is possible to get sexually transmitted infections (STIs) after phalloplasty, metoidioplasty or erectile tissue release. The following recommendations can help reduce the chance of getting an STI. These recommendations are general and apply to anyone, whether they have had a genital surgery or not. Not every recommendation will apply to you, but they are helpful to be aware of:

  • Wear a condom during sex.
  • Make a habit of regularly checking that the condom has not torn or fallen off. The shaft of your penis will likely be numb for the first 12 months after surgery, so you may not feel it if this happens.
  • Ask your partner(s) to wear condoms during receptive sex (including genital and anal sex).
  • Ask your partners to have STI screening, including chlamydia, gonorrhea, HIV and syphilis.
  • Avoid having genital sex (or use condoms) if you have genital irritation or inflammation.
  • Speak with your GP or NP about how often you would benefit from getting STI screening (this is based on your sexual activities).

Learn about HIV Pre-Exposure Prophylaxis (HIV PrEP) and speak with your GP or NP if you think this might be a good option for you.

Attention: The information on this website is a brief summary of what you might expect after surgery and does not replace the information you receive from your surgeon. If there are any differences, you should follow your surgeon’s instructions.