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

It is important to follow your surgeon’s instructions for aftercare.

The information in this guide is a brief summary and does not replace the information you receive from your surgeon. If there are any differences between your surgeon’s instructions and the content found in this guide, you should follow your surgeon’s instructions.

GSP BC (Vancouver):

Before your surgery, the Gender Surgery Program of BC will provide you with a booklet called “Enhanced recovery After Surgery” for Vaginoplasty. 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.

GRS Montreal:

You can find examples of GRS Montreal’s post-surgical instructions on their website:

Know what to expect after surgery

It takes about one year to fully recover from lower surgery. During this time, expect the appearance of your genitals to continue to change quite a bit.

The Surgical Site

For the first few days after surgery, you will have:

  • a large gauze dressing over your vulva,
  • a surgical drain in your mons to stop fluid from building up in your body,
  • A urinary catheter to drain pee,
  • A stent inside your vagina to help maintain depth (for vaginoplasty only). The labia will be temporarily sewn together to hold the stent in place.

Bruising and Swelling

It is normal to have bruising and swelling after surgery. The bruising may go from your hips to your knees. You may have more swelling on one side than the other and it can change throughout the day. It will go down gradually, taking up to 6 months to resolve.

Your vulva will get smaller as your swelling goes down. This might make it seem like you are losing vaginal depth because your vulva will cover less of the dilator when you are looking down at it. Keep in mind that the depth of your vagina is measured from your vaginal opening to the back, and not from the outer edge of the labia.

Blood Clot on Clitoris

It is normal to have a blood clot on your clitoris. Do not pull it off. It will fall off on its own.

Vaginal Discharge (for vaginoplasty only)

Vaginal discharge is made up of lubricant and skin cells. It may be tinged with small amounts of blood. It is normal for vaginal discharge to have a healthy smell. If the smell changes significantly, or becomes very strong, speak with your surgeon, doctor or nurse practitioner.

Fibrin

Fibrin is the yellowish stuff that builds up around your wounds. It should dry up and falloff on its own. If your wound is too moist, it won’t dry up and fall off. This is why you’ll be asked to expose your surgical site to air as much as possible. If the fibrin is building up a lot and not falling off, speak with your healthcare provider.

Peeing

In the first few months after surgery, your urine may spray or dribble rather than come out in a straight line. This is caused by swelling around the urethra, the opening that pee comes from. As the swelling goes down, the spraying and dribbling should stop.

Incisions and Scars

Your incisions will be closed with sutures. These sutures will dissolve within 1-3 months. Talk to your surgeon if you find that your scars are starting to thicken up.

Changes in Sensation

It is common to have numbness or less sensation in some areas. It can take 6-12 months for the nerve endings to heal or grow back in these areas. Once in a while, you might even feel prickly, stinging, or burning sensations as the nerves heal and grow. There can be permanent changes to sensation, including areas of complete numbness or hypersensitivity.

Take good care of your body

Check for Signs of Infection

Talk to your healthcare provider if you experience:

  • Redness around your incisions
  • Heat around the incisions
  • Foul-smelling yellow or green discharge
  • Chills or a fever over 38.5 degrees Celsius (101.3 Fahrenheit) by mouth
  • An increase in pain at the surgical site

Check for Signs of Urinary Tract Infection

Talk to your healthcare provider if you experience:

  • Burning sensation when peeing
  • Peeing often in small amounts
  • Pee that is cloudy, pink, or brown and foul-smelling
  • Pain in your pelvis, back, or rectum
  • Chills or a fever over 38.5 degrees Celsius (101.3 Fahrenheit) by mouth

Check for Signs of Hypergranulation tissue

Talk to your healthcare provider if you experience:

  • Blood in your discharge or on your dilator
  • Areas of bright red tissue that bleed easily

It is not uncommon to develop hypergranulation tissue within weeks or months after surgery. There are various treatment options that your health care provider can suggest.

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 your dilation schedule.

  • Stick to a pain medication schedule. Don’t wait to take medication once the pain is overwhelming, as your pain will be harder to control.
  • You may wish to use the pain medication tracking chart in the Workbook for Vaginoplasty and Vulvoplasty Surgery.
  • You can also apply ice to the area as recommended by your surgeon.

Wash Hands Frequently

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

Take Sitz Baths

About four days after surgery, a nurse will show you how to take a sitz bath. A sitz bath involves bathing your genitals with warm, soapy water. There are two methods:you can sit in a bathtub or you can place a special sitz bath bin on your toilet seat. Follow your surgeon’s instructions about how to bathe yourself, type of soap to use, and air drying your genitals afterwards. You’ll have a sitz bath twice a day for two months.

Dilate (for vaginoplasty only)

About five days after surgery, a nurse will show you how to dilate. A dilator is a device used to keep the width and depth of your vagina. You will be given a set of dilators with many different sizes and a schedule for using them. It is important to follow your dilation schedule because once width or depth has been lost, it cannot be regained again. Dilating can be uncomfortable, especially in the beginning. You may want to:

  • Time your pain medication so that discomfort is well managed during dilation
  • Urinate or have a bowel movement before you dilate
  • Drink a small glass of water first
  • Distract yourself with some music or a podcast, movie, or guided meditation.

Dilating will become part of your regular routine throughout your life.

HOT TIP: You may find this guided mindfulness activity for dilation by Dustienne at YourPlace Yoga to be helpful.

Douche (for vaginoplasty only)

About five days after surgery, a nurse will show you how to cleanse your vagina by douching. A douche is a device used to squirt saline solution (and later, water) into your vagina to clear out dead skin so that your body heals properly. Your surgeon will provide details about how often  to douche. Douching will become part of your regular routine throughout your life.

Expose Vulva and Perineum to Air

The vaginal opening and perineum (area between the vulva and anus) are often the slowest to heal. This is caused by pressure on the area when sitting; friction from dilation; and dampness from discharge, lube, and aftercare activities. Keep this area exposed to air as much as possible to help it dry out and heal well.

Walk

Walk for 15-20 minutes at least 4 times a day. Walking helps to relieve pain, improve blood flow and prevent blood clots. It can also be good for your mood. If walking is not an option for you, speak with your health care providers about alternative options, like leg and deep breathing exercises.

Get Lots of Rest

You may feel very tired after vaginoplasty. 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 the healing process.

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. Drinking a glass or two of cranberry juice each day also helps.

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.

Massage Your Scars

Massage your scars once your incisions close (usually around Week 4) using a cream recommended by your surgeon. Remember to wash your hands with soap before and after to prevent infection.

Avoid Alcohol and Tobacco

Avoid alcohol for at least two weeks and tobacco for at least 6 weeks after surgery.

Attend Your Check-Ups

It is a good idea to have appointments booked with your health care provider for when you get home from Montreal.  Your health care provider will make sure your incisions are healing well. They may ask about pain, bleeding, bowel movements, fever, and how you are feeling physically and emotionally. They will also ask questions about how you are managing your dilations and aftercare activities.

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.

Common recommendations are listed below:

Rest

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

Driving

Avoid driving for 2-4 weeks and until you are no longer taking any opiate pain medication or feeling distracted by pain. 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

Avoid lifting objects over ten pounds until 4-6 weeks after surgery.

Work

Take at least 8-12 weeks off work, or longer, depending on the type of work and how you are healing. Check with your surgeon, GP, or NP before going back to work.

Exercise

Ask your surgeon about when it is safe for you to resume exercising. It is usually recommended to wait for 8-12 weeks after surgery before participating in physical activity.

Your surgical team may recommend you have a session with a pelvic floor physiotherapist prior to/or after surgery. This will help teach you how to relax the muscles in your pelvic area, which can help with dilations and future sexual activity. You may be surprised how tired you feel when you start exercising again- this is a normal feeling. Your energy levels will improve as you continue to heal.

  • Continue with your deep breathing and coughing exercises
  • Begin by taking short walks, and gradually increase how far you walk
  • You may notice a connection between exercise and the feelings of increased tenderness or swelling the next day
  • Adjust your activity levels according to the feedback from your body

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

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
  • 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

  • You can usually begin to gently explore the clitoral area
  • Using vibrators on different settings (low, medium, or high) or with different motors (rumbly or buzzy) may be helpful
  • Many of your sensitive nerve endings are located just above and at your clitoris, so touching, massaging, or using a vibrator in this area can be useful
  • Do not place anything inside your vagina or rectum beyond what has been recommended by your surgeon(s)
  • See the Workbook for Vaginoplasty and Vulvoplasty Surgery in BC for some suggested mindfulness activities.

12 weeks after surgery

Wait until 12 weeks after surgery before having oral, vaginal, and anal sex. Some people may need to wait longer depending on their healing and pain levels.

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 vagina or rectum other than what has been recommended by your surgeon(s).
  • Most people need to use lubricant during vaginal sex- this helps to increase sensations of pleasure and also prevent uncomfortable friction or skin tearing.
    • Some people like to use a different kind of lubricant than the one they use during dilation, though this is optional.
    • If you and your partner(s) use condoms, choose water- or silicon-based lubricant.
  • You may find that your endurance or tolerance for different activities and sensations is affected by your surgery or pain medications.
  • You may feel gentle stretching of your vagina or vaginal opening during sex- this can be normal.
  • 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 (your urethra is shorter now and bacteria can easily get pushed inside during sexual contact).
  • 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, 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 BDSM 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 partner sex if they have spoken with their partner(s) about sexual health and STI screening.

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

  • Ask your partner(s) to wear condoms during sex (including vaginal and anal sex)
  • Ask your partners to have STI screening, including chlamydia, gonorrhea, HIV and syphilis.
  • Avoid having vaginal sex (or use condoms) if you have vaginal irritation or inflammation (for example, hypergranulation tissue)
  • 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: This section is to supplement what you receive from your surgeon. If there are any differences, you should follow the advice provided by your surgeon.