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Vaginoplasty for Gender Affirmation: What to Expect at Home

Your Recovery

Vaginoplasty is surgery to create a vulva and a vagina. The vulva includes the labia, clitoris, and urethra. The scrotum was most likely used to form the labia. The head of the penis was used to create a clitoris. The urethra was shortened and placed below the clitoris.

The doctor used the skin of the penis to form the vaginal wall. If extra skin was needed, it may have come from the lower belly, hip, or scrotum. If you had robotic surgery, the doctor may have used skin from the penis, scrotum, and the lining of the belly (peritoneum).

You may need a urinary catheter for about 4 to 5 days. This is a flexible plastic tube used to drain urine from your bladder. If the catheter is still in place when you go home, your doctor will give you instructions on how to care for it.

You will have a dressing (bandage) over the surgical site that includes a gauze packing in your vagina. You will have it for about 3 to 5 days. The packing will be removed by your doctor.

The surgical area will be bruised and swollen. Most of the swelling should go away in 6 to 8 weeks.

You may have vaginal drainage for about 4 to 6 weeks. It may have an odour, and it may look brownish yellow. You can expect some vaginal bleeding and spotting for a month or more. Use sanitary pads, not tampons, for bleeding.

You will need to dilate your vagina. Your doctor will tell you how to do this and how often. It's important to follow your doctor's instructions to prevent losing vaginal depth and width. When to dilate, how often, and how long may be different for each person.

You will probably feel better and stronger each day. But you may get tired easily or have less energy than usual. This may last for several weeks after surgery.

This care sheet gives you a general idea about how long it will take for you to recover. But each person recovers at a different pace. Follow the steps below to get better as quickly as possible.

How can you care for yourself at home?

Activity

Allow your body to heal. Don't move quickly, lift anything heavy, or do any activities until your doctor says it's okay. This includes walking, jogging, biking, weight lifting, and aerobic exercise.
Rest when you feel tired. Getting enough sleep will help you recover.
Be active if your doctor says it's okay. It can help prevent problems and help you recover. Walking is a good option for many. Talk to your doctor before you begin any activity, including walking. Tell your doctor right away if you develop discomfort, pain, or changes in your surgical area.
Your doctor will tell you when you can return to work. This will depend on the surgery you had and the type of work you do.
If it hurts to sit, try sitting on a donut-style pillow or leaning back (reclined).
Ask your doctor when it's okay for you to have sex.
Ask your doctor when you can drive again.

Diet

You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
If your bowel movements are not regular right after surgery, try to avoid constipation and straining. Drink plenty of water. Your doctor will likely suggest fibre, a stool softener, or a mild laxative.

Medicines

Your doctor will tell you if and when you can restart your medicines, including hormones. The doctor will also give you instructions about taking any new medicines.
If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
Be safe with medicines. Read and follow all instructions on the label.
- If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
- If the doctor gave you a prescription medicine for pain, take it as prescribed.
- Store your prescription pain medicines where no one else can get to them. When you are done using them, dispose of them quickly and safely. Your local pharmacy or hospital may have a drop-off site.
If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

Incision care

Follow your doctor's instructions for how to care for your incision.
Keep the surgical areas clean and dry. Wash the area daily with warm water, and pat it dry. Don't use hydrogen peroxide or alcohol. They can slow healing.
You may have one or more drains. Your doctor will tell you how to take care of them.
While you're healing, wear the type of underwear your doctor recommends.

Ice

You can try using ice on the area to help with swelling and soreness. Find out what your doctor recommends.

Hygiene

Your doctor will tell you when you can take a shower. Do not take a bath, swim, or use a hot tub until your doctor tells you it is okay.
Wash your hands before and after contact with the genital area.
Gently pat dry front-to-back after using the toilet.
Vaginal douching may be recommended by your doctor. Follow your doctor's instructions on how to do this and how often to do it.

Other instructions

Use pads. Do not use tampons. You may have a yellowish brown vaginal drainage, odour, bleeding, or spotting for several weeks. This is normal.
You may have gauze packing in your vagina. Your doctor will remove it.
You will need to dilate your vagina. Your doctor will tell you when, how often, and how long to dilate.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line (811 in most provinces and territories) if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

You have severe bleeding that won't stop.
You passed out (lost consciousness).
You have chest pain, are short of breath, or cough up blood.

Call your doctor or nurse advice line now or seek immediate medical care if:

You are sick to your stomach or cannot drink fluids.
You have pain that does not get better after you take pain medicine.
You have loose stitches, or your incision comes open.
You are bleeding from the incision or you have vaginal bleeding that is more than spotting.
Bloody drainage from a drain increases or won't stop.
You have bruising and swelling that gets worse.
You have signs of infection, such as:
- Increased pain, swelling, warmth, or redness.
- Red streaks leading from the incision.
- Pus draining from the incision.
- A fever.
- Vaginal drainage that has increased in amount or smells bad.
You have signs of a blood clot in your leg (called deep vein thrombosis), such as:
- Pain in the calf, back of the knee, thigh, or groin.
- Swelling in the leg or groin.
- A colour change on the leg or groin. The skin may be reddish or purplish, depending on your usual skin colour.
You have symptoms of a urinary tract infection. These may include:
- Pain or burning when you urinate.
- A frequent need to urinate without being able to pass much urine.
- Pain in your lower back (below the rib cage and above the waist).
- Blood in your urine.
You cannot pass stools or gas.

Watch closely for changes in your health, and be sure to contact your doctor or nurse advice line if:

You can't dilate because of pain or have increasing pain when you dilate.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

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Care instructions adapted under license by your healthcare professional. If you have questions about a medical condition or this instruction, always ask your healthcare professional. Healthwise, Incorporated disclaims any warranty or liability for your use of this information.