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Surgery,Recovery and HealingCARE AFTER SURGERY
The Hospital or Surgery Center Check in early and meet your surgical team,including anesthesiologist. Discuss any negative experiences with generalanesthesia with your anesthesiologist and surgeon. Vaginoplasty surgery time 4-6 Hours Vulvoplasty surgery 3 Hours Orchiectomy surgery 2 Hours Labiaplasty 2 Hours After surgery: You will recover in the PACU for 2-3hours. You may feel nauseous, elated, groggy, tearful,thirsty/hungry. Depending on surgery/surgeon, you will bedischarged from PACU or moved to a hospital room.
Recovery ctomyHospital Length ofStay7 nights5-7 nights1 nightoutpatientInitial Recovery6-8 weeks4 weeks2 weeks2-3 weeksNo ActivityRestrictions12 weeks4-6 weeks2-4 weeks4 weeksBack to Baseline6-9 months12 weeks4 weeks4 weeksFollow-up ApptsYesYesYesYes*This graphic illustrates a typical course of recovery, but individual recovery may vary
Hospital Stay Helpful to have a friend or family member present in the room toremember details provided by nurse and surgeon One person is allowed to spend the night with you, if you’d like You may be asked to walk before you feel ready. Walking will helpyou recover more quickly and help decrease complications Main tasks for patients in the hospital are: rest, hydrate, controlpain, ask questions
A Note About Pain It is normal to experience pain and discomfort after surgery Stress associated with untreated and excessive pain can preventhealing While you are in the hospital, communicate with your nursing teamabout your pain level Before you are discharged you will be tapered to oral painmedication Discuss past negative experiences with pain medication or addictionhistory with your surgeon. DO NOT take NSAIDS (ibuprofen, Aleve) for pain for first 7-10 days DO NOT take Tylenol in addition to prescribed pain medications
Normal Healing Incisions There will be incisions along the edges of the labia. These will need tobe kept clean and dry. Applying ointment to the labia incisions may beadvised. Packing (not needed for vulvoplasty)The vagina will be full of gauze packing that will usually be removed onday 6 in the hospital. After the packing is removed from the vagina, the surgeon will giveinstructions about dilating and douching.
Normal Healing Pain Swelling: Expect quite a bit of swelling for a few months post operatively. Sudden swelling requiresurgent attention. Nausea/vomiting: Common reaction to anesthesia as well as narcotic pain medications. Itching: Common reaction to anesthesia as well as narcotic pain medications. Also can be causedby adhesive dressings. Constipation: Take stool softeners to minimize strain and pressure to the genital area Blood in the urine for up to 6 weeks: As your new urethra heals, it is normal to have some blood inyour urine. Incontinence of urine: While your neo-urethra is swollen, it is normal to have some incontinence(leaking). The urethra can remain swollen for up 12 weeks.
Hospital Discharge You will need someone to drive you homefrom surgery You will need someone to be presentwhen you are given discharge instructions Anesthesia impairs short term memoryfunctioning
Caregiving Needs Plan for a caregiver around the clock for about 3-5 days after discharge from the hospital. Have at least one identified caregiver in place. If you can, identify a team of caregivers so noone caregiver is overwhelmed and each caregiver can provide care based on their strengths You will need help with lifting, laundry, cleaning, meal preparation, errands and care forchildren and pets for at least 3-4 weeks after surgery. You may need help with personal care including help in the bathroom with showering andcleaning. It is common for patients to think they have more strength than they actually do in the first fewmonths after surgery. Taking it slow at first is important.
Dilation EXTREMELY IMPORTANT to follow dilation instructions to maintain vaginal depth EXTREMELY DIFFICULT to create more depth if vaginal canal narrows or shortens Surgeon will give you exact instructions about frequency of dilation and show youhow to do it General guidelines are:Month One4x per dayMonth Two3x per dayMonth Three – Month Twelve2x per day and then 1x per day once surgeon gives the okMonth Thirteen – Rest of Your Life1-2x per week May need to increase frequency if dilation starts to feel difficult to maintain thevaginal opening and depth
Troubleshooting DilationWhat to do if dilation is difficult: Increase frequency (number of times per day)Once dilator is inserted, make gentle small circles with dilator, to help stretch tissueIncrease amount of lubricationTry taking pain medication 1 hour before dilationAsk your surgeon about lidocaine jelly (to help with pain)Try using Kegel Nation App (created by Cedars-Sinai Urologist, Maurice Garcia) Helps to isolate pelvic muscles and relax them Call Oakland or San Francisco nurse for advice!
Douching Douching is a method of cleaning the inside of the vagina Surgeon recommends using water based solution with unscentedcastile soap to clean the inside of the vagina Important to follow surgeons directions and not to over use Not recommended to use scented products or chemicaldouches General guidelines: Starting on post op day 8, you should douchethree to four times per week for the first month, then as dischargelessens, you can decrease frequency of douching. Douching will be recommended for lifetime maintenance Recommended to douche after sex when ejaculate is present
A Note About Urine !fter urinating, wipe “front to back” Start by holding tissue at top of vagina(above clitoris) wipe down to base of vaginalopening Urine spray while urinating is normal May take a while for swelling of urethra todecrease and spray to consolidate Urine stream will be permanently changedand will not be a steady single stream
Resuming Activities after Surgeryo Each person’s healing is differento Listen to your body and if hurts, use caution or stop!o General guideline is wait at least 6 weeks beforerestarting moderate activities and obtain clearance fromsurgeono Check in with surgeon about time before driving,swimming, taking a bath, bike riding, and strenuousexerciseo Best to abstain from all nicotine and not to even bearound cigarette smoke for 1 month. If resuming nicotineuse, wait at least one month and avoid excessive alcoholintake.
Sexual Health after Surgeryo Surgeons generally recommend waiting at least 6 months after surgery before beginning penetrative sex (vaginal or anal). Check inwith your surgeon about when it’s ok to start.oClitoral stimulation can be initiated around 2 weeks after surgery or when the patient feels comfortableoIt often takes longer (3-6 months) to feel comfortable with touch and to relearn what feels good.o Just like anyone else who has sex, people who have had vaginoplasty can also get or transmit a sexually transmitted infection (STI) orHIV.o Methods to reduce HIV and STI transmission:oCondoms and lubeoTreatment as Prevention (TasP)oPre-exposure Prophylaxis (PrEP)oPost-exposure prophylaxis (PEP)oClean needle useo Use water-based lubricants to reduce tearing and for increased comfort
Healthcare Tipso Other things to keep in mind to stay healthy:o Your doctor may still want to do routine prostate screenings after age 50o Routine anal paps to screen for anal cancer is recommended if having anal sexo In the first year after surgery vaginoplasty post-op care should be managed by your surgeonoSince you will not have a cervix, there is no need for cervical cancer screenings (pap smears).oContact your surgeon if you experience any pain, new odors, new discharge
What to do if you have concerns? First, contact your surgeon and review symptoms Surgeon may want to see you at the office KP Advice Nurse: 415-833-2200 Ask nurse to page on call plastic surgeon at KP SF If surgeon tells you to go to the emergency room: Go to your nearest Kaiser Permanente ER Tell the ER doctor that you’ve had surgery Ask them to contact your surgeon and the SanFrancisco Kaiser Permanente Plastic SurgeryDepartment
Sample Timeline for Surgery Recovery1 week post-op2 weeks post-op4 weeks post-op6-8 weeks post-op12 weeks post-op6-9 months post-opSurgery24 hour careneededDischargedfrom thehospital1st post-opvisitCaregiving neededfor chores Able toreturn towork/school 2nd post-opvisitMostactivitiespermitted Most swellinggone andsensationstable 3rd post-opvisit
Normal Healing Pain Swelling: Expect quite a bit of swelling for a few months post operatively.Sudden swelling requires urgent attention. Nausea/vomiting: Common reaction to anesthesia as well as narcotic pain medications. Itching: Common reaction to anesthesia as well as narcotic pain medications. Also can be caused by adhesive dressings.
