Recovering from surgery | Trans Care BC

Important

It is important to follow your surgeon’s instructions for aftercare. If there are any differences between the information on this website and the instructions your surgeon provides, you should follow the surgeon’s advice.

Recovery guides

Gender Surgery Program B.C.

Before your surgery, the Gender Surgery Program of B.C. will provide you with a workbook called Enhanced Recovery After Surgery (ERAS). 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 GrS Montreal’s post-surgical instructions on their website:

What to expect immediately after surgery

This section provides a general description so that you can imagine the experience of waking up from surgery. You’ll receive more detailed information from your surgical team.

In general, you can expect the following:

After surgery, you will be moved to the Post Anesthesia Care Unit (PACU). You will feel quite drowsy when you wake up, which is normal. It is also normal if you feel sick to your stomach or throw up after surgery.
Members of your surgical and postoperative 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 postoperative instructions, your body will recuperate with time.

You can also expect to wake up with the following items:

You may have an oxygen mask, an IV line and calf compressors to prevent blood clots
Your vulva will be covered by a large gauze dressing
You will have a surgical drain in your mons to stop fluid from building up in your body
You have a catheter to drain your urine.
- 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.

If you have had vaginoplasty you will also have a stent inside your vagina to help maintain depth. The labia will be temporarily sewn together to hold the stent in place.

What to expect while you heal

After surgery, you’ll likely be prescribed painkillers to make you comfortable and antibiotics to reduce the chance of infection.

As a normal part of the healing process, you should expect:

Bruising and swelling — It is common to have bruising and swelling. You may have this in more than one area and it can change throughout the day. Swelling should go down gradually and take up to six months to resolve. Your vulva will get smaller as your swelling goes down. If your swelling seems to be worsening, speak with your surgical team as soon as possible. (Note: If you have had vaginoplasty, a reduction in swelling may 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.)
Clotted blood or a scab on clitoris — This is normal and will fall off on its own. Do not pull it off.
Fibrin — This is a yellowish substance that builds up around wounds. It should dry up and fall off on its own. If your surgical area is too moist, the fibrin 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 health care 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 and should stop as the swelling goes down.
Changes in sensation — It is quite common to experience changes in sensation in your groin area. It can take 6–12 months for your nerve endings to heal or grow back. Once in a while, you might even feel prickly, stinging or burning sensations as the nerves heal and grow. There can also be permanent changes to sensation, including areas of complete numbness or hypersensitivity. Most people maintain the ability to have an orgasm.
Itchiness — It is also common to experience itchiness after surgery. It can be caused by your swelling going down or an allergic reaction to the adhesive in your bandages. Try to avoid scratching the itchy area as scratching can break the skin and cause infection. If you’re also experiencing swelling and redness as well as itchiness, this can be a sign of infection. Ask your health care provider how to manage itchiness.
Incisions and scars — Your incision lines can become red or bumpy as they heal. You will have some drainage from the incision sites as well. Talk to your surgeon if you find that your incision line scars are starting to thicken.

If you have had vaginoplasty you may also have:

Vaginal discharge — This is made up of lubricant and skin cells. It may be tinged with small amounts of blood and it’s common for vaginal discharge to have a mild smell. If the smell changes significantly, or becomes very strong, speak with your surgeon, physician or nurse practitioner.

When to get medical help

Pay close attention to the parts of your body affected by your surgery. Being aware of possible complications and knowing signs of infection are vitally important.

In general, you should contact your surgeon (or go to the nearest hospital emergency room) if you experience any of the following:

Your pain gets worse or does not go away with pain medication.
The tissue becomes cold to the touch or the skin becomes darker
You have a fever over 38.5° C (101.3° F).
Your incision becomes red, swollen or hot to touch, or the edges begin to separate and the redness gets worse or spreads.
You notice green or yellow liquid or a foul smell coming from your incision.
You start bleeding from your incision.
Difficulties with swallowing resulting in a decreased appetite and constant weight loss.
You feel sick to your stomach (nauseated) or throw up (vomit) often for more than 24 hours.
You have diarrhea that lasts for more than 2 days.
No bowel function for 48 hours.
You are unable to pee or your catheter is not draining.
If you experience any pain, aching or redness in your calves or swelling of the legs.
You have difficulty breathing.
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
Blood in your discharge or on your dilator
Areas of bright red tissue that bleed easily

Tips to help recovery

Your recovery is affected by the type of surgery, your body’s reaction to the surgery and other factors. In general, many people are able to return to their regular activities, including work, within 6–8 weeks. Depending on the type of work and your healing, you may need longer.

Your primary care provider and surgical team can help you to come up with a plan to return to work more gradually. As with all activities after surgery, it will be important to pace yourself and plan in extra time to rest and recover.

Remember, proper rest helps speed this process.

We’ve provided some general information regarding how to recover well from surgery, but it’s important to follow your surgeon’s instructions.

Caring for your incisions

Your incisions and donor sites will require care. Your surgeon will provide you with instructions on how to do this. Wound care is something new for most people so don’t be shy to ask questions. Your surgical team wants to support you to feel comfortable and knowledgeable.

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.

Stick to a pain medication schedule. Don’t wait to take medication once the pain is overwhelming, as it will be harder to control. You can use the pain medication tracking chart in the Vaginoplasty and Vulvoplasty Workbook.
Avoid rubbing or scratching your incisions as they heal. Itchiness is a normal part of the healing process.

Wash hands frequently

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

Minimize the risk of infection

Wear a high quality mask, ensure up-to-date influenza and COVID-19 vaccinations with boosters. You can also request COVID-19 testing and masking before visiting with others. Coughing after surgery can cause complications and infections can slow down postoperative healing.

Take sitz baths

A few days after surgery, a nurse will show you how to take a sitz bath, which involves bathing your genitals with warm, salty water. Follow your surgeon’s instructions for the ratio of salt to water and how to air dry your vulva afterwards.

Expose your 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.

Get lots of rest

Many people share that they are surprised by how exhausted and weak they feel after surgery.

Plan to do less activity during the day and allow yourself to nap. Your body needs extra sleep while you are healing. If you take the rest you need, your body will slowly build its energy and strength again.

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. Sample relation techniques are provided in the Vaginoplasty & Vulvoplasty Workbook.

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. In general, you should begin with short walks and slowly increase how far you walk.

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. Sample breathing exercises are provided in the Vaginoplasty and Vulvoplasty Workbook.

Enjoy foods that promote wound healing

Your body will need extra calories, proteins and nutrients to heal so look for foods that contain:

Protein (meats, eggs and nuts)
Zinc (whole grains, spinach, nuts)
Vitamin A (carrots, broccoli, eggs)
Vitamin C (strawberries, peppers)

If you have questions, you may find it helpful to speak with a dietitian. You can contact a dietitian by calling 8-1-1 (HealthLink BC).

Drink lots of water

It is important to drink lots of water and empty your bladder regularly. This helps to prevent urinary tract infections. Your urine should be clear or pale yellow.

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 health care provider.

Avoid alcohol, nicotine and other substances

Many substances, including alcohol and nicotine, disrupt the healing process. If you made a care plan to avoid substances like methamphetamines, cocaine or heroin, it is important to stick with that plan during surgical recovery. If you have any questions about this, speak with your surgical team.

Attend your check-ups

You will be given your postoperative follow-up plan before you go home.

GSPBC patients — All your follow-up care will be completed by the surgical team at GSPBC. If you traveled to Vancouver, you will be expected to stay in the Lower Mainland for 2 weeks after discharge so you can attend in-person follow up appointments with your surgical team. You may want to arrange to see your primary care provider within a week of going home as well. They will review your postoperative baseline and see how you’re feeling.
GrS patients — Your follow-up care will be provided by a local care provider in conjunction with GrS Montreal. Your local care provider may be your primary care provider or a postoperative support team (like Trans Speciality Care at Three Bridges Community Health Centre).

Self-care

Getting ready for and having surgery is an intense experience. Many people feel emotional after surgery, and these feelings may be amplified by having to stop taking hormone therapy leading up to surgery. There are some holistic self-care planning exercises in our Vaginoplasty and Vulvoplasty Workbook.

Dilate your vagina

If you’ve had vaginoplasty, a nurse will show you how to use a dilator, a device used to maintain the width and depth of your vagina. You will be given a set of dilators with three different sizes and a schedule for using them. It’s 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, but will become part of your regular routine throughout your life. As time goes on, you will not need to dilate as frequently.

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 music, a podcast, movie or guided meditation

Dilating tip

You may find this guided mindfulness activity for dilation by Dustienne at YourPaceYoga to be helpful while you dilate.

Douche your vagina

This is also called vaginal rinsing. If you’ve had vaginoplasty, a nurse will show you how to cleanse your vagina by douching. You will use a device to squirt saline solution (and later, water) into your vagina to clear out skin cells and lubricant to help your body heal. Your surgeon will provide details about how often to douche. Douching will become part of your regular routine throughout your life.

Mindfully return to activities

Your surgeon will give you instructions for when and how you can resume your usual activities. These instructions will help keep your incisions and genitals safe while it is going through the different stages of healing. The instructions may differ based on the surgery. We’ve provided some general information on returning to activity below, but it does not replace the information you receive from your surgeon. If there are any differences, you should follow your surgeon’s instructions.

First 10 days after surgery

Resting

Resting is very important during this time. 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, running, biking, driving or walking a dog.

Limits on activities

Your surgical team may give you specific activities to avoid to make sure that you do not accidentally put too much pressure on your surgical site (these are called activity or mobility restrictions). This will include limits on how much you can lift.

Walking

Your surgeon may recommend that you take a short, gentle walk each day, making sure not to tire yourself out. You will feel tired during this time frame and it is important to follow the advice of your surgical team.

2–4 weeks after surgery

Limits on activities

While your energy may start to return, you will still need lots of rest during this time. It is important to keep in mind that you will need to rest a lot between activities, no matter how short or gentle the activity.

You will still have many mobility and activity restrictions to follow, including limits on how much you can lift. This includes not lifting children, pets or groceries (since they may be over the safe weight limit); not pushing heavy doors, strollers or shopping carts; and not having pets pull on a leash or toy.

Driving

Depending on the advice from your surgeon, you may be driving again by this point. It is important to 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 brake quickly and without pain, safely do a shoulder check and 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 and pee often.

4–6 weeks after surgery

As you continue to heal, you may feel better and more energetic. It can be tempting to want to return to your usual activities, but it is still important to take it slow and follow the advice of your surgeon. Some people express that while their body starts to feel better after the first month from surgery, they have a lower mood or begin to feel lonely over the second month, particularly because you will still have a time-consuming aftercare routine.

Limits on activities

6–8 weeks after surgery

Limits on activities

A general rule is to wait until 6–8 weeks after your surgery before participating in intense physical activity. Some people may slowly begin to return to work or exercise around this time. Speak with your surgeon about how you can restart any activity, including work and exercise. They will give you tips about how to pace yourself and slowly increase your activity levels.

You may still have some mobility and activity restrictions to follow, including doing any activities that strain your abdominal muscles.

Keep in mind that your genitals will still be numb at this time and your incisions are still vulnerable—this can make it hard to know if you are pushing your body too hard. It is important to follow all the postoperative instructions and be very gentle with your vulva and vagina.

Return to work

You may be ready to return to work between 6–8 weeks after surgery. Your primary care provider and surgical team can help you to come up with a plan to return to work more gradually. As with all activities after surgery, it will be important to pace yourself and plan in extra time to rest and recover.

8–12 weeks after surgery

You can usually begin to gently explore your vulva, including the clitoris and surrounding area. In consultation with your surgical team, you can integrate some new activities to your aftercare routine that highlight touch and pleasure without aiming for specific sexual outcomes. This can include sensory stimulation, pelvic floor, breath and visualization exercises and scar massage.

These activities help you create a connection between your brain and new anatomy, relax your pelvic floor muscles and develop a positive connection with your vulva and vagina. The goal is to help your brain develop a new map of your body, and for you to find out what feels pleasurable and fun.

Some people may have orgasms at this point in their healing, and others may need more time to heal or find out what feels right. The Vaginoplasty and Vulvoplasty Workbook has some suggestions for activities that can be helpful during this time.

Keep in mind that, besides dilating, you should not place anything inside your genitals or rectum other than what has been recommended by your surgeon(s).

12 weeks after surgery

Return to sexual activity

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

Lots of people have questions about returning to sexual activity after vulva and vagina construction, and your surgeons will be comfortable answering these questions. This includes activities like masturbation and sex with other people. First and foremost, follow your surgeons’ recommendations.

As you heal, you may find your interest in sex is different from before surgery. It might be lower during your healing period or you might find it’s higher. It’s important to remember that everyone is different. Changes to your sexual response are a normal part of your healing journey and will balance out over time. If you have concerns about this, you can speak with your health care provider about whether there are any treatments that could address your libido (for example, adding a small amount of testosterone to your hormone therapy).

As we mentioned above, 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 explore how you enjoy being touched. We’ve provided some general guidelines below so you know what to expect, but it does not replace the information you receive from your surgeon. If there are any differences, you should follow your surgeon’s instructions.

Ease back into your sexual activities gradually. Take time to learn your body’s needs and preferences.
Remember that it is normal to not orgasm from penetration alone. You may need more clitoral stimulation than can be achieved in certain sexual positions
Try different positions and activities. Focus on pleasure and start with gentle, sensitive movements.
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, anxiety or fear, or if your clitoris or vagina become sensitive to the point that touch is not pleasurable.
Pay attention to whether your swelling or tenderness increases after sex. If so, you may want to wait before having sex again.
Use lubricant during vaginal sex as this helps to increase sensations of pleasure and prevents 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 a water- or silicon-based lubricant.
Pee before and after sexual activity to reduce the chances of urinary tract infections.
It is important to speak with your surgeons before starting any kink activities in the months after surgery. Your surgeon will likely welcome these questions. You can start by saying, “Could I ask you a question about whether or not my body has healed enough to participate in a particular kinky activity?” If relevant, be sure to ask about activities that can lead to internal or external bleeding, compromised blood flow and injury to nerves and healing tissues. This includes:
- Activities that could affect (stretch or 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

Dealing with post surgery depression

Many people experience a wide range of emotions following surgery. Medications, limitations on activity, and your healing body can contribute to postoperative depression. 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 into action.
Make lists of things you enjoy and reflect on how you can experience these sources of joy. Examples of these include:
- Eating foods you love
- Surrounding yourself with calming smells and inspiring sounds
- Keeping a journal
- Writing letters of thanks to those who have helped you
Speak with a family member, friend, counsellor or other health care professional about the feelings you are having.