Once You Are Home: What You Can Expect During Recovery
Immediate complications are rare. Some blood is to be expected from the incision sites, and there may also be some blood when the catheter is removed. If there is any active bleeding, a little pressure directly over the bleeding for 5 minutes with a fingertip should solve the problem. If there is any significant bleeding, call Dr. Whitehead. There may be some oozing and discharge which is normal. Anything particularly foul smelling or frankly purulent should prompt a call to Dr. Whitehead. Fever over 101F or significant or new pain should prompt a call to Dr. Whitehead. Wounds commonly separate, and they heal in on their own. Call Dr. Whitehead if this happens as he will likely direct you to do some salt-baths. The surgical site typically looks the worst weeks 2-3 after surgery, after which things usually make dramatic improvement. Swelling will take months to return to normal.
The bladder catheter stays until post-op day 7 (or thereabouts) to make certain that all the swelling has subsided and that you will be able to pee on your own. We will teach you how to care for it. You will be able to leave the house with the catheter while it is in.
The vaginal walls of all women like to be next to each other. Natal women have constant sloughing and lubrication which keeps them from fusing. Not so for the trans woman. The trans woman needs to dilate or have regular penetrative intercourse to preserve the neovagina. Use the largest dilator that can be comfortably inserted. Ensure the dilator is clean. You can clean it with antibacterial soap and water. Apply water based KY Jelly prior to insertion. Gently insert into the vagina with the dilator tilted slightly toward the navel. Expect to feel a small amount of resistance and tenderness. If there is too much of either, stop and use a smaller dilator. Insert to the full depth and leave in place for 15 minutes. We recommend 3x daily for 15 minutes each time for 3 months, followed by twice daily for 9 months, then daily thereafter. The dilators are marked, and you can use these markings to determine if you are losing or gaining depth over time. Dilators are medical devices; however, they can cause harm if used improperly. Be sure to use the size that is prescribed for you, and to always point the curved edge toward the navel. Pointing downward can injure the rectum. Lie absolutely flat when dilating – this allows the rectum to fall away from the vagina and to reduce incidence of rectal injury. Always use plenty of water-based lubrication! The first goal is to establish depth. The second goal is to progressively upsize the size of the dilator to stretch the vaginal diameter. Wash dilators with soap and water after each use and store clean and dry.
Douche every other day for the first 2 months following surgery, then twice weekly, and after penetrative sex.
Your bowels may slow due to narcotic pain medication. An over the counter stool softener is useful while you are taking pain medication. If you don’t have a bowel movement in several days Miralax usually does the job. You can find it in your local pharmacy over the counter. You should not strain at all to have a bowel movement as this will increase risk of vaginal prolapse. Keep your stool on the soft side for the first month postoperatively.
Recommend beginning 12 weeks after surgery. Expect that you will need to use lubricant during penetration.
No lifting anything heavier than a gallon of milk for 6 weeks. You can start gentle exercise after 4 weeks. Full, unrestricted activity, ie horseback riding, should be reserved until full healing, 12 weeks.
No open water, hot tubs, swimming pools until full healing, 12 weeks.