The Surgery Timeline
Checklist: Below is a partial list of what you should expect in the immediate transition phase. When you book your surgery, you will be given a detailed checklist of everything that must be done prior to surgery. Please pay close attention, and ensure everything has been taken care of prior to arriving in Miami for surgery. No one likes surprises at the last minute which can result in cancellation of the surgery. Your utmost safety is our top concern.
Before you leave home:
If you are traveling from out of town, bring what you need to feel most comfortable during your week of recovery. Nightgowns, bathrobe, slippers, body lotion, lip balm, lozenges, gum, water-based KY-jelly, sanitary pads, books, ipad, etc. Bring clothes that are comfortable to travel in. Skirts/dresses are ideal after surgery as you will have a bladder catheter for a week and that makes wearing pants difficult. We recommend you bring some older underwear that you don’t mind getting soiled as there will be some blood and discharge immediately after surgery. A handheld mirror is nice to have. Bring your dilators – you can purchase them online at soulsource.com or you can purchase them here at our office. If you have prescription drug insurance, bring your card so that you can obtain your pain medication at a local pharmacy. We will provide you with dressings and bacitracin to care for your wounds postoperatively.
Once you are in Miami:
Make yourself at home in the hotel and acquaint yourself with beautiful Bal Harbor and Miami Beach. If you feel comfortable, shave the operative area being careful not to cut the skin two days prior to surgery. Hair removal is suggested but not mandatory. If hair is left, it can be difficult to keep the vagina clean, the hair can break off during intercourse and remain in the vagina and be a setup for chronic irritation and infection. Remaining hair can also cause a tugging and unpleasant sensation during intercourse. If you opt for hair removal, we suggest you remove the hair from the scrotum and shaft of the penis, and from the area between the thigh crease above the scrotum to the anus. We will remove hair at the time of surgery, however hair grows in stages and whatever we do in the operating room will reduce overall hair growth but will not remove all of it. If you plan on laser treatment to remove hair (which we can help with if you are local), plan to do several treatments over a 6-month period preoperatively. Stop treatments at least 3 weeks prior to permit time to heal. Laser hair removal works well on hair that is dark with light complexion. Electrolysis may be a better option if hair is very light or you have a dark complexion. Pick up prescriptions from the pharmacy. Relax on the beach and get ready for your big day!
Your pre-operative visit:
You will meet with our team to ensure we have answered any last-minute questions that you may have. You will also meet with Dr. Ramirez, your anesthesiologist to discuss this component of your surgery. We will give you all your discharge instructions and follow-up information at this time, to minimize confusion post-operatively.
The day prior to your surgery:
The day prior to surgery, you may drink only clear liquids. Anything that you can see-through is fair game. Jell-O is fine too. Follow the bowel preparation instructions provided to you in your pre-operative visit. Shower or bathe the night before, or morning prior to surgery is fine, as you won’t shower for a few days following surgery.
The day of your surgery:
Come to our center with your friend or loved one. You will be greeted warmly, and you will meet with your full team again. We will secure your belongings in a personal locker. You will meet your nurse. At this time, if you would like, Dr. Ramirez—a Yale trained, board certified anesthesiologist—can give you something for relaxation. When we are ready to begin, you are gently put to sleep by Dr. Ramirez who will be with you from the time you go to sleep until the time you wake up. After you are comfortably asleep under general anesthesia, the testicles are removed. The erectile tissue of the penis is removed. A neo-vagina is created by inverting the penile skin. A scrotal skin graft may be used to augment the vaginal depth. The urethra is shortened and fixed so that you may urinate (into the bowl!) while seated. The clitoris is formed from part of the glans penis. The nerves are preserved allowing for sensitivity and full orgasm. After the surgery is complete, you will wake in the recovery room. You may be sore but should not have pain. You may feel the need to pee, though you will have a catheter in the bladder and may urinate whenever you have the urge. You may have a sense of fullness below due to the vaginal packing. Take pain meds as needed but minimize them to avoid complications of constipation. You can sip some clear liquids in the evening.
The day after your surgery:
We refer to this as post-operative day 1. Your job is to keep your pain manageable, and to rest, recover, and heal. You may have some breakfast. You may move around in bed and sit up in bed.
Day 2 after your surgery:
Relax and heal. You should get out of bed and sit in a chair. Walk around the room with some help.
Day 3 after your surgery:
If you have a JP drain, it will most likely come out today. Doctor will change surgical dressings as well.
Day 4-6 after your surgery:
Relax. Rest. Recover. Heal. Walk a bit more each day.
Day 7 after your surgery:
Today you come back to the office for vaginal packing removal, and bladder catheter removal. You will also be taught how to dilate and douche. You can take a shower today and blot the incision site dry. No soaking in baths or going to the ocean or pool.
Day 8 after your surgery:
Relax in your hotel room, to ensure everything went smoothly with dilating. Get ready to travel tomorrow if you would like! Long travels in seated positions are the WORST for post operative healing. If you must travel it is best if you can do so in a lying position. There is also no harm in staying in the area for a few more days either if you are from out of town.
Day 9 after your surgery/going home:
We will send you home with your Surgical Declaration letter. Your surgeons and your anesthesiologist welcome your texts or calls if there are any concerns. We will be with you forever!