Vaginoplasty: Recovery

A Type of Gender-Affirming Surgery

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Recovery from a vaginoplasty takes around six weeks. In order to help prevent complications and to ensure the success of the surgery, it's important to follow all of your surgeon's post-operative instructions. These instructions will include restricting certain activities, adhering to your vaginal dilation schedule, and carefully following hygiene protocols.

Surgery Follow-Up

After a vaginoplasty, you can expect to have follow-up appointments approximately one to two times a week for at least the first month. During these appointments, your surgeon will check the progress of your surgery and monitor for any complications (e.g., wound infection or dehiscence).

About four to six weeks after surgery, you will start pelvic floor physical therapy. This type of therapy will help decrease vaginal pain and tension after surgery. It will also help strengthen your pelvic muscles.

Recovery Timeline

After your operation, you will be taken to the post-anesthesia care unit (PACU) where you will wake up from your anesthesia. This is where your recovery begins.

In the PACU, nurses will monitor your vital signs and pain level. From here, you will be moved to a hospital room, where you can expect to stay for the next five to seven days before being discharged.

Once in your hospital room, you may notice the following dressings and drains on or within your body:

  • You will have a large gauze dressing located over your wound on the outside of the vagina.
  • Your vagina will be packed tightly with gauze or contain a stenting device.
  • You will have a Foley catheter in your bladder that drains urine into a bag.
  • You will have one or more surgical drains—these drains remove excess fluid that may place pressure on the wound site.

In terms of your recovery timeline, you can expect the following schedule:

  • Post-operative day one to two: You will rest in your hospital bed to avoid excess tension on your incision site. This rest time also allows your skin graft to start growing into the tissue within your vaginal canal.
  • Post-operative day two to three: Your surgeon will remove your dressings and drains. You will now begin to sit up in your bed and carefully walk around.
  • Post-operative day five to seven: Your surgeon will remove the tight vaginal packing or the stenting device in your vagina. Your Foley catheter will also be removed. At this time, you may be taught how to perform vaginal dilation. The dilators (usually four) will be provided by your surgeon.

Activity Restrictions

Once home, be sure to follow your surgeon's instructions regarding activity restrictions.

These may include:

  • Avoiding smoking for at least one month after surgery
  • Avoiding any strenuous activity for six weeks
  • Avoiding baths for eight weeks
  • Avoiding sexual intercourse, swimming, or riding a bike for 12 weeks

Vaginal Dilation

Vaginal dilation is a critical part of your recovery process. It's necessary for keeping the vaginal canal open and maintaining its width and depth. In most cases, patients start dilating right away after the packing is removed from their vagina.

Here is a typical dilation schedule:

  • For the first three months after surgery, you will perform vaginal dilation three times daily.
  • After the first three months, you will advance to a larger diameter-sized dilator and dilate one to two times daily for three more months.
  • Six months after surgery, you will likely dilate once a day (if not sexually active) and at least once weekly (if sexually active).

In addition to a guided dilation schedule, your surgeon will provide specific instructions on how to dilate.

Example instructions may include:

  • Clean your dilator with soap and warm water and dry with a clean paper towel prior to each use
  • Apply vaginal lubricant onto the dilator (your surgeon will provide you with a medicated lubricant first, and then you can later proceed with a water-based lubricant, like KY jelly).
  • Starting at an angle of 45 degrees under the pubic bone, gently insert the dilator into the full depth of your vagina.
  • Once inserted, leave the dilator in place for 10 to 30 minutes (per your surgeon's instructions). You may experience a moderate pressure sensation during this time, which is normal.
  • After each dilation, clean your vaginal canal with soap and water, and then store your dilator in a cool and dry place.

Hygiene Practices

Besides vaginal dilation and restricting activities, keeping your genital area clean and dry after surgery is paramount for maximizing healing—and avoiding contamination and infection.

Some healthy hygiene habits to practice include:

  • Wash your hands with soap and water before and after touching your genital area.
  • Wipe from front to back after urinating.
  • Shower each day and gently pat your incision site dry.
  • Avoid tight clothing, as friction may lead to bacteria transfer from your bottom area to the vagina.

Seek Medical Attention

If you have any of the following symptoms during your recovery process, please call your doctor:

  • Significant bleeding from the incision site, or if you notice the site is reopening
  • Symptoms of an incision site infection (e.g., redness, abnormal drainage, increased tenderness, swelling, or fever)
  • Severe pain or swelling
  • Severe nausea and vomiting
  • Numbness, tingling, or skin discoloration of the hands and feet

Call 911 if you are experiencing chest tightness, are having difficulty breathing, or are experiencing pain, redness, or swelling in your calf, knee, thigh, or groin.

Coping With Recovery

Coping after a vaginoplasty entails addressing and managing both physical and emotional symptoms.

Physical Symptoms

After surgery, it's normal to experience pain. Your surgeon will treat your pain with prescription medications, like an opioid to start, until you can be transitioned to over-the-counter Tylenol (acetaminophen).

Nausea and constipation are also common after surgery. Your surgeon may prescribe you an anti-nausea medication and a stool softener.

Swelling of the labia after surgery will go away on its own within six to eight weeks. In the meantime, to ease any discomfort (usually the first week after surgery), your surgeon may advise you to apply an ice pack or cold compress on your perineum (the area between your vagina and your anus) for 20 minutes every hour.

To manage vaginal discharge after surgery, which may last four to six weeks, you can wear pads in your underwear and begin daily douching with soap and water.

Emotional Symptoms

Stress, anxiety, and intense emotions (often mixed) are common after a vaginoplasty. During this time, be sure to reach out to loved ones, those who have undergone the surgery (perhaps peers from a support group), or a therapist who has experience with this type of procedure. If you are experiencing symptoms of depression, please reach out to your doctor.

A Word From Verywell

Healing from a vaginoplasty requires hard work and focus on your part. Try your best to be as prepared as possible for the recovery process by talking with your doctor in-depth about it prior to your surgery. Then, as you recover, take each day as it comes—and don't hesitate to reach out to your surgical team if any questions or concerns arise.

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Article Sources
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