Post-Op:
The first 21 days toward your recovery
Drain tube is removed and packing is pulled
Now it is time for us to rest, heal and recover. This will look like asking for help these first 21 days. If you’re tired, sleep. If you’re in too much pain, follow your doctor’s advice on pain management medication. Even having someone to change the Foley bag that first week can make a big difference. Sitting is nearly out of the question, unless you have lots of pillows and your as a slight angle. Rest recover and send beautiful healing thoughts to your new vagina.
IMPORTANT
Although this first part is broken into 4-21 day sections. Those first 2 weeks are when you will need the most assistance, so plan accordingly. The second 2 weeks, it becomes easier to get around the house or living space. After 2 weeks my personal help went back to work, and that is the week I had asked friends and family to bring me prepared foods.
First 21 days
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- Your post op walk.
- Wound Care
- Swelling and Bruising
- Help with Healing: Bromelain, Arnica, Turmeric
- Showering
- Sitz Bath
- Urinating
- Nerves and Tissue: Nerve Damage, Nerve Zingers, Sutured Nerves.
- Dilation: Physical Therapy Sound Advice Lidocaine.
- Douche
- Padsicles
- Bleeding
- Donut Cushions
- Discharge and Menstrual Pads
- Hot Compress
- Massage and Acupressure
- Food that Heals
- Food For Thought
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- Bone broth
- Site Sensations
- Ice the Sound Advice
- Sloughing Skin
- The Smell
- Stenosis
- Sacred Basin
IMPORTANT:
I would like to start with a basic question. What is the best way to keep a wound clean? If you cut your finger deeply, you would probably wash it, wrap it up and keep it clean and disinfected.
Our number ONE priority those first 8 weeks is to keep our neo-vagina clean, cared for and disinfected. This should be our first thought those first six weeks. Below are some helpful suggestions.
Your post op walk:
Around day three you may be asked to take a little walk. One thing to remember is our pelvic floor has just been renovated. Do your best to not sit up in bed. I would suggest rolling onto one of your butt cheeks and prop yourself up onto your legs and feet. Sitting upright will be extremely painful and you probably don’t want that.
Vaginoplasty, Wound & Surgical Site:
Before moving forward let’s clarify what an infection looks like to us? Fever, chills, redness, soreness, and or swelling in the area of surgery or wound. Shortness of breath, cough or change in cough, pain or burning sensation when urinating. Unusual vaginal discharge or excessive bleeding. New onset of pain, diarrhea, and or vomiting,
This Procedure is lifesaving for those that can receive it. Those first few months can be hard at times. In an effort to look at myself & my patients’ vaginoplasty as a medical healing facet. I chose those first 6-8 weeks to look at this procedure not just as a neo-vagina, but also as a wound and surgical site.
Sound Advice: As a dear friend once told me. “That first month all you are doing is caring for your glorious new vagina.” I took it to heart as should you.
Swelling and Bruising:
There will be swelling and bruising of the inner thigh, lower abdomen, anywhere around the pelvic cavity. Have your ice pack ready (see Supply List), also see the padsicles sections and have your running shorts on hand (see Sound Advice)
We will be going more in depth later about what ligaments and so forth. But as mentioned above the inner thighs, lower to middle abdomen (below your belly button) and our pelvic floor will be affected by this procedure. I cannot recommend enough the benefits of having arnica ointment and or gel nearby (see Arnica details below).
I felt like someone had taken a belt sander to my groin for 3 weeks. The burning sensation was painful and uncomfortable. Keep up your prescribed meds, I did have some relief with diaper rash cream. Like a Triple Paste cream to soothe the aggravated tissue. Do not apply in or on the surgical site.
Bruising can be extensive throughout the inner thigh and abdomen. Personally and professionally I recommend using arnica 2-3 times a day, as needed those first 6 weeks. My bruising was contained only to my lower abdomen, I had no bruising of my inner thigh and my bruising was contained to less than 10 days. Anecdotally I believe it was the arnica that prevented the bruising from progressing into my inner thigh. That being said there are some folks who never bruise on the inner thigh other in the abdomen only. We are all different and unique individuals and we heal and recover in our own way.
Hydration:
One aspect of inflammation is dehydration. I like to recommend to my patients that around half your body’s weight in water daily. An example is an individual weighs 170 pounds they would drink roughly 85 ounces a day. Remember to keep water on your radar.
Help with Recovery and Healing
Bromelain is an enzyme that comes from the pineapple plant, it is also known as pineapple extract. Pineapple extract is mother nature’s natural anti-inflammatory; it comes in pill or capsule form. Found at your local natural grocery store or from a reputable source. Bromelain is wonderful at decreasing bruising and reducing inflammation but like any wound it takes time and care. I suggest taking it the second day out of surgery. I also took it 5 days before my surgical date. I brought it into the hospital with my usual supplies (cell phone charger, laptop, book and personal meds). You may take it on an empty stomach, it is not hard on our digestive tract. If you are allergic to pineapple I would not suggest this at all. Use only fresh pineapple, do not purchase canned or processed.
I also would not rule out the benefits of turmeric tablets as a way to reduce inflammation. In my professional practice I have seen wonderful results with bromelain.
Bromelain Tidbit: I once had an individual tell me that they were at a wedding and accidentally had eaten something with shellfish. Their throat began to close up and they started having breathing issues. It just so happened that in the buffet line were fresh cut pineapples. Without thinking they just started eating the fresh pineapple. Within a minute their throat cleared and their breathing issues had decreased. They did eventually get an Epipen to assist them with the allergic reaction. They had no idea that pineapple was an anti-inflammatory.
Arnica
Arnica is a plant, when used in small amounts it can help with bruising, swelling and general inflammation. Arnica ointment and or gel are a topical product that helps amazingly with bruising, swelling and inflammation. You do not need a lot and oftentimes it can be added to small amounts of massage oil to help with injured regions.
Showers:
After not having a shower for a few days in Post-Op it will be nice to take a shower. Those first few weeks showering may seem scary. That said, there are a few ways to look at it . Use the shower as the cleaning cycle for the non surgical areas. Leave the Sitz bath as the cleaning cycle for the surgical area.
Sitz bath:
It may help if we look at Sitz bath as the most optimal way to keep our surgical site clean and disinfected. I know some who did not like their Sitz bath time. I personally loved my Sitz bath time. Those first 2 times I came to describe it as my own personal vagina hot tub. Keep your water mildly hot. Too hot you can irritate the wound, check the water with your finger before going for your dunk.
Since the Sitz bath is the best way to keep the surgical site clean and disinfected. A small dollop size of vinegar or antibacterial soap goes a long way in our recovery. I cannot stress enough how important a Sitz bath is. Those first 6-8 weeks the Sitz bath is the best way to keep our vagina on the healthy healing path. It felt so good I would soak for 10 minutes. I preferred it prior to AM dilation and PM dilation. It seemed to make it easier. Knowing that a Sitz bath is the best way to keep the surgical site clean I would utilize it as often as possible!
Air Out:
One aspect of a wound is to air that area out. That region is swollen, red, sore and irritated. After one of your showers or a Sitz bath. Lay out on a towel, with those legs open and air out the surgical region. If you can squeeze that in one of your recovery days it will help.
Urination:
Once it is time to have your catheter out it is time for two wonderful thing. The first is often a test to make sure that there is no Stenosis happening to the ureter the little tub running from our bladder to the outside. There is a section. On Stenosis below. The second part of this is peeing. I found that my stream changed over the the course of 12 weeks. You have probably heard the stories about how your pee stream will change. You can try tilting your pelvic up and down. Be prepared for that shower head or urine.
Nerves and Tissue
Yes we now have our vagina! Let’s take some time to look at the bigger picture. We have just had some very notable nerves and tissue surgically rearranged downstairs. Our basement has been completely and elegantly remodeled. The healing process takes time, I will repeat.
THE HEALING AND RECOVERY PROCESS TAKES TIME.
Nerve Zingers
As our nerves, muscles, mind and soft tissue repairs itself from surgery. You will inevitably get a nerve zinger. If you are fortunate enough to not have one good for you. The sensation is that of electricity shooting down into a nerve fiber. Many times you will get them when the tissue around the surgical site is swollen and inflamed. It reminds me of electrolysis x 5, the discomfort can double you over. I cannot stress the importance of self massage with some Arnica. It is one of THE best ways to mitigate those sensations. A hot compress has also shown to lower those nerve zingers too.
Regular self massage (using gloves) around the surgical region promotes healing, increases recovery time and promotes blood flow. See the Massage Therapy section under recovery
Nerve Damage:
Within a few weeks I noticed that I had some numb tissue around a very small section of my surgical site. As time passed the region became very local. I have had 2 nerves removed in my feet as a professional dancer. What ends up happening is you lose sensation between those two toes for a few years. That being said it takes time for nerves to regenerate. I have had patients that I saw nerve regeneration within one to two years. It takes time and patiences. Self massage therapy along with some creative acupuncture techniques can increase nerve recovery.
One friend had asked me about how to help a small numb patch on their skin. I recommended self massage and a vibrator to stimulate the tissue. Basic vibration encourages the nerve tissue to grow. I’ve seen nerves recover in two different aspects of my professional career. As a massage therapist I’ve helped a number of patients regain their nerve sensation through regular, consistent massage therapy. As an acupuncturist there are more tools in my tool kit to help those with nerve damage. Since it takes time, in some cases 1-2 years. Regular regional self massage makes a huge difference.
In my acupuncture practice I use a moxibustion technique to regain nerve damage. I would encourage self massage and a vibrator to stimulate the tissue that may appear hurt or damaged. Please consult the Self Massage section for more detailed information. If you have some personal question feel free to contact me directly at [email protected]
Also see Revision below.
Sutured Nerves: This may or may not happen. But if it does, it is not pleasant! There are a great number of sutures in our procedure. Surface nerves are extremely hard to find in western medicine. When it does happen it will undoubtedly hurt. It is vital you consult your medical practitioner. It will take up to 9 months to a year to completely heal and recover. Have patience check in with your physical and consult the scar tissue in the second three week section.
Dilation
Some doctors will suggest a more rigorous dilation practice early on between 1 hour 3 x a day.
The pelvic floor is in nearly continuous use all day long. The pelvic floor is a support structure to our bodies. Therefore the pelvic floor wants to pinch our new vagina closed. They muscle group has an inherent nature to control posture, so they are always on.
Releasing the pelvic floor take time and patience
Not enough lube can cause the dilator to get stuck.
These first 3 weeks I did not go wild with dilation. This is the time for tares in the graft. I’ve known a few girls that tore or ripped some of the graft. The goal these first few weeks is to keep that new vaginal opening open. I didn’t go up a dilator size for the first 3 weeks. Only when I was certain that the sutures had healed up more did I move up a dilator.
As I mentioned earlier, if we would like to look at our neo-vagina as a wound those first 6 weeks. Often serious wounds or injuries will require physical therapy. I preferred to look at the early dilation sessions as a form of physical therapy those first 6 to 12 weeks. Distraction during dilation will be very helpful those first 6 to 12 weeks. Dilation has two facets, one to help the diameter of or neo-vagina. The second is depth. It will help to also visualize your pelvic floor/bottom of your pelvis opening out like a flower in bloom. Remember to breathe the whole time and try not to hold your breath. You will have daily and nightly discharge from your frequent physical therapy or dilation, keep an eye out for it in your pad.
SIMPLE ADVICE:
One small piece of advice, buy a ton of the recommended lube!
Time: Once you get your packing out it is recommended to dilate for 15 minutes 3 times a day. It will be uncomfortable at times. One piece of advice I was given by a patient. She said “DO NOT miss one dilation session!” Particularly those first 6 weeks. I know it hurts and your pelvic floor will be swollen. It will hurt upon entry and just holding it in place. Breathe into the process, so not rush the process, and have patience. Always consult your physical therapist.
Lidocaine: Ask for Lidocaine! I really wish this was part of my take home medication. Dilation hurts those first few weeks and months, particularly if you have any granulation. Lidocaine applied 5 minutes before your daily physical therapy/dilation routine will ease that initial penetration discomfort.
Granulation: Some folks will see and or develop granulation around the neo-vagina’s. I cannot emphasize enough to go see your physician and have them remove it. It does really make a difference. Granulation is just one aspect of your body’s healing process, but it does cause dilation pain.
The initial discomfort: Let’s identify this initial discomfort. We are not just recovering and working through the pain from recent surgery. But we now need to practice regular physical therapy on our pelvic floor. And that hurts! There are no two ways around it. You may find muscle relaxants will help with the inflammation of the pelvic floor, please consult your surgeon.
Take your time, have patience and remember to breathe. We can open our pelvic floor if we breathe and think of our vagina as a blooming flower opening up to the morning sunlight. Please consult your physical therapist for more useful ways to get through these hard 6-10 weeks.
Any ongoing discomfort: So we may have ongoing pelvic floor pain. I did, it took a few visits to my physical therapist to recognize that one of my leg rotators was sore and or tight. After a few exercises working on my leg rotators it was able to decrease. Personally, one of the most beneficial ways to break through some discomfort, was to slowly increase to a larger dilator. It was not until 16 weeks before using the largest dilator. After that one time penetrative sex became painless. We really never want to experience pain while having sex. If you do have pain during penetration consult your physical therapist or physician.
Different dilators: It was recommended by my physical therapist to find an easier dilator. Intimate Rose makes some wonderful soft dilators. Check with your physical therapist first. Do your own research and you may actually find something else that works. This is just a guide to help you heal and recovery happily.
Ice, Heat, or Room temp. I’ve heard of folks chilling or cooling their dilators prior to use. Personally I soaked my dilators in a pitcher of hot tap water prior to use. My professional thought is that muscles like heat, and since the surgery went through the pelvic floor muscles. But often muscles relax when heat is applied. This is anecdotal but it helped me. Past 12 weeks I stopped soaking my dilators in hot water and just used them at room temperature.
Sound advice:
Some of the best advice I was given was to not miss any sessions of dilation!
Here’s medically why; The natural instinct of the body tissue is the close things, such as hole, a wound or a newly formed cavity, like our newly formed vaginal opening. This is the hard pill to swallow, those first few weeks the body naturally wants to close the newly formed vaginal opening. The down side is we can lose vaginal depth very quickly if we do not dilate regularly.
If you are planning on penetrative sex. I know it is painful and can be uncomfortable! It goes a long way the more diligent we are those first 6 weeks.
MORE Sound Advice:
The second part of the advice is keep the dilator in for an extra 3-5 minutes. UGH I know it hurts. This short amount of time does go a long way in the healthy development of our vagina’s. The pelvic floor will become inflamed if we try for longer than 20 minutes.
I know folks that don’t have penetrative sex so depth and width is not a concern. So staying with a smaller dilator is cool too.
Personal thoughts:
I tried for 25 minutes and it only hurt more, 20 minute seemed to be a good medium for me. My Physical therapist clarified that with me when I came in with regular pelvic floor pain and discomfort at week 4. I tapered down the 20 minutes and the result was much better.
Douching
You will read it a lot in this write up but practice makes perfect. Douching of the surgical site takes practice and time. If you practice it enough it becomes second nature. Keep an eye on your water temperature too hot and it will hurt you. By the 10-15 week point you will be a pro. I sometimes would do a quick douche after each dilation session. For me that tapered off around week 12. Remember to use a little apple cider vinegar about once a week after week 12. In the first 6 weeks you will see sloughing skin come out of your vagina and or a stitch don’t be surprised.
Padsicles
This piece of advice came from a patient with postpartum discomfort. Feel free to look up “Padsicles” (website). Their recipe is aloe, witch hazel and lavender oil. I had asked my doctor/surgeon about these padsicles. The doctor was not a fan of witch hazel because it can cause the surgical site to dry up, since witch hazel is an astringent. And professionally lavender oil is not good for our surgical site either. So I came up with my own padsicle recipe. I also ran it done by my surgeon. However, do consult your surgical staff.
Padsicle Recipe: (Consult your surgeon or physician)
One large overnight pad.
Open one pad but do not remove it from the sticky backing.
Apply 1 part Aloe Vera to the pad (enough to fill the pad), I used a bunch those first few weeks.
Apply Bacitracin to the center of the pad (½ part).
Fold back up and place in the freezer.
When you need a fresh pad placed in your underwear, you will have a nice soothing sensation on your stellar vagina.
Personal note: I made about 3-4 for each day and I always ended up with a few for the following day. The Aloe Vera with the Bacitracin was amazing for the recovery of the surgical site and the Aloe is very soothing to the skin.
The Donut cushion:
Many if not all of us are encouraged to purchase or borrow a donut cushion. You are or have just had reconstructive surgery on and around our pelvic floor. Either shallow or full depth procedure, our pelvic floor has been modified, more so with a full depth procedure. When we sit for too long, blood will follow gravity and will pool in the muscles of our pelvic floor. Since we just had surgery down there, there will be swelling. That means our surgical site will become swollen. This might lead to a swollen surgical site, and skin can become tight and full of blood causing some discomfort. The excessive dependency ended up causing me to have some hard and tough tissue around the surgical site. Five days of mandatory bed rest and 30 minutes of massage therapy 2-3 times a day took care of that swelling and the tough tissue. I found it better to stand rather than sit, if I had to sit I would use the donut cushion for limited times.
If you must sit and are using the pillow, make sure you can lay down and or are moving regularly. If you have sat throughout the day, you may actually find it harder to dilate just from blood flowing into the pelvic floor and swelling of the surgical site. Expect to use the cushion for 11 to 12 weeks. That being said, do what is comfortable for you.
Hot compress: It is suggested to place a hot compress over the surgical site to ease tension, pain and swelling. It will be very effective when it comes to the nerve zingers mentioned earlier. Oftentimes tap water was not hot enough so I used water just off a boil. (be careful it is very hot) Pour it onto a washcloth, ring out with tongs and then wrap that into another dry towel. Apply to Mons Pubis and Labia.
Discharge and Menstrual Pads
With the full depth procedure you will have packing in for the first 6-8 days. It will feel uncomfortable. Rest and heal. Once that packing is removed you will begin dilating and you will begin wearing a pad. We will have discharge, there will be blood, maybe a stitch or two, some lube from your last dilation session. Don’t be too surprised. If you have excessive bleeding that fills the pad from end to end go to the ER and contact your surgeon. Those first 6 weeks the discharge is regular, consistent, smelly and over the course of 12 weeks it will taper off. There may be skin sloughing off the surgical site (see Skin Sloughing section below).
Keeping an eye on your discharge is important and to the surgical site. Too much blood may be a serious issue and may need immediate medical attention. You will want to start off with a thick & large overnight pad. Those hours that we sleep are important to our healing bodies. Put in a fresh Padsicle for the night. You can also use those adult diapers such as Depends too.
After about week 3 or 4 you will no longer need the larger overnight pads. This is your chance to change to a slightly thinner pad, the size and padding will be noticeable. Keep up with your padsicles too. The very thin and small pantyliners are good after 10-12 weeks onward. I have had a few individuals develop rashes from the pads with wings and or from the adhesive, Triple Paste Diaper rash or Vaseline is a great product to add to your supplies. Play around with whatever pad works best for you. Between week 6 and 8 you will know your pad choice. If you can afford them a natural pad from a natural grocer will go a long way in a healthy recovery too.
Recovery and Massage Therapy:
These first 21 days our self massage should be light and gentle. Our primary focus will be on distinct regions: the inner thigh, abdomen with acupressure point on the inner ankles, wrist and top of the head. Learning to perform self massage on yourself will go so far in reducing pain and speed recovery. Self massage during this time should be no more than 1 pounds of pressure, or the weight of 1 apple or 1 orange.
We do not ever want to apply too much pressure!
We can save that for later in our healing.
Our body and muscles will hold onto trauma, so gently with compassionate massage will increase the body’s healing response. Traumatic memories of our surgery reside in the soft tissue of the pelvis, abdomen, groin and inner thighs. This surgery is invasive, the memory of that trauma is very fresh to the surrounding tissue.
To maintain a healthy surgical site, latex, nitrite or vinyl gloves are REQUIRED the first 8 weeks. This is to keep the “surgical site or wound” clean and disinfected.
The first area we will work will be the inner thigh. This stroke or gliding motion will move towards our heart, so the inner thigh strokes should start near the inner knee and glide towards the pelvis or our vagina. There are a bunch of lymph (see lymph below) in our inner thighs so regular massage with light pressure will go a long way in recovery.
The next region to be covered will be on the abdomen. The last area will be acupressure on each inner ankle and inner shin.
“I gently massaged my inner thighs the week after surgery, the pain decreased by more than half in just a few strokes.”
Daily self massage starting at day 7, can reduce swelling and pain noticeably. The simplest of massage strokes will increase circulation and alleviate surgical trauma.
Massage therapy week 2-3
- These first 21 days just use Arnica ointment, if you wish to include massage oil use more arnica then oil. Apply arnica to gloved hands or a little dab directly on desired region. Gently and lightly glide your hand from your inner knee upward toward your groin. Your hand pressure should be the weight of 1 orange. Repeat 5-10 times on each leg.
- Place your hands one on top of each other, then place both your hands just below your navel palm down. Very gently with the pressure of an orange lightly perform circular motion on the lower abdomen. Apply arnica to the area to ease bruising and swelling.
- Repeat this 1- 2 times a day for the first 3 weeks.
The included use of arnica ointment or gel cannot be stated enough. Please remember to use gloves up to week 8.
I cannot stress enough the pressure during massage is very important. Too much can lead to blood clots these first few months. Focus on moving the surgical trauma and keep the pressure light and easy.
When I have had patients come in after their vaginoplasty there are a few particular acupuncture points. These points can easily be utilized using acupressure. The few acupressure points we will use will help ease pain or discomfort and promote healing. Let’s look at these acupressure points