Different hospitals will have different processes and arrangements, but this page is your (non-exhaustive) guide to a hospital stay for transition related surgery.
On the day you go into hospital:
- Don’t eat or drink. You’ll have been sent instructions about eating and drinking, but if you’re going to have a general anaesthetic you can expect to be told not to eat after midnight the night before surgery. You’ll be able to drink sips of clear fluids (ie water or tea and coffee without milk) the morning of surgery. You may be asked to take some of your usual medications with a sip of water on the morning of surgery. This will have been discussed at your pre-op appointment.
You should also avoid smoking and chewing gum. - Wear comfortable clothes. But don’t worry too much about them as you’ll be asked to change into a hospital gown, net underwear and a hospital dressing gown. Make sure you’ve removed any jewellery, nail varnish, make up and dentures. Remove or tape over any body piercings.
- Arrive on time. It’s typical to be asked to arrive early in the morning on the day of surgery. Some hospitals ask you to arrive the night before.
- Tell them you’ve arrived. Follow the instructions on your appointment letter about where to go when you arrive in hospital. In some hospitals you’ll be taken straight to the ward or room you’ll be staying in. In other hospitals you’ll be taken to a surgical admissions area where you’ll sit in a small bay or room with a chair in it.
- Take a supportive friend or family member. Hospitals might have different policies about whether a supportive friend or family member can wait with you – this is something you might want to ask about at your pre-op appointment.
- Settle in. If you’re taken to a room with a bed or to a bed on the ward, ask if this is where you’ll be staying after surgery. If it is, take the time to unpack and set the room up how you want it – put things on your bedside table ready and remember that you won’t be able to reach much at first.
- Be prepared to wait. Unless you’re first on the list for surgery that day, you might be waiting for several hours. Try and relax by distracting yourself with a book, a film on your phone, or anything else that will keep you entertained.
- Remember it’s normal to be nervous. Surgery is a big deal, if you weren’t nervous it would be a surprise. Most hospital staff will be understanding about nerves and anxiety.
- Communicate your needs. If you have any specific access or communication needs, it’s a good idea to tell the hospital staff when you arrive at the place you’ll be waiting for surgery. They might already be aware, but it can be handy to check. Take a look at the communicating about my needs page for hints and tips around that.
You’ll have lots of visits from different medical staff whilst you’re waiting to go into surgery. This is a good opportunity for you to reiterate any dietary requirements, allergies, accessibility needs, communication needs you may have.
Nurses and healthcare assistants
A nurse or healthcare assistant is likely to:
- Check your pulse and blood pressure.
- Check your temperature.
- Give you a Covid test.
- Measure you for surgical stockings and then ask you to put some on.
- Weigh you and measure your height or ask you for your height and weight. It’s important to be honest about your weight, they use this information to calculate how much anaesthetic to give you.
- Ask you about any medication you’re taking.
- Ask you about any allergies you’ve got.
- Give you a hospital bracelet to put on. This has your name and hospital number on it, as well as details of any allergies.
The nurse or healthcare assistant might also:
- Ask you for a urine sample. If you have a uterus, they will use the urine for a pregnancy test. This is something they have to do and you can expect them be discrete about it.
- Take a blood sample.
- Give you an anticoagulant injection. This prevents blood clots and is sometimes given when you’re already under general anaesthetic.
- Give you an enema. The surgical team will have told you in advance if this is something you’ll need to do. It’s commonly needed for vaginoplasty and less common for other surgeries. If you do have an enema, you’ll be asked to shower afterwards.
Surgeons
The surgeon will visit you to:
- Talk through the surgery, including any risks that come with it.
- Answer any questions you might have.
- Ask you to sign the consent form.
For some surgeries, the surgeon might draw on your body to guide them when they’re operating.
Anaesthetists
The anaesthetist is the person in charge of controlling your pain and making sure you remain safely unconscious during surgery. The anaesthetist will visit you to:
- Talk through any risks associated with the anaesthetic.
- Ask questions about your medical history and any allergies.
My belongings
If you’ve been waiting for surgery in a room with a bed in it, ask the hospital staff if this is the room you’ll be in after surgery. If it is, you’ll be able to leave your personal belongings in the room.
If you were waiting in a surgical admissions area, you’ll be asked to give your bag to a member of hospital staff. The member of staff will put a label on it and it’ll be taken to your ward or room once you’re out of surgery.
If you wear glasses, dentures or hearing aids, use an inhaler, or have an EpiPen, they might ask you to bring them with you to the operating theatre. You should leave all your other belongings in your bag unless you’ve already checked with a member of staff first.
On the way to theatre
You’ll typically be asked to walk (or travel in your wheelchair if you’re a wheelchair user) to the operating theatre with a member of hospital staff.
Most hospitals in the UK have an anaesthetic room that leads into the operating theatre. Some hospitals might not have an anaesthetic room and will ask you to walk into the operating theatre itself.
The anaesthetic room
In the anaesthetic room, there will usually be an anaesthetist and one or two other members of hospital staff.
A typical sequence of events might be:
- You’re asked to lie on the bed. The staff may help you undo the back of your gown, to avoid you lying on the knots.
- They check you’re the right person and might ask your name, date of birth and what operation you’re about to have.
- They attach a cannula to your hand. This is a tiny plastic tube that is placed into one of the veins on your hand or forearm. It is attached with tape and is used to inject medication into you as well as for attaching a drip later on.
- They attach a blood pressure cuff to your arm and clip a pulse oximeter to your finger. This is so they can measure your blood pressure, heart rate and blood oxygen levels during the operation.
- They inject anaesthetic into the cannula and/or you’re asked to breathe anaesthetic gas and oxygen through a mask. The medicine injected in the cannula may make your arm feel cold or heavy; this is normal. You’ll be given some warning before they do this and they’ll let you know when you’re about to become unconscious.
- They place a tube in your throat to help you breathe.
- If you need a catheter placed into your bladder, or other special lines placing, this will usually be done by the anaesthetist or a skilled member of staff once you are unconscious.
- You’ll be wheeled into the operating theatre (if you were in an anaesthetic room and not already in the operating theatre).
What happens after your operation will depend on the hospital, on the type of surgery you had and on your own medical needs.
In most UK hospitals, you will be taken from the operating theatre to the recovery room. You will gradually regain consciousness in the recovery room, but you are unlikely to remember much of it afterwards.
The staff in the recovery room will be looking after you and any other patients in the room, monitoring things like your blood pressure, heart rate and temperature. If you’ve had stage 1 phalloplasty, they might be taking doppler scans to check the blood flow to your penis.
The staff are also there to offer you reassurance as you regain consciousness – it can be confusing and disorienting.
Medical equipment and bandages
When waking up from surgery, most people will have:
- An oxygen mask (the tube will already have been removed).
- A cannula attached to a drip. The drip may contain medication as well as fluids.
- Dressings over their wounds.
Depending on the type of surgery you have, you might also have:
- A surgical drain/drains. This is a tube (or two tubes) coming from the area you had surgery on. It drains any excess fluid into a container/containers attached to the side(s) of your bed.
- A catheter. This is a tube going via your urethra to your bladder or through your abdomen to your bladder. It drains your wee into a bag that is attached to the side of your bed.
- Pressure dressings or bandages. This is the case for a few types of surgery, including for vaginoplasty and mastectomy.
- A vaginal pack. In the case of people recovering from vaginoplasty.
- A PCA (patient controlled analgesia) button. When you press this, it will give you a dose of pain relief (typically morphine). It’s limited to prevent you from overdosing. If this is something that could act as a trigger for you in relation to experiences of addiction, talk to the surgical team about it in advance.
Feelings
When waking up from surgery it’s not unusual to feel:
- Sick. Let the nurse know if this is the case so that they can give you anti-sickness medication and/or have a sick bucket close at hand.
- Confused, light headed and sleepy. The effects of the anaesthetic usually take a while to wear off.
- Scared or anxious. You’ve just gone through major surgery and are likely to be disoriented.
- Euphoric or giddy. You might have waited for a long time for this surgery and may also be on strong pain killers.
- Like you have a sore throat. This is caused by the tube they put down your throat during surgery.
- Hungry and thirsty. Ask the nurse if you can eat and drink something.
When you’re awake and on the ward or in your room:
- Keep the call bell close at hand and use it as soon as you think you’re going to need something. Remember that you’re not the only person the nurses are looking after, so it might take them a while to get to you.
- Set up the items on your bed table how you want them, if you hadn’t already. Don’t be afraid to ask a member of hospital staff for help with this. For example, by asking them to bring your bag over to the bed or getting specific items out.
- Tell a member of hospital staff if there are any issues. If there’s anything about the ward or your room that is causing sensory issues for you, tell a nurse or another member of hospital staff. There might be something they can do about it.
- Let your loved ones know that you’re awake! You might have spent several hours unconscious, but they have spent that time awake and might have been worried about you.
It’s important to tell hospital staff about any communication or access needs you might have. You’ll find some ideas to support you to do that on the Communicating about my needs page.
- Chelsea Centre for Gender Surgery
- Hull University Teaching Hospitals NHS Trust (top surgery)
- Parkside Hospital (vaginoplasty and vulvoplasty)
Community voices
Errors or omissions
Is there something missing from this page? Have you spotted something that isn’t correct? E-mail info@transactual.org.uk to let us know.
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