Everyone’s recovery from surgery will be different. Lots of things can impact your recovery – some of these are things you might be able to control, others are not. Of course, what recovery looks and feels like for you will also depend on the type of surgery you had. Use this page to get a general sense of what you might be able to expect from surgical recovery. We hope it will help you to prepare mentally, physically and also practically. Almost all surgical teams will give you information on post-op care, dressing changes and what you should and shouldn’t do. Make sure you follow their guidance.
- Get plenty of rest. Your body has been through a lot and is having to do a lot of healing. This is likely to make you feel very tired. Listen to your body and get plenty of rest – sleep when you need to. You’re likely to find that you’re very tired for the first week or two after surgery, and after that your energy will slowly start returning to normal.
- Drink plenty of water. Having a couple of water bottles next to your bed or by the sofa can help with this!
- Eat a healthy diet. Lots of people recommend eating plenty of protein and colourful fruits and vegetables. Colourful fruits and vegetables are rich in anti-oxidants and high in magnesium and vitamins C and K. Whole grains are a good source of vitamin B. These vitamins and minerals are thought to help with healing.
Protein is needed to repair your body, so make sure you eat plenty of it. Meat, fish, eggs and cheese are good sources of protein. Good plant based (vegan) sources of protein include nuts and nut butters, lentils, oats, quinoa, beans and soya (tofu, veggie sausages etc). - Keep your bowels moving. If you’re struggling to do a poo, eating dried fruits (such as dates, figs or apricots) or liquorice can help. Some people also say that prune juice helps them.
- Stay entertained. In the first week or two, you might find it harder to concentrate. Have things that you can do that don’t take much brain power. You could binge watch a box set (or ten), listen to audiobooks and podcasts, knit, colour in – whatever you want to do, provided it’s something you can do whilst resting your body.
- Get up and move around. Light exercise, such as going for a walk, is typically encouraged by surgeons after surgery. We’re not talking a yoga routine or 3 mile run here, but things that are very gentle. It might be that at first your ‘light exercise’ is walking around your living room. Build yourself up to a walk around the block and gradually increase your distance (or number of laps if you’re worried about going too far from home). Listen to your body – stop if it feels like you’ve pushed yourself too far.
- Stay in contact with your friends and/or family. Recovering from surgery can be tough and at times you might need some emotional support. Stay in regular contact with friends and/or family members and talk to them about how you’re feeling.
- Wet wipes and dry shampoo. If you’re not allowed to shower yet, wet wipes and dry shampoo can at least help you to freshen up.
- Getting dry after a wash. After a wash, shower or a bath, it’s important to pat your wounds dry so that you don’t damage any healing skin. Using a hairdryer on cold setting is a very good option, especially if you’re recovering from lower surgery.
- Getting dressed might be tricky, depending on what surgery you’re recovering from. Make life easy for yourself – stick to loose, easy to put on clothes.
- Sleeping on your back. This can be a challenge, especially if you’re not used to it. You might find it easier to sleep on your back if your body is propped up at a slight angle. For some surgeries you’ll be told to sleep like this for a certain amount of time. A v-pillow and memory foam pillow can come in handy here. Putting a pillow under your knees can also help.
- Pain management. The pain medication you’re advised to take will depend on a lot of things, always follow the instructions of your doctor or nurse. If you’re finding you’re still in pain, talk to your surgical team and/or GP. Some people find it useful to set an alarm to let them know when their next pain dose of medication is due.
- Don’t pick at it! Whether it’s a scab, a stitch poking through, or medical glue sealing a wound – don’t pick at it. The scabs will fall off naturally on their own and picking might impact what your scars look like. If they’re itching, apply some E45 cream or vaseline.
If there’s a stitch poking out do not pick at it or pull it – let your surgical team know, you might be able to snip it down so that it’s less annoying.
Medical glue is there to do a job – it’s sometimes used instead of stitches. It’s a very good idea to leave it alone and let it do its job – it’ll fall off when its ready to. - Cold packs can help with swelling. Always wrap them in a towel or cloth and don’t leave them on for more than 20 minutes at a time. Always check that your surgical team are happy for you to use a cold pack on your surgical sites. Heat packs should be avoided.
- Dressing changes. If you need to change any dressings, make sure you’ve washed your hands and/or used antibacterial gel. This will help prevent infection. When you’re changing a dressing, have a look at the wound (or use your phone to take a photo if you can’t see it) to check that it looks ok.
- Salt baths are very good for healing. However, only have a bath if you’ve been told you can.
- Getting rid of stains. If there are blood stains on your clothes or bedding, the best thing to do is start by soaking the item in cold salt water. When the stain has faded, put the item in the washing machine and wash it as usual.
- Antihistamines can help with itching. This is particularly useful if you’ve had an allergic reaction to the medical tape on your dressings. If you think you’ve had an allergic reaction to something, make sure you tell a medial professional.
- Take photos of your surgical sites when you’re having a dressing change. Yes, even if you’ve had genital surgery. Taking photos or making videos of your surgical sites will help you to keep track of how you’re healing and will make it more likely that you identify any potential issues quickly – especially if they’re on a part of your body you don’t normally see.
We know that not everybody is fortunate enough to have people around them to support them when they’re recovering from surgery.
Here are some things that will make life easier if you’re recovering at home:
- Keep cooking simple. If you can, prepare your home by filling your freezer with bulk cooked food that can go straight in the microwave. If not, jars of sauce are your friend – add tinned beans or chickpeas as a good source of protein. Prechopped green veg or spinach are also a good addition to jar pasta sauce.
- Get your groceries delivered. When they arrive, don’t be afraid to ask the delivery driver to come in and place the items on your work surface. Just tell them that you’re recovering from an operation.
- Work smart not hard. If you’ve got out or bed or off the sofa, make it count. What are the things you might want or need in the next couple of hours? Whilst you’re on your feet, get them and put them next to where you’re sitting or lying.
- Seek out human contact. If you have friends and/or family that you can phone or have a video call with, make sure you do. If you don’t, there might be someone from your local trans support group you can be in regular contact with. Even something as simple as a slow walk to the nearest shop (see the section elsewhere about light exercise) can give you the opportunity to interact with other human beings, even at a very surface level.
- Protect your bed linen. A lot of people find changing their bed linen a nightmare at the best of times. The worst bits are the sheet and the duvet cover, so do what you can to protect them. Lie on a towel or an Incopad or puppy pad – that way, when it’s dirty you can just swap it for a fresh one. Sleep under a sheet in addition to (or instead of, depending on the time of year) your duvet. That way you can use a fresh one when needed without having to wrangle the duvet out of and then into a duvet cover.
- Be prepared. Before you go to hospital, set up your home with everything you’re likely to need in easy reach. Make sure you’ve given it a good clean – that way you’re at least starting from a state of cleanliness when you get home from hospital. This is especially useful if you’re not going to be able to do a proper clean for a while after surgery.
It is normal to experience a whole range of emotions whilst recovering from surgery. Different emotions might come at different times and for different reasons, and some may come all at once! These emotions might include happiness, excitement and gender euphoria – those aren’t things to ‘manage’, so our suggestion is to just enjoy those feelings.
Low mood
Post-op depression often happens between 3 and 5 days after surgery, but can happen any time after surgery. You’re tired, your body has been through a lot, there might have been a lot of anxiety and/or excitement leading up to surgery. You might feel frustrated at having to depend on other people, being able to do less than usual, at any complications you might have experienced, or if healing is taking longer than you expected it to. You might also feel a bit lonely.
If you’re recovering on your own, it’s a good idea to arrange for friends and/or family to come and visit you. If nobody is able to visit you, having a video call might help lift your mood. Think of the things that make you feel good – it could be a little bit of chocolate or a favourite film, these small pleasures can help you get through this stage.
Anxiety
It is normal to be anxious about your healing process – particularly around whether or not your surgical sites should look or feel the way they do. This is where peer support can come in useful. As well as asking your surgical team whether what you’re experiencing is normal, you can ask other trans people who’ve had the same operation as you. Surgery-specific Facebook groups and Reddit pages are particularly useful in these circumstances, but please remember that they should always be an addition to medical advice!
Adjusting to your new body shape
You’ve spent your life so far with a certain set of body parts, but now you’ve had something added and/or removed. Your body has changed shape, but it’ll take your brain a while to catch up. It’ll take a while for you to get used to your body looking different, and that’s ok. Some of us experience a similar experience after changing our hair colour or getting glasses for the first time.
Sometimes our brains play tricks on us. There’s something called ‘phantom limb syndrome’ which effects people who have had an arm or leg removed, but this has been shown to impact people who’ve had other body parts removed too. In short: the brain takes a while to catch up with the new developments and keeps thinking that the body part is still there. For most people this feeling reduces over time and eventually disappears. Read more about ‘phantom limb syndrome’.
Light exercise, such as going for a walk, is encouraged even during the early stages of recovery. However, some types of exercise should be avoided for longer. This includes swimming, lifting heavy weights, riding a bike (in the case of genital surgery) and anything very strenuous.
Your recovery is your own and it might be that you can do things sooner or later than the examples given in this table. Ask your surgical team for advice if you’re not sure.
| Surgery | Strenuous exercise |
|---|---|
| Body recontouring | 1-3 weeks |
| Breast augmentation | 4-6 weeks |
| Facial surgeries | 6 weeks |
| Hysterectomy (Laparoscopic) | 6 weeks |
| Hysterectomy (Abdominal) | 6-8 weeks |
| Mastectomy | 6 weeks |
| Metoidioplasty | 6+ weeks |
| Orchidectomy (as a stand-alone procedure) | 4-6 weeks |
| Phalloplasty (Stage 1) | 6-8 weeks |
| Phalloplasty (Stage 2) | 4-6 weeks |
| Phalloplasty (Stage 3) | 4-6 weeks |
| Tracheal shave | 6 weeks |
| Vaginoplasty | 6-10 weeks |
| Vocal Surgery | 1 week |
| Vulvoplasty | 6 weeks |
Your recovery is your own and it might be that you are ready to go back to work sooner or later than the examples given in this table. Don’t go back until you’re ready and remember that you can ask for a phased return or for adaptations if you need them.
| Surgery | Work |
|---|---|
| Body recontouring | 1-3 weeks |
| Breast augmentation | 1-2 weeks |
| Facial surgeries | 1-2 weeks |
| Hysterectomy (Laparoscopic) | 2-6 weeks |
| Hysterectomy (Abdominal) | 6-8 weeks |
| Mastectomy | 2-6 weeks |
| Metoidioplasty | 2 months |
| Orchidectomy (as a stand-alone procedure) | 1-3 weeks |
| Phalloplasty (Stage 1) | 6+ weeks |
| Phalloplasty (Stage 2) | 4 weeks |
| Phalloplasty (Stage 3) | 2 weeks |
| Tracheal shave | 1 week |
| Vaginoplasty | 6-10 weeks |
| Vocal Surgery | 1-2 weeks |
| Vulvoplasty | 6 weeks |
The general advice for driving after recovering from surgery is that you need to be able to do an emergency stop comfortably. However, you shouldn’t drive within 24 hours of having a general anaesthetic.
Your recovery is your own and it might be that you can do things sooner or later than the examples given in this table. Ask your surgical team for advice if you’re not sure.
| Surgery | Drive |
|---|---|
| Body recontouring | 24 hours |
| Breast augmentation | 1 week |
| Facial surgeries | 1-2 weeks |
| Hysterectomy (Laparoscopic) | 2-6 weeks |
| Hysterectomy (Abdominal) | 3-6 weeks |
| Mastectomy | 2 weeks |
| Metoidioplasty | 2 weeks |
| Orchidectomy (as a stand-alone procedure) | 1 week |
| Phalloplasty (Stage 1) | 6+ weeks |
| Phalloplasty (Stage 2) | 2 weeks |
| Phalloplasty (Stage 3) | 2 weeks |
| Tracheal shave | 24 hours |
| Vaginoplasty | 4-6 weeks |
| Vocal Surgery | 24 hours |
| Vulvoplasty | 4-6 weeks |
Wound healing
Anywhere you’ve had surgery is considered a wound. Remember that even if you only have quite small incision sites on your skin, there can be bigger wounds inside your body. This is particularly true for laproscopic hysterectomy.
There are fours stages of wound healing:
- Blood clotting (haemostasis). The blood cells stick together to form a blood clot. For bigger wounds, blood clotting can take 2 days. When you see a scab on your skin, it’s a dried blood clot.
- Inflammation. This is one of the body’s natural defence mechanisms. Your body will produce liquid at the source of a wound – it will clean it and make the area ready for new growth. This causes swelling. The inflammation stage of healing can be painful and typically lasts around 6 days, depending on the size of the wound.
- Rebuilding (proliferation). Your body has to do a lot of hard work at this stage. The area is filled with new tissue (called granulation tissue), the edges of the wound are pulled closer together, and a protective barrier of cells is created. This stage typically takes between 4 and 30 days and will depend on the size of the wound. At the end of this stage, the wound is closed.
- Strengthening (maturation). This is the stage where scar tissue forms. The cells that were used to do the repair work at the rebuilding stage aren’t needed any more, so the body gets rid of them. The tissue in the healing wound gradually gets stronger and more flexible. This is by far the longest stage, and can take up to two years.
Read more about the stages of healing on the Elastoplast website.
Watch a video about wound healing.
Sometimes your surgical sites will look and feel worse as part of normal healing. It’s a good idea to ask the surgical team what good healing will look like and what you need to look out for.
Discharge and blood
When your surgical sites are at the inflammation stage of healing, there might be some watery liquid coming from them at first. It might go a bit crusty when it dries. This is normal. However, tell a doctor if this liquid smells or is yellow, green, grey, brown or white in colour.
People who have had a hysterectomy or a vaginoplasty can expect that there will be some discharge from their vagina. It’s a good idea to use a sanitary towel to protect the underwear. The discharge might include stitches falling out and old blood. You can tell that blood is old because it is dark in colour and sometimes it looks brown. People who’ve had hysterectomy might experience no bleeding at first and then a sudden rush of it a week or two after surgery. This can feel a bit worrying, but is normal. If the blood looks fresh (bright red) or looks like it has blood clots in it, contact a doctor straight away.
Read more about wound discharge.
Swelling and bruising
Swelling and bruising are to be expected after surgery. Over time, the bruises will change colour and fade. The swelling will get less and then disappear. If you notice new swelling or new bruising, contact a surgical team and/or talk to a doctor.
Scars
The surgical incision sites will eventually become scars. It is usual for scars to stay a pink colour for several months, and it can take more than a year for them to settle down. There’s information on scar care elsewhere on this page.
Funny feelings
When your surgical wounds are healing, they might feel itchy. This is normal. Try to resist the urge to scratch your wounds or pick at your scabs. If the wound has closed, you could apply moisturiser or vaseline instead. Some people report that scratching an area of skin near to the surgical incision can help with this too.
Tingling sensations or strange sensations are also normal for people who’ve had genital surgery or mastectomy. Your body is in the process of rebuilding the nerves that run to and from those very sensitive areas of your body and those sensations are a sign that it’s working. People who’ve had phalloplasty might have a strange sensation in their lower abdomen, where the nerve for their penis was hooked up. There’s more on that elsewhere on this page.
The skin around your scars (or soon-to-be) scars might feel different. It might feel numb, it might feel more sensitive than normal. With time, you might regain feeling in numb areas – this can take more than a year. Those areas that were much more sensitive than normal might also settle down.
There’s a lot of information out there about scar care, with different people recommending different products. However, whatever scar care products you do (or don’t use), there are some things that there is agreement on:
- Putting medical tape on top surgery scars is important. The tape applies pressure and reduces the tension in the healing skin. However, when you’re taping scars (top surgery or otherwise), don’t remove the tape daily – doing this removes the top layer of skin, and you’re going to need that! Instead, wait until the tape is peeling off.
- It is helpful to massage your scars. Massaging the scars helps them form more evenly, soften them, and improve their flexibility. It can also reduce itchiness.
Wait until your surgical wounds have properly healed (there are no scabs or visible stitches and the skin has closed properly) before massaging your scars. Put some moisturiser or vaseline on your fingers and gently rub each part of the scar from side to side and up and down. St George’s Hospital have a resource about scar massage if you’d like to know more info about it. - It’s important to protect your scars from the sun. Keep them covered from the sun for your first year after surgery, then use sun cream with a high SPF after that. This is especially important for people who’ve had a skin graft as part of phalloplasty.
- There are lots of scar care products available. These are designed to make scars look more similar to your skin tone. Some examples of widely recommended products include BioOil, Kelo-Cote, and silicone dressings or gels.
What are keloid scars?
Keloid scars are raised areas of scar tissue. They are hard and smooth.
Keloid scars are different to other types of scar because they spread beyond the line(s) made by the surgical incision and because they are hard and raised. Other types of scar usually stay along the line(s) made by the incision and become softer and flatter with time.
When a keloid scar is growing it can feel itchy or painful. If the scar is near a joint it can limit movement or make it uncomfortable.
Who gets keloid scars?
Anyone could get a keloid scar. If someone in your family gets keloid scars, you are more likely to get them too. This is because there’s something in your genetic make-up that makes your body more likely to scar in this way.
Black and brown people are more likely to get keloid scars than white people. Melanin (the thing that gives people their skin, hair and eye colour) is thought to play a role in keloid scarring. People with darker skin have more melanin in their skin than people with lighter skin, so are therefore more likely to get keloid scars.
When do keloid scars form?
Keloid scars don’t form straight away. They might start developing a few weeks after surgery, or they might appear years after surgery. When they appear, they can take months or years to finish growing.
Can keloid scars be treated?
Keloid scars can’t be removed, but there are things that can be done to help with what they look like or any pain or irritation you might experience.
These treatments include:
- Steroid injections
- Steroid cream
- Silicone dressings
- Silicone gels
- Cryotherapy (a treatment to freeze the scar)
- Laser therapy
Content note: This section is about things that could, but probably won’t, go wrong. If you experience health anxiety, you might want to give this section a miss and ask a trusted friend or family member to read it instead.
As mentioned elsewhere on this page, it’s a good idea to ask your surgical team for specific things to watch out for during your recovery process. However, there are some things to be aware of regardless of what surgery you have.
Common issues
Some common issues with healing from transition related surgery include:
- Fistulas. These are holes where there shouldn’t be holes. For someone who’s had vaginoplasty, this could be a hole that lets wee leak from their urethra into their vagina. For someone who’s had phalloplasty or metoidioplasty, this could be a hole in their new urethra – this may or may not leak out of the body through a hole at the surface.
- Haematomas. A collection of blood that is sitting in the body, not inside a blood vessel. If you have one, you might be able to see or feel it under the skin and it might be purple in colour.
- Hypergranulation. This is when too much new tissue appears in the wound. It makes the incision site raised and red and can impact part or all of the healing wound. This type of tissue might bleed more easily and have a jelly like texture. It can slow healing down.
- Infections. If the surgical incision feels hotter than other parts of your body, is redder and more swollen than it was, and/or there is smelly or funny coloured liquid coming from it, then you might have an infection. These can be treated with antibiotics, medical honey, iodine dressings, or other types of dressing or medication. If there’s a suspected infection, your surgical team will ask you to get a swab taken by the nurse at your local GP practice. That will help them to know what treatment to give you.
- Seromas. A collection of fluid under the skin. These sometimes go away on their own.
- Urethral strictures. These are narrowings of the urethra and are more likely to be experienced if someone is recovering from from phalloplasty or metoidioplasty with urethral lengthening.
- Urinary tract infections (UTIs). Typical signs of a UTI include: a stinging sensation when having a wee, weeing more often than usual, cloudy and strongly smelling wee. If they are left untreated, they can potentially turn into bladder infections.
- Wound breakdown. This is also known as wound dehiscence or wound separation. It’s when a surgical incision re-opens and is be more likely to happen within 10 days of surgery. You might be experiencing this if any of your surgical sites look like they have a hole in them rather than being neatly stitched together, become more swollen, redder or start bleeding.
If you experience any of these issues, contact your surgical team and/or your GP right away.
Please note that this is a non-exhaustive list. Your surgeon should tell you all of the risks of the surgical procedure before your operation.
Warning signs
Get medical advice if:
- Your pain is getting worse rather than better.
- The painkillers you’ve been given aren’t working.
- You constantly feel cold or shivery and nothing is helping.
- You have a body temperature above 37.5°. If this is the case, phone 111 straight away.
- Your surgical sites are warmer than the other parts of your body and/or have become redder.
- There is fresh blood coming through your dressings or if you are Bleeding from any other part of your body and don’t know why. Phone 111 in this situation.
- There is new swelling or new bruising and you don’t know why. If there is new swelling in your groin or lower leg, phone 111 or 999 – this could be a sign of the kind of blood clots that could put your life at risk.
- There is discharge that is smells or is yellow, green, grey, brown or white in colour.
- The skin at your surgical sites (including your penis, if you’ve had phalloplasty) turns a different colour than usual and a different colour to the rest of your skin.
- You keep being sick (vomiting).
- You’ve had a hysterectomy and any of the following things come from the vagina afterwards: heavy bleeding with fresh (bright red) blood, blood clots, strong smelling discharge.
- You haven’t been able to do a wee even though your bladder is full. If you’re using a catheter, this will be if no wee at all has gone into your catheter bag or come out of your flip flow valve.
As with everything else relating to surgery and recovery, the type of support you’ll get from the surgical team will depend on whether you had surgery on the NHS or went private, on the surgical team, on your health and healing, and on how well surgery went or you.
An increasing number of surgical teams have one or more Clinical Nurse Specialists (CNS). You might be given the same nurse as a point of contact both before and after surgery. Clinical Nurse Specialists are able to answer your questions, check in on your healing and wellbeing, and identify when things aren’t going right.
If you’re worried about anything to do with your recovery, contact the surgical team.
For surgeries involving regular follow up appointments, most of the appointments will be with a nurse. However, you can expect to have at least one follow up appointment with a surgeon. You can read more about this on the post-op appointments page.
Catheters and catheter care
If you’ve been sent home with a catheter you’ll either keep using a catheter bag or you might move onto using a flip flow valve. A flip flow valve is what it sounds like – you essentially aim the end over a toilet and turn the tap-like valve on it when you’d like to have a wee.
Having a catheter can make you feel like you always need a wee, so it can be hard to tell what is a genuine feeling of needing to go. However, you’re likely to tune into your body and will get to know if you genuinely need a wee or if your bladder just feels a bit strange.
Some people find that having a catheter feels a bit strange or uncomfortable, and other people experience bladder spasms because the catheter is irritating their bladder. It’s important to drink plenty of water to reduce the risk of this happening and to help prevent infection. Cranberry juice is also said to be useful in preventing urinary tract infections. If you are in pain due to your catheter, tell your GP or your surgical team – you might be able to have some medication to help reduce the spasms.
If you’re using a flip flow valve, remember to open it and have a wee before sitting down to have a poo – our bodies naturally try and wee when we’re having a poo, so having already emptied your bladder can reduce the chance of urine coming out of places it shouldn’t.
If you keep using a catheter bag, you might have a leg bag and a night bag. The leg bag is usually smaller and can be attached to your leg, the night bag is usually bigger and is kept on a stand or attached to your bed overnight. It’s important to keep your catheter bag lower than your bladder is so that urine is able to flow along the tube and into it. When the bag is full, empty it over the toilet. You can expect to be sent home from hospital with catheter supplies. If you aren’t, or you run out, ask the surgical team or your GP. You can also buy catheter supplies online.
It’s important to keep your catheter tube, bag and the area where it enters your body (whether through your urethra or through your abdomen) as clean and dry as possible. Use hand sanitiser or wash your hands before touching anything associated with your catheter.
The first wee
If you’ve been sent home with a suprapubic catheter, you’ll usually be asked to do a ‘pee trial’ before it’s removed. People having urethral lengthening as part of phalloplasty or metoidioplasty will definitely have to do this.
You’ll be asked to wee through your urethra and into a measuring container. Typically this happens at home and it’s advisable to do this whilst standing in the bath or shower cubicle – it takes a while to get used to and for the spray to calm down. Make a note of how much wee comes out and if any comes out of any unexpected places. Next aim the flip flow valve over your empty measuring container, open the valve and measure how much wee comes out (if any). If no wee comes out when you open the flip flow valve but lots came out through your urethra, that’s a good sign.
You’re likely to be asked to repeat this ‘pee trial’ several times within a day to confirm that you’re ready for the suprapubic catheter to be removed.
Catheter removal
Different people have different experiences, but catheter removal is usually fast and painless – it might feel a bit weird but will be over very quickly.
You’ll find more information about catheters and catheter care on the Bladder and Bowel UK website.
A lot of people worry about personal hygiene when recovering from surgery.
Here are some top tips:
- Follow the instructions. Someone from the surgical team ought to have told you what you can and can’t do in relation to getting your stitches or surgical sites wet during recovery. If they haven’t done, contact them to ask. This is important because the instructions will depend on the type of stitches they used when closing your surgical sites.
- Scent free products. Your skin might be more sensitive around your surgical sites, so scent free soap or shower gel is a good option.
- Be gentle. In the shower or when having a flannel wash, avoid rubbing your incision sites. Instead, gently apply shower gel and then let water run over it to wash it off. This will prevent you from knocking your scabs off or damaging your stitches.
- Keep your bum clean. It’s very important to keep surgical incisions clean, but that can be tricky when they’re on your genitals. After having a poo, there are a few things you can do to clean yourself gently:
- Use the water method. It’s a method that is used by billions of people world wide. Pour water over your anus with a portable bidet, lota, or a jug. Some people use toilet paper next to remove most of the poo. Either way, next gently wipe your anus and surrounding area with your fingers (being careful not to touch your stitches) whilst still pouring the water. Keep going until your bottom feels clean. Wash your hands thoroughly before gently patting yourself dry with some toilet paper, a small towel, or by using a hairdryer on the cold setting. If you’re not sure how to use this method, take a look at this video about the water method of cleaning your bum.
- Use wet wipes or damp toilet paper. Be sure to be gentle, wipe from front to back and avoid the toilet paper touching your surgical incisions. Wash your hands thoroughly afterwards.
- See the sections on this page about recovering from phallo and meta and from vaginoplasty and vulvoplasty for some other relevant info.
- Use the water method. It’s a method that is used by billions of people world wide. Pour water over your anus with a portable bidet, lota, or a jug. Some people use toilet paper next to remove most of the poo. Either way, next gently wipe your anus and surrounding area with your fingers (being careful not to touch your stitches) whilst still pouring the water. Keep going until your bottom feels clean. Wash your hands thoroughly before gently patting yourself dry with some toilet paper, a small towel, or by using a hairdryer on the cold setting. If you’re not sure how to use this method, take a look at this video about the water method of cleaning your bum.
- Get used to your new body parts. Even after recovery, it might take a while to get used to your new body parts (or absence of old parts). If you’ve had genital surgery, make sure you wash thoroughly in all the creases of skin – you will (hopefully) have been used to doing that before surgery, it’s just a case of getting used to the skin being in different places! Remember to use scent free products on your genitals.
When will I be able to have a shower?
| Surgery | Shower |
|---|---|
| Body recontouring | 5 days after |
| Breast augmentation | 2 days after |
| Facial surgeries | 2 days after |
| Hysterectomy (Laparoscopic) | Next day |
| Hysterectomy (Abdominal) | Next day |
| Mastectomy | 14 days after |
| Metoidioplasty | 7-10 days after |
| Orchidectomy (as a stand-alone procedure) | 2 days after |
| Phalloplasty (Stage 1) | 1 week after (keeping graft site dry) |
| Phalloplasty (Stage 2) | 1 week after |
| Phalloplasty (Stage 3) | Next day |
| Tracheal shave | Next day |
| Vaginoplasty | 5 days after |
| Vocal Surgery | Next day |
| Vulvoplasty | 2 days after |
Stage 1 phalloplasty recovery
Most people who’ve had phalloplasty say that stage 1 has the most difficult recovery. That’s because it’s a very long and complicated operation and you leave hospital with lots of healing wounds.
After stage 1, your post-op care will be a joint effort between the surgical team and the nurse(s) at your GP practice.
You’re likely to have regular phone appointments with your named nurse from the surgical team. You’ll be asked to send them photos so that the team can check your recovery is going as they’d expect it to. As you recover, your phone appointments will become less often. You can expect to have at least one in-person post-op appointment where they check your penis is healthy and show you how to flush it through with water (more info later in this section).
You’re likely to be asked to have the dressing on your graft site changed by a nurse once a week. Ask the nurse to take photos of your graft site before it’s re-dressed, as you’ll need to send them to the surgical team. If everything’s going well, you’re likely to be told that you can stop going for dressing changes at around 4-6 weeks after surgery. After that, you might be told to cover your graft site with a light dressing and to submerge it in a salt bath on a regular basis. If you had radial forearm phalloplasty, a baby bath can be useful for bathing your arm.
If you have medical staples, you’re likely to be asked to get them removed at your GP practice around 2 weeks after surgery. If you have radial forearm phalloplasty, they’ll be on your bum and you’re likely to be grateful they’ve been removed!
Read more about the skin graft healing process.
Flushing your new urethra
Note: these instructions are for people who’ve had stage 1 phalloplasty in the UK – without urethral hookup, which happens at stage 2.
- Stand in the bath or shower tray, or sit on the toilet.
- Fill a cup with luke-warm water.
- Fill a 10ml syringe with water from the cup.
- Hold your penis so it’s pointing upwards towards the ceiling.
- Place the tip of the syringe into the end of your urethra at the tip of your penis.
- Gently squeeze the tip of your penis around the tip of the syringe.
- Slowly push the plunger of the syringe so that it squirts water through your new urethra.
- Repeat the steps with 2 more syringes of water.
Stage 2 phalloplasty recovery
After stage 2 of phalloplasty, you’re likely to have regular phone appointments with your named nurse from the surgical team. You’ll be asked to send them photos so that the team can check your recovery is going as they’d expect it to. As you recover, your phone appointments will become less often.
Recovery after urethral lengthening
If you have urethral lengthening, your urethral catheter (the one in your new urethra) will usually be removed a week after surgery. Your suprapubic catheter (the one going into your abdomen) will usually be removed 3 weeks after surgery. Catheter removal is normally done in your local area – either by a nurse at your GP practice, a district nurse, or at your local hospital. Talk to your GP practice to find out what arrangements you’ll need to make for this.
You’ll find more info on catheters in the ‘catheter care’ section of this page.
Having a wee after urethral lengthening
Post-void drip (drips of wee coming out after you’ve already finished and done your trousers up) is very common for people who have a penis – including for cis men. For people who’ve had phalloplasty or metoidioplasty, it might feel a bit worrying. A process called ‘milking’ might help you.
- Hold your penis over the toilet bowl and give it a firm shake before doing your trousers up.
- Put your finger on your scrotum at the point where wee used to leave your body.
- Push firmly (but not so hard it hurts) and trace your finger along the route of your new urethra to the base of your penis.
- Use your other hand to squeeze the base of your penis (again, not so hard that it hurts). Keep holding your penis in this way but move your hand to the end of the penis. The last drops of wee should come out.
- Some people also dab the end of their penis with toilet roll at this point.
Some people can get worried or self conscious about post-void drip. If this affects you, you might wish to buy lightweight liners for your underwear – there are types designed specifically for men.
Sensation
People who’ve had phalloplasty report feeling a particular feeling in their lower abdomen, where the nerve for their penis was hooked up – this is because their body has not yet realised that the sensation is coming from their penis. At first it can be hard to distinguish between feelings related to pain, pleasure and temperature – but people normally get used to it. It can take several years for sensation to fully develop, so be patient.
Ejaculation
Trans men and non-binary people who weren’t born with a penis are sometimes able to ejaculate. If you were able to ejaculate before phalloplasty or metoidioplasty, you might still be able to ejaculate after surgery. If you’ve had urethral lengthening, then it’ll come out of your penis. The liquid will still be transparent and watery.
I’ve had phalloplasty but don’t have an erection device, can I penetrate my partner with my penis?
There are a couple of things you might be able to try:
- Wrap your penis in Coban tape and then put one or two condoms on.
- A penis sleeve
Douching
Douching is a way to clean your vagina if you’ve had vaginoplasty. You’re likely to be asked to douche every day for 6 weeks, then as and when required for personal hygiene after that. You are likely to experience discharge from your vagina for the first few weeks after surgery, possibly up to 8 weeks.
A nurse is likely to show you how to douche whilst in hospital, follow their instructions. However, the following info will help you to have an idea of what is involved:
- Fill a clean container with sterile saline.
- Squeeze the bulb of the douche to fill it up.
- Stand in the bath or shower tray, or sit on the toilet.
- Insert the nozzle of the douche into your vagina.
- Squeeze the bulb of the douche to squirt the contents into your vagina.
- The water and any discharge from your vagina will flow out of your vagina.
Dilation
Dilation is a process that helps you to make sure that your vagina stays a certain size after having a vaginoplasty.
As with douching, a nurse is likely to show you how to dilate whilst in hospital, follow their instructions. You can expect to dilate 3 times a day for 8 weeks. If you find you’re struggling, it might help to take paracetamol 30min before you’re planning to dilate. As dilating becomes easier, you will be able to drop to two sessions a day, and then one a day. By 9 months post-op, you can expect to dilate once a week.
However, the following info will help you to have an idea of what is involved and give you some suggestions on what you can do if you’re finding it difficult.
- Go to the toilet to make sure you don’t need a poo or a wee.
- Put your dilators in a bowl of warm water.
- Set up a relaxing atmosphere. Put on some music and light some scented candles (if you’re into that sort of thing).
- Put an old towel on the bed and lie on it.
- Apply lots of water-based lube to your dilator and massage your vaginal opening.
- Hold the small dilator in one hand and put a finger of the other hand into your vagina, using it as a guide for the dilator.
- Take your finger out of your vagina and place the dilator inside as far as it can go. Avoid applying excess pressure and take your time. Avoid twisting.
- If you’re ready to, remove the small dilator and use a larger size inside your vagina for 20min. It can be helpful to imagine your pelvic floor muscles relaxing.
- Start by placing a small dilator in your vagina as a guide, then use a bigger size inside your vagina for 20min.
- Remove the dilator and wash your dilators with hot soapy water.
Using the toilet
After vaginoplasty or vulvoplasty, your urine stream might be a bit unpredictable at first, and might come out as a spray. That’s because of the swelling around your urethra, it will calm down.
Whilst your wounds are healing, it is a good idea to pour warm water over your wounds and urethral opening after having a wee. You could use a jug for this, or you might find a portable bidet or lota useful.
Once you are able to use toilet paper, remember to always wipe from front to back after using the toilet – this will help to prevent urinary tract infections (UTIs).
Hormones
If you’d been asked to stop taking oestrogen before surgery, you’ll be able to start it again when you get home. You’ll no longer need to take blockers. It’s a good idea to check your hormone levels 8 weeks after starting oestrogen again, as your levels might need adjusting.
When can I have sex or masturbate?
After surgery on your genitals and after hysterectomy, it’s important to not have sex or to masturbate until you’re ready to. This means being healed enough, but also being emotionally ready. Don’t be afraid to ask the surgeon or nurse supporting your aftercare when it’s safe for you to have sex or masturbate. The important thing is to be gentle at first and stop if anything feels painful or uncomfortable. When you’re first having sex, make sure your partner(s) understand the need to be gentle.
| Surgery | Penetrative sex from |
|---|---|
| Hysterectomy | 4-6+ weeks after surgery |
| Metoidioplasty | 4-6+ weeks after surgery |
| Orchidectomy | When comfortable to |
| Phalloplasty | 6+ weeks after surgery |
| Vaginoplasty | 12+ weeks after surgery |
| Vulvoplasty | 4+ weeks after surgery |
Will I still be able to orgasm?
There are no guarantees, but you are likely to still be able to orgasm. If you’re on hormone therapy, you may have noticed that your orgasms feel different already. Genital surgery will potentially change that again – it would be a surprise if it didn’t.
Remember that your brain and your body are getting used to old body parts being gone and new body parts being there. This might mean your experience of sexual sensation changes with time – generally for the better. Your body and your relationship to it will continue to change, and you could be pleasantly surprised months or even years after lower surgery.
What do I need to know about sexual health?
If you’ve had genital surgery the way you look after your sexual health might need to change. Take a look at Terrence Higgins Trust’s information on sexual health for trans people.
To find out more about the hospital you’ll be staying in, take a look at the hospital website.
Other sources of information include:
- American Academy of Dermatology Association – Keloid Scars – causes
- Bladder and Bowel UK website
- Chelsea and Westminster Hospital – Gender Affirming Hysterectomy
- John Hopkins Medicine – Phalloplasty for Gender Affirmation
- John Hopkins Medicine – Top Surgery
- Keloid scars
- Metoidoiplasty.net
- My Health Alberta – Orchiectomy
- Parkside Hospital – Vaginoplasty
- Phallo.net
- Phalloplasty – What is it, risks, benefits
- Scar massage
- Skin grafts
- St Luke’s Hospital Discharge Instructions for Your Split Thickness Skin Graft Site
- Terrence Higgins Trust – Sexual health for trans and non-binary people
- The stages of wound healing
- TopSurgery.net
- Trans Aid Cymru surgery aftercare resources
- Types of drainage from a surgical wound
- MTFSurgery.net
- University Hospitals Sussex – Treatment of Hypergranulation
- University of California, San Francisco – Vaginoplasty procedures, complications and aftercare
- University of California, San Francisco – Phalloplasty and metoidioplasty – overview and postoperative considerations
- Women’s College Hospital – Douching
- Wound dehiscence
- Vaginoplasty at Brighton Hospital
- Video about wound healing.
- You can find more PDFs and websites about surgery in the Surgery section on genderarchive.org.uk.
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