- Post-Operative period in the hospital
Tube drains and catheter
The urinary catheter and tube drains will stay in place for 5 days when the anesthesia wears off and you will you will be feeling the tube drain. Due to the catheter irritating the bladder, you will always feel like urinating. However, this shouldn’t worry you as the urine will slowly pass through the catheter. The patient is not allowed to walk on their own. The surgeon will start training the bladder by holding the urine catheter every 4 hours to maintain bladder muscle tone and function normally to minimize the dilemma of urination. When the catheter is removed, you will be able to urinate on your own while seated.
Pain: when the anesthesia wears off, you will experience pain but it’s minimal and lasts for one day and will slowly subside. You will get IV fluid and strong antibiotics. On the first day, IV morphine will be issued for pain. On the second day, the pain will have reduced and oral analgesia can reduce pain. However, if it’s extremely painful, you can request for occasional morphine injection.
Food: when you wake up, you can take soft meals and drinks in the first few days and you will begin consistent meals after your bowel movements become regular. Avoid vegetables, fruits and fiber packed foods so that you do not pass stool.
However, if it’s a must you pass stool, you can still do it but ensure the anal area is thoroughly cleaned since it’s next to the surgical wound. On the third day, bladder training commences. You can stand up and walk around the room or sit on the bedside sofa.
Vaginal stent: the vaginal packing will remain in the same position for 5 days. On the 5th day, tube drain, vaginal packing and catheter will be removed at the same time to keep it clean and off infection.
The post-operative period requires one to stay in the hospital for 6 days. When the vaginal packing is removed, the patient is able to walk and leave the hospital. However, you will need another 7-14 days to recover and be ready to travel. It’s best to stay in a hotel near the clinic so that our team can attend to you until you leave Thailand.
When the vaginal packing is removed, one might experience bleeding from the urethral and vaginal opening. We recommend that you stretch your leg, put your knees together and remain still for 30 minutes, the bleeding will stop. If it doesn’t stop, pressure compression by gauze can assist to halt bleeding.
After vaginal packing is removed, the nurse will assist you to the toilet to shower for the first time and begin urinating. At the first time to void with all bladder power because it is swelling around the urethral opening. To pass the urine to this area you need more power than normal voiding. If you can void, you can move to the nearby hotel.
If you are unable to pass urine, you may have to remain in hospital and may require catheter retaining for another week.
If you have already moved to the hotel and experience problems while urinating, it’s recommended to get back to the hospital or call the hotline number to advice and put another catheter by the nurses.
If you are able to pass urine, you can leave the hospital. Here is a checklist of items that we will give you to carry to the hotel:
- Appointment card: we will book an appointment on 12-14 day after operation or day 7 after discharge from the hospital for sectional stitch off, assess the vaginal cavity and begin dilation. During this appointment, please come with a small dilator and a piece of napkin with you to the clinic on day 10 after procedure to assess the surgery wound, day 14 for vaginal assessment and complete stitch off final check on same day before you leave Bangkok.
- Namecard of our hospital and staff should any problems arise concerning urination and wound care.
The clinic will offer a home set for those patients that insist on the following items:
- Donut ring seat. This makes it comfortable and will protect you from sitting on surgical wounds.
- 2 different sizes of mold or dilator
- 5 packets of condom
- A syringe ball for vaginal douches
- Post op medication
- A bottle of betadine
- A tube of sterile gel
- Post-Operative Care
2.1 Wound Care
- The wound should thoroughly washed with betadine solution in the shower, then douche when seated on the toilet seat.
- Douche solution (measurements) = 5-10 ml (cc) of Betadine solution combined with 1L of water or until the container is full.
- Put the douche completely inside, squeeze and tightly hold the container
- Remove the douche while you are tightly holding the container
- Ensure the wound remains dry and apply betadine solution with cotton balls. In case there is any bleeding, apply pressure with a dry cotton ball to the area for 15 minutes. On the first weeks after surgery, tampons must be changed often during the day because of usual vaginal bleeding during the recovery period.
- After a month of SRS operation, you will be expected to begin applying premarin cream on your neo-vagina. Apply twice a day to make your neo-vagina supple. This will take about 6 months.
- Before you are discharged from the hospital, the nurse will show you how to take care of your vagina and prescribe some medicines. The sutures will be removed 7-10 days after surgery and you can go back home.
2.2 Dilation: when recovering on your first day in the hotel, you must follow the following instructions:
- To ensure your procedure is successful, dilating is crucial. If you do not dilate as instructed by the doctor, it cause the newly created vagina to shorten both in depth and width because of the scar contracture.
- Lack of proper dilation can also cause fatal injury. You will be showed how to slowly dilate towards the right direction when the vaginal packing is removed.
- Dilation can be painful during first weeks, but it’s important for creating total depth and ensuring post-operative functioning of the neovagina.
Insertion the dilator
Before you begin, semiflex your knee and relax the muscles.
Cover the dilator with a condom, apply KY-jelly and slide slowly and keep it up for approximately 15-30 minutes. When done, clean as instructed and apply antibiotic ointment on the stitching and any other area where there is a fresh wound.
Begin with a small dilator and gradually progress to the bigger ones offered.
Do not skip dilation even it feels painful. If you do, it may result in partial or total collapse.
Clean out the lubricant after dilation and smear antibiotic ointment or betadine solution until the wound completely heals.
A month after SRS operation, you will be expected to begin applying Premarin cream on your neo-vagina. Apply twice a day to make your neo-vagina supple. This will last about 6 months.
Four weeks after surgery you will be able to engage in neo-vaginal intercourse. The neo-vagina will require some kind of lubrication. Generally, patients will enjoy sexual intercourse after successfully dilating the neo-vagina to the last size of vaginal dilators.
Sex partner should put on a condom and smear lubricant in the vaginal cavity during neovaginal penetrative sex in the 1st month to stop trauma effect from lack of lubricant. On the 2nd month, intercourse can be done with no condom but lubricant must be used.
Return to female hormones:
Patients can recommence taking oral female hormones 2 months after procedure. However, the need for female hormones is minimal than before procedure.
You will be issued with documents to certify that you have successfully gone through sex reassignment surgery.
Insurance and Legal issues
Insurance companies may omit transsexual treatment similar to the way they do on aesthetic surgery
Legally changing your name and birth certificate are achieved according to the laws of your given country or state.