Recovery after sex change surgery and complication related to sex reassignment surgery

It is highly recommended that you should stay only in your room for one week. Unnecessary walk or any postures that induce strain on the area can cause wound complication.

You should start taking shower daily while recuperating at the hotel, never take bath or swimming before 2 months.

Clean the labia and vaginal opening gently with provided baby wipe papers after emptying your bladder or bowel.

Do not wipe the urethra or clitoral area since these structures tend to get bleed.

Always keep your legs far apart while lying. No need for sanitary pad (while staying in your room) to avoid dampness or wound compression.

The first douche will normally be started at the clinic on the follow up date (usually after 10 days).

You can start douching by your own douch kit later using diluted Betadine solution (3-5 drops mixed with 1 glass of clean water)

Douche should be done only 2 times per week and I recommend you to douche right after vaginal dilatation.

After douching, you should repeat dilatation with the last size of dilator for a while which can help squeeze out water inside vagina.

All stitched are all self-dissolving, but need time (may be 2 months) to loose the notch and coming off.

No food restriction.

You have to limit your activities for 6-8 weeks after surgery. Hard activities or sport can be resumed after 10-12 weeks.

Hormonal treatment should be ceased during your recovery in Thailand to avoid risk of thrombosis during flight back home. You can resume female hormones safely after going back home.

The girls of the Bann Siririma hotel

Warm recuperation for all at Bann Siri

SRS follow up at Dr.Chet's clinic

The follow up for checking your vaginal depth and skin graft inside, external wound healing and also the level of sensation on neoclitoris and labia minora will be done during the second week of your recuperation.

Sex change surgery certification and all necessary documents, for example the letter requesting a wheel chair and special seat on the plane will be provided.

SRS minor/ major complication and how to fix the problem

1. Difficult or unable to void after the urinary catheter is removed:
This may come from the swelling around the urthral opening and/or the tense up pelvic floor muscle.

Treatment: Intermittent self-catheter is needed till the inflammation subsides.

2. Spray of the urine while urinating:
This may come from the swelling (epecially the firt month after surgery) or the excess skin/ mucosa at the urethral opening which can block or deviate the flow of urine.

Treatment: Surgical removal of excess skin or mucosa

3. Excess corpus spongiosum:
Unadequate remove of spongy tissue around the urethra may cause the bulge of tissue above the introitus and engorge during sexual arousal which can make partial obstruction at vaginal opening.

Treatment: Remove the corpus spongiosum. If the position of urethra is too high, it can be relocated at the same time.

4. Bleeding or hematoma (collection of blood clot in the wound)
The neoclitoris and the stump of urethral opening are two new structures which tend to get bleeding during the first week after surgery. The bleeding inside vagina is also possible from the vessels at the floor of vagina if the healing of skin graft is not good.

Treatment: Stop bleeding and/or remove hematoma.

5. Sloughing or necrosis of the penile skin
This may cause by hematoma or any external pressure against the penile skin and then interupt the blood supply.

Treatment: Debridement (remove the dead skin) and the skin graft will be used to cover the wound.

6. Skin graft necrosis inside vagina.
The graft rejection is possible if the wound is not suitalbe for the graft taking (for example: bleeding underneath the skin graft or any external force that make the skin graft separate from the wound bed).

Treatment: Debridement (remove the dead skin graft) and the new skin graft will be replaced to cover the wound.

7. Genital wound infection
This is very unusual unless you have some underlying disease such as diabetic or HIV.

Treatment: Antibiotic administration, surgical drainage will be also needed if there is any pus collection.

8. Rectovaginal fistula
A rectovaginal fistula is a medical condition where there is a fistula or abnormal connection between the rectum and the vagina.

This may come from the rectal injury during vaginal dissection. If the entrance of rectum was detected immediately and the hole can be primarily closed without contamination (due to the emptyness of bowel), the chance to get fistula will be significantly decreased.

Treatment: Once the recto-vaginal fistula was detected after surgery, the surgical intervention with colon vaginoplasty is the best solution, in my opinion, to close the fistula and provide the new lining inside vagina with excellent depth.

9. Urethrovaginal fistula
A rectovaginal fistula is a medical condition where there is a fistula or abnormal connection between the urethra/ bladder and the vagina.

This may come from the urethal/ bladder injury during vaginal dissection.

Treatment: the fistula can be closed by local skin flap or by colon vaginoplasty for those whose vaginal depth is also short.

Please note that all mentioned complication is very rare in hands of experienced SRS surgeons.

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