How to prevent possible complications after Sex reassignment surgery

Recommendations to Prevent Complications After Sex Reassignment Surgery (SRS)

1. Avoid Medications That Cause Bleeding

Bleeding after Sex Reassignment Surgery is possible; however, the chance of major bleeding is very low when performed by a competent and highly experienced surgeon. At Chettawut Plastic Surgery Center, there have been no serious bleeding complications or cases requiring blood transfusion due to surgery. Dr. Chettawut meticulously controls and stops bleeding using an electrosurgical unit and hemostatic agents.

Certain medications or underlying diseases might increase the risk of bleeding during SRS. It is crucial not to conceal any known conditions or diseases that might cause post-operative bleeding or complications.


The following medications must be completely stopped at least 2 weeks prior to surgery:

  • Aspirin (ASA) or Baby aspirin, or any medications containing aspirin (e.g., Percodan, Endodan).
  • Blood thinner medications (e.g., Coumadin, Pradaxa, Brilinta, Clopidogrel, Persantine, Plavix, Ticagrelor, Ticlid).
  • NSAIDs (e.g., Advil, Celebrex, Diclofenac, Ibuprofen, Meloxicam, Piroxicam).
  • Vitamin E
  • Some antidepressants known as selective serotonin reuptake inhibitors (SSRIs), such as Prozac (fluoxetine) and Paxil (paroxetine).

2. Complete Bowel Cleaning Before SRS

Gender Reassignment Surgery is classified as clean surgery, with a low risk of infection. However, the risk increases if your bowel is not clean during the operation. Bowel movement during the operation or early recovery stages can lead to genital wound infection.

Dr. Chettawut implements a thorough bowel cleaning program before SRS and colon vaginoplasty to minimize the risk of wound contamination and infection.


Dr. Chettawut’s SRS patients must arrive in Bangkok at least 3 full days prior to surgery to complete the bowel cleaning program:

  • Change to a clear liquid diet 3 days before SRS or colon vaginoplasty.
  • Take laxative pills and Fleet enema on the second day before surgery.
  • Consume Swiff (Sodium phosphate oral solution) on the day before surgery. Note: Swiff solution is a strong laxative, causing urgent bowel movements within 1-2 hours. It is recommended to mix it with soda or fruit juice to improve taste.
Swiff (Sodium phosphate oral solution) needs to be consumed on the first day prior to SRS or colon vaginoplasty.

3. Preventing Vaginal Shortening or Collapse After SRS

Dr. Chettawut’s vaginal dilator set (5 sizes)

Dr. Chettawut aims to create the maximum depth of your vagina. While the average vaginal depth with skin graft technique is 6.5 inches, and 8.5 inches with colon graft technique, proper dilation is crucial to maintain this depth.

Vaginal shortening or collapse can occur if dilation is not performed adequately or correctly, leading to the shrinking of the skin graft inside the vagina.


For patients with skin graft technique, Dr. Chettawut emphasizes applying light and constant pressure with the dilator’s tip against the vaginal bottom to prevent skin-graft contraction. For colon graft technique, a dilator with a diameter of 32 mm or more is recommended to avoid ring scar contraction around the vaginal opening.

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