For a transsexual the ultimate goal is THE OPERATION. Much has been written about crossliving and it's problems, as well as how to deal with the events leading up to the BIG DAY. Even the surgical procedures are well known to many. Unfortunately, it seems the stories and advice end there and very little has been written about the phase immediately following surgery.

This oversight was brought home to me, both literally and figuratively, recently when one of my closest friends was about 10 days post-op. To fully appreciate the story you must realize that Sharon is one of those stoic Celtic people who never panic in any crisis and can remain calm in the face of sheer terror.

About 8 a.m. my telephone rang and on the other end was Britain's newest female. "Michelle, I think something is wrong. I think everything is falling out," she said with a touch of worry in her voice.

"Impossible! You're too far along for vaginal prolapse to occur. Tell me what happened."

When she described what was going on it was obviously an entirely different problem. I suggested she call the Visiting Nurse and offered to go over. She took my suggestion but declined my offer.

Shortly after 11 a.m. my phone rang again and the voice I heard had a touch of panic in it. "The Visiting Nurse just left. She said I have an infection -- she made an appointment with the doctor at one, but I just KNOW she's wrong," she was half crying now.

"Okay. Look, try to calm down. Believe me, I had much the same problem. It happens a lot with our surgery. Go to the doctor and let me know what happens."

She sounded relieved, but I realized I had a lot of educating to do.

I was washing clothes when the doorbell gang. Glancing at my watch I saw it 2 p.m. and it didn't take a psychic to know who was at the door. I opened the door to find my dearest friend doing her best to imitate a corpse. "You look worse than my last patient, and she died."

"I knew you'd be sympathetic," she said trying to smile. "Now shut up and help me to the couch."

I helped her into the living room and after getting her onto the couch I fixed us a pot of tea and started trying to find out what the real source of her problem was.

To be sure, she DID have a small infection, but that's normal after any major surgery and is easily handled with antibiotics. It was obvious her main problem was due to lack of knowledge about what to expect during the recuperative period immediately following her release from the hospital.

We talked for about two hours and, when she finally left for home I noted it was a much more confident Sharon who left my house than the one who had arrived. Now she knew what to expect, and in terms SHE could understand. This whole unfortunate situation could have been avoided with just a little more teaching. Even the nurse who visited Sharon had contributed to the problem because most medical people don't know much about the care of the post-op and there are very few people around like me who are both a post-op and a nurse. It's important that a TS understand what will happen the first month following surgery, and that is the subject of this article.

Before I get into the actual management portion I hasten to point out the actual surgical procedures are well within the province of the individual doctor and the information I'm about to impart in no way reflects on the quality of medical care. I've based this article on what I know to be the general procedures in the U.S., England and continental Europe and the chronology is deliberately generalized to allow for individual variations. The purpose of this article is to give you some idea of what to expect and is not intended to indicate a method of treatment. In general however, the prosthesis method is less restrictive and allows for more normal activities than does the packing method.

OP Day -1 month.
Stop smoking. Lose weight if needed and try to exercise -- walking 2 miles a day is a good way to exercise.

OP Day -14 days.
If your doctor requires it (some don't) stop taking hormones about now.

OP Day -1.
Eat a light lunch and dinner. Upon admission to the hospital you'll have several tests; blood, urine and possibly allergy. Usually you'll have a chest X-ray and perhaps a cardiogram. You'll probably receive an enema and the surgical site will be shaved. Expect a visit from the anaesthesiologist. You won't be allowed to eat or drink after midnight. You'll probably be offered a sleeping pill or injection.

OP Day: BEFORE Surgery.
Still nothing allowed by mouth. Expect a pre-surgical injection which is usually given in the hip or thigh. It will cause a burning sensation for a minute or two. You won't be allowed out of bed after the injection so finish your "toilet" beforehand.

OP Day: AFTER Surgery.
You'll feel groggy and possibly a little sick. Your mouth will feel dry and you may have a sore throat. Very possibly you'll have an IV in your arm or hand and you may have blood transfusing. Unless you're in severe pain DON'T ask for a shot as you can have only a limited amount of morphine and it's better to save it for when you REALLY need it. The number and type of tubes you'll have sticking out of you will depend on hospital procedure. Of course, you have a catheter tube and, if your doctor uses an inflatable prosthesis it will have 2 tubes. You may have a drain in the labia (lips). If you are offered food it may be anything from ice chips to a full meal -- this varies greatly depending on the physician. You'll be encouraged to move around in bed but you can not get up.

OP Day +1.
The major difference in management during the next three days will have to do with the type and amount of activity allowed. Much depends on the method used to keep your new vagina open and your general condition. On Day One this may be anything from being flat on your back in bed to being allowed to sit in a chair. Expect your temperature and respiration to be taken frequently. (If you received blood you may have a temperature -- this is quite normal). The surgical site will be swollen and very colourful. You may have a sensation, best described as having your penis hanging on fish hooks -- this will pass in about 2 weeks. Food intake may be anything from nothing by mouth to starting solid foods.

OP Day +2.
Again, your activity will vary from complete bed rest to being allowed to stand by the bedside or even being allowed to walk around. If you have an IV it may be taken out and you are encouraged to drink as much fluid as possible - about a gallon a day is typical. If you have been on solid food since the day of your surgery you may have your first stool about now. You can expect it to be dry, hard and difficult. With some procedures you may have a small tube in each labia and one of them is taken out. If your surgeon used an inflatable dilator you will probably start doing your own inflations and deflations now --- though amounts vary to procedure is to inflate, wait 10 minutes and deflate. This is done hourly. The amount of fluid used starts small and is increased daily.

OP Day +3.
Activity can again be anything from bed rest to up walking around the hospital. If your IV is still in, it will be taken out today. If you had a small tube removed yesterday the other will probably be removed today.

OP Day +4.
If you have been on bed rest you will, probably, get to stand by your bed or even be allowed to move around your room -- be careful, you will be weak. Some of the sutures may be taken out. This is about the earliest your catheter can be removed so you should be drinking lots of fluids by now. You will have to learn to urinate again and you'll find all the cute stories about this are true. If you haven't been on solid foods yet, you will be now.

OP Day 5/6.
If you haven't had your first stool by now you will within the next day or two. This is important as you won't usually be allowed to leave the hospital until you do. As uncomfortable as it will be it won't hurt you inside, so don't let it worry you.

OP Day +6.
You may have some sutures taken out. You MAY be allowed to go home. If you have an inflatable dilator it will probably be taken out, as will your catheter if it hasn't been.

OP Day +7/8.
More sutures will be removed. Most patients are released.

OP Day +9/10.
Most of the swelling will have gone down. You will feel a tightening inside. There will be a body disorientation as your mind tried to interpret signals. Don't be surprised if you hurt where you KNOW nothing exists. (Phantom Limb Syndrome). Remember, many of the nerves are still in place, it's your penis that's been turned inside out.

OP Day +14.
The rest of the sutures will be removed today and, you will now be able to walk upright again. The pain and discomfort you've been feeling the past few days will usually disappear with the sutures. The cleansing routine you have had to follow after urination will no longer be required and you will feel things are getting back to normal.

OP Day +15.
You will probably start dilating with 1 finger.

OP Day +21.
You should be dilating with 2 fingers by now and perhaps even a small dilator, depending on your doctor. You will probably start douching with a small syringe.

OP Day +1 month.
You should be dilating with larger dilator by now and you should be able to use a standard sized douche nozzle. You can start wearing pants comfortably again. You can usually return to work.

OP Day +2/3 months.
This is when all the healing is going on so it can be a time of real problems in that your new vagina may grow closed. Dilating on the schedule your doctor prescribed is VERY important.

Perhaps a few other bits of advice are in order. Don't over romanticize the surgery. Much of the pain you've heard about may be more psychological than physiological, so if you aren't in pain consider yourself lucky. You may have very little more pain than if you had a bad case of flu -- it has happened.

Don't be in a hurry to have sex either. I know a number of TSs who did it after six weeks, but I didn't feel ready until I was some 5 months post-op. You'll know when you're ready, just be honest with yourself. You've waited years to become (physically) what you are now and you want to be able to enjoy it.

Last Modified 19 Jan 2002