Preparing for surgery and beyond can be overwhelming and honestly, scary. In addition to asking all the questions, it can be helpful to have a short list of pre- and post-surgical tips and tricks on hand to help you navigate this life changing event from the perspective of a pelvic floor physical therapist.
Pre-surgery Tips: Vaginoplasty
After your pre-op consultation, your surgical team will have made several recommendations regarding lifestyle changes and opportunities to consider before surgery. You may find it worthwhile to write down a list of your questions to bring with you. Some of the more common pre-op recommendations include: hair removal, nicotine and tobacco cessation, weight loss and therapy. Let’s highlight a few of them:
Smoking/Vaping Cessation – Tobacco/Tobacc-no!
Regardless of whether you are a regular smoker or partake only occasionally, it is imperative to stop all smoking at least 10 weeks prior to your scheduled surgery date. Nicotine not only can cause a delay in wound healing but it causes your body to be at a higher risk for complications post op. Using tobacco reduces blood flow and also increases risk of infection after surgery, so quitting will improve the rate of blood flow and healing.
Find Your People – It really does take a village!
Having a loved one by your side throughout the pre and post surgery process is important to ensure your well being is supported and your recovery is as smooth as possible. Not only will you legally need someone to drive you home afterwards, but having someone to help you run errands, do household chores and pick up your medications can be critical to a smooth recovery. Not to mention the benefit to your emotional and mental well being.
Ask about Pelvic Floor Physical Therapy
If it has not already been discussed during your pre-op consultations, ask about your physical therapy options before and after surgery. Your pelvic physical therapist will help you to prep for surgery by addressing any existing pelvic dysfunction relating to your bowels, bladder and sexual history. They will also be an important part of all things after including navigating and understanding the anatomy, dilation and to assist you in resumption of your daily routine.
Post-operative considerations are as important as pre-operative considerations, if not more so. After all, it will likely feel like there is a lot going on at one time and we want to make sure you feel informed as well as supported. You will generally see your physical therapist 3-4 weeks post op to assist you with the early days of dilation and to address any other concerns or issues related to urinary and bowel function, pain and healing.
Relax – Relax, Dilate, Repeat
You will need to learn to relax your pelvic floor muscles to optimize dilation and eventually, sexual activity. It can be challenging to consistently dedicate chunks of your day to dilate. We suggest starting early, even before surgery, to make sure you have the opportunity to efficiently relax and maximize each dilation session.
Stay Calm and Spa On
Dilation can be challenging and experiences vary from person to person. Making sure to establish a quiet and private space in your home (or wherever you will be recovering) is essential for relaxing those pelvic floor muscles. Some folks optimize relaxation by ensuring their environment and their surroundings are conducive to being able to focus on their task. This may include playing calming music or sounds, dimming the lights or lighting candles or having a support person present.
Dilation
While anatomy varies from person to person, dilators are pretty standard when it comes to post op dilation. Dilators are typically silicone or medical grade plastic and come in a range of sizes. Usually best paired with water-based lubricants, dilators are made to improve diameter and depth of the vaginal canal. A standard protocol can look something like: dilation starting 5-14 days after the surgery for 30 minutes, 3 times per day for 12 weeks. It’s very important to be consistent with your dilation routine. Your surgeon, followed by your pelvic floor PT, will be able to guide you. Be sure to reach out to your surgical team if you have any questions or concerns.
In Summary
Post-surgical care for trans women undergoing gender-affirming surgery is a crucial part of the transition process. Ensuring a safe recovery and promoting long-term health and well-being is top priority and the holistic approach that combines medical care, emotional support, and peer connections is vital for a successful recovery. Compassionate healthcare providers who are familiar with transgender-specific care play a key role in offering a supportive environment and fostering positive outcomes.