Vaginoplasty: Recovery

Aug 09, 2023

A Type of Gender-Affirming Surgery

Recovery from a vaginoplasty takes around six weeks. In order to help prevent complications and to ensure the success of the surgery, it's important to follow all of your surgeon's post-operative instructions. These instructions will include restricting certain activities, adhering to your vaginal dilation schedule, and carefully following hygiene protocols.

After a vaginoplasty, you can expect to have follow-up appointments approximately one to two times a week for at least the first month. During these appointments, your surgeon will check the progress of your surgery and monitor for any complications (e.g., wound infection or dehiscence).

Hormone therapy (estrogen) will be restarted about one to two weeks after surgery. About four to six weeks after surgery, you will start pelvic floor physical therapy. This type of therapy will help decrease vaginal pain and tension after surgery. It will also help strengthen your pelvic muscles.

After your operation, you will be taken to the post-anesthesia care unit (PACU) where you will wake up from your anesthesia. This is where your recovery begins.

In the PACU, nurses will monitor your vital signs and pain level. From here (usually after two to three hours), you will be moved to a hospital room, where you can expect to stay for the next five to seven days before being discharged.

Once in your hospital room, you may notice the following dressings and drains on or within your body:

In terms of your recovery timeline, you can expect the following schedule:

Your Foley catheter will also be removed prior to discharge. At this time, you may be taught how to perform vaginal dilation. The dilators (usually four) will be provided by your surgeon.

Once home, be sure to follow your surgeon's instructions regarding activity restrictions.

These may include:

Vaginal dilation is a critical part of your recovery process. It's necessary for keeping the vaginal canal open and maintaining its width and depth. In most cases, patients start dilating right away after the packing is removed from their vagina.

Here is a typical dilation schedule:

In addition to a guided dilation schedule, your surgeon will provide specific instructions on how to dilate.

Example instructions may include:

Besides vaginal dilation and restricting activities, keeping your genital area clean and dry after surgery is paramount for maximizing healing—and avoiding contamination and infection.

Some healthy hygiene habits to practice include:

If you have any of the following symptoms during your recovery process, please call your healthcare provider:

Call 911 if you are experiencing chest tightness, are having difficulty breathing, or are experiencing pain, redness, or swelling in your calf, knee, thigh, or groin.

Coping after a vaginoplasty entails addressing and managing both physical and emotional symptoms.

Physical Symptoms

After surgery, it's normal to experience pain. Your surgeon will treat your pain with prescription medications, like an opioid to start, until you can be transitioned to over-the-counter Tylenol (acetaminophen).

Nausea and constipation are also common after surgery. Your surgeon may prescribe you an anti-nausea medication and a stool softener.

Swelling of the labia after surgery will go away on its own within six to eight weeks. In the meantime, to ease any discomfort (usually the first week after surgery), your surgeon may advise you to apply an ice pack or cold compress on your perineum (the area between your vagina and your anus) for 20 minutes every hour.

To manage vaginal discharge after surgery, which may last four to six weeks, you can wear pads in your underwear and begin daily washing with soap and water.

Emotional Symptoms

Stress, anxiety, and intense emotions (often mixed) are common after a vaginoplasty. During this time, be sure to reach out to loved ones, those who have undergone the surgery (perhaps peers from a support group), or a therapist who has experience with this type of procedure. If you are experiencing symptoms of depression, please reach out to your healthcare provider.

Healing from a vaginoplasty requires hard work and focus on your part. Try your best to be as prepared as possible for the recovery process by talking with your healthcare provider in-depth about it prior to your surgery. Then, as you recover, take each day as it comes—and don't hesitate to reach out to your surgical team if any questions or concerns arise.

Johns Hopkins. FAQ: Vaginoplasty.

University of Wisconsin. (2020). Plastic and Reconstructive Surgery: Vaginoplasty.

University of Utah. Dilation instructions.

Kaiser Permanente Medical Group. Recovering from vaginoplasty and other feminizing genital surgeries.

Pariser JJ, Kim N. Transgender vaginoplasty: techniques and outcomes. Transl Androl Urol. 8(3): 241–247. doi:10.21037/tau.2019.06.03

Ferrando CU, Thomas TN. Transgender surgery: Male to female. UpToDate.

University of Utah. Transfeminine bottom surgery: Vaginoplasty

Meltzer T. Vaginoplasty procedures, complications and aftercare. UCSF.

By Colleen Doherty, MD Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.