Prepping For Recovery After my Vulvoplasty

I am sure that my preparations for recovery from my vulvoplasty helped me be happy with my results. In my opinion recovery is the Holy Grail of any surgery. The operation itself is just a point in time; a quick methodical controlled trauma. Then recovery starts. Here I discuss most of things I specifically did to improve the chances of an uneventful convalescence after my vulvoplasty.

This is the 3rd. and last article about my very personal thought process and preparation for genital reconstruction surgery. These 3 articles are closely related, maybe even repetitive, to their sister article on the TransAvenue blog (en français). The question of ‘how to get a natural relationship with the neo-vagina’ (or neo-vulva in my case) was the inspiration.

The first article in this group touches on the mental housekeeping I needed to do to consider genital reconstruction. Then the second one details my desire to thoroughly understand all aspects of the surgery, including risks and recovery.

Securing Aftercare Once Back Home

Weeks before leaving for surgery I met with who would be my aftercare nurse at the gender clinic. In that initial meeting I asked a lot of questions about the recovery process. Also on that introductory appointment we booked the first of many aftercare followups. That first checkup was booked about a week after I returned home from surgery.

Although I trust my family doctor I thought that having a nurse from the local gender clinic follow up on my recovery after a vulvoplasty would be better. I thought anyone from the gender clinic would have had more experience and hands-on knowledge with this kind of surgery than my family doctor.

The Postoperative Care Documentation

Before I decided to have surgery I downloaded the postoperative care documentation from the GrS Montréal website. I used it to fully understand the surgery and its recovery. Right after the operation I got a hard copy to read and follow. I referred to the post-op care documentation every day during recovery. This even after reading it many times long before deciding on the surgery itself.

I flew home after surgery on a Tuesday evening and started following the at-home aftercare routine. On the Friday I saw a dehiscense at the fourchette – a suture separation at the furthest point of the surgical site. I tried to reach the local gender clinic with little success; no one would answer the phone on a Friday afternoon. At that point I started to worry because it looked somewhat scary to the untrained eye.

I went back to the post-op care booklet before calling my family doctor. I remembered reading something about the chances of a dehiscense, and yes, there it was. The documentation explained that there was the possibility of an opening of a surgical incision and that it was normal. Reading this calmed me down until I saw my attending nurse at the gender clinic on the following Tuesday. When I met with her she confirmed the dehiscense and explained they are very common.

Not Wailing Over Things Outside my Control

Most of what I wrote in the post about gathering knowledge deals things I could control and understanding them. But there’s always many other things that we cannot control. Though I believe it’s very important to identify what we can’t control, I too think that it’s as important not to spend energy worrying about them.

How is Recovery From a Vulvoplasty Going to Feel?

Is it going to hurt? When will I be able to get back to dance class? Will I be satisfied with how it will look? For the most part we have no or little control over these questions and so many more. So why worry about them if they’re outside of our control or at least if there is nothing we could do to control them ahead of time.

An example I love is when someone asks how much is going hurt and here’s why it’s irrelevant. Yes, it’s going to be painful but I won’t be able to know how much until it actually starts to hurt. Until then the only thing I can do is know that it will hurt. Based on the documentation and my past experiences I know I could control it with basic analgesics or narcotics if it’s beyond my normal threshold. I too know that so many other people have gone before me so statistically I should be ok. My motto is that I’ll worry about pain control when I get there.

Recovery is Only Temporary

Other things I knew but not in detail was that I’d be physically limited for some weeks. I knew I would get tired and I knew some aspects of recovery from a vulvoplasty would be harder than others. Again, the documentation was helpful in providing some guidelines, but it wasn’t until I lived through it that I truly was able to figure out these things.

You may have picked up by now that I was very concerned about recovery. Apart from the technical knowledge I had that helped me prepare for recovery, I also was acutely aware that it would be temporary. So by knowing what to expect and how to deal with it, I too knew that it would pass. As much as I was concerned about recovery I had enough information to feel confident it would not be a long term situation.

I Was Expecting The Unexpected & Complications

Though I prepared the most for my vulvoplasty than any other prior surgeries, I still knew that something could go wrong. As I said in the previous article, knowing about the procedure was pivotal to be at ease should anything go astray. As I left the recovery home one of the nurses gave me last minute recommendations. These were based on what the nursing staff had noted about my recovery while I was in Montréal. So it was personal and provided me an idea of what to look for.

The fact that I was aware of possible complications helped me be at ease. Of course the plan was to have no issues, but I felt I had enough information should something go wrong. Another subjective source of tranquility was knowing that so many other people had gone through a similar experience before me.

Still, with all my preparation and knowledge, when I saw the dehiscence I got very concerned. Earlier I talked about how the documentation eventually calmed me down until I had a consultation at the gender clinic.

After all, the surgical site is very dynamic, with lots of soft tissue modifications. By virtue of that, it’s not a bad thing to expect the unexpected.

What Would Sex be Like?

This question kept popping in head and every time I would come up with a different answer. After a few times going through this cycle it dawned on me that there was no way to know until after surgery. Don’t get me wrong, fantasizing what sex could be like after surgery was lots of fun. But I still had to be careful to separate the fantasy from creating an expectation. Specially since there is absolutely no way to know if that expectation would be accurate after recovery.

My Past Surgical Experiences

In the preoperative documentation it briefly mentions that “your own scarring history should be a good indication of what you can expect”. Throughout my past surgeries I’ve noted that they share more than my scarring history. Since the common element between all my surgeries is my body and my person, I’ve observed that almost everything about my past surgeries is a good indication of how the next one will be.

Knowing this gave me great confidence because I pride myself in being a good patient. I pay attention to and follow the documentation surgeons provide me. I also try to follow the indications of the professionals, understand the reason for those indications, and in general acknowledge that they have the medical experience. On the other hand, I’ve learnt to roughly know what to expect from my own body. Since I don’t have a history of smoking and probably thanks to my genetics, it seems I’m a good healer.

What I’m trying to get at is that everything in my past surgeries was similar. From the relationships I developed with the surgeons, nurses, and staff in general, to the way my body healed, all of it gave me a fair idea of how going to Montréal would turn out for me. Though every time I’ve had surgery I feel a bit nervous, it’s never been overwhelming. By reading this post you should get an idea of why. 🙂

Asclépiade – The Recovery Home

Once that I knew I would be having surgery at GrS Montréal, I was looking forward to staying at their convalescence home, Asclépiade. Genital surgery is complex to say the least, and recovery too, so the environment where I’d spend the first few days right after surgery was important to me. My two main reasons why I knew staying at Asclépiade would add to my natural relationship with my results were 1) being under the care of experienced nurses, and 2) getting to know the other patients that would be sharing very similar experiences with me.

Nurses and Staff

Asclépiade is staffed by an experienced group of caregivers. I’m sure they have seen every variation. By extension I felt pretty comfortable that if I had any problem during the first few days, I’d be in good hands.

Before arriving to the recovery home, I had not given any thought to their level of organization. Since they have so many patients almost every week of the year, and they’ve been doing this for years, they have streamlined their processes. A couple of examples I noted was how they scheduled pain control medication for each patient. Or the resources required to thoroughly clean the bath tubs in the washrooms every time they are used by any patient.

To give you an idea of the experience and complexity the Asclépiade’s staff deals with, we were at least 15 patients while I was there. Each of us with slightly different needs and they have the protocols to deal with such load.

Support From Other Patients

Being with my fellow patients for the first few days of recovery meant sharing a lot of very personal experiences. This level of sharing would, and indeed gave me a lot of perspective. Though sometimes the conversations would be repetitive, since most of us had similar types of surgeries, it still provided me a sort of measuring stick to compare my recovery with others. What’s more, I made a few life-long friendships that have been part of my support system. After we returned home, we’ve stayed in touch sharing our recovery experiences at home, even while being a few time zones apart.

Preparing For my Return & Recovery at Home

The return home and later the first few weeks of recovery after a vulvoplasty were a big scary unknown to me. As mentioned earlier, the information package provided me with the great majority of guidance. Before I left to Montréal I didn’t know this but the nurses at Asclépiade also provided with more detailed practical procedures to follow when I got home. It was more personal as it was based on my recovery during the first few days while under their care. Based on how I reacted to the pain control medications and how the surgical site was recovering, they were able to provide me with specific comments, suggestions, aftercare procedures, and general expectations.

Arranging my Trip to and From Montréal

From past surgical experiences I learnt that travel arrangements can make a huge difference. These are the most important things I knew when I booked my trip to and from Montréal:

Every day of recovery before flying makes a difference. In my case I decided to stay one more night at a hotel in Montréal before flying home.
The more direct route the easier on the body. Making stops and/or changing planes is very taxing on the body. I was able to book a non-stop flight home.
The better the seat, the less stress on the body and mind. On the way to Montréal I didn’t care as much about the kind of seat I bought. The flight back home was a different story. I went to the extent of figuring out the cabin configuration of the flight options I had. I booked on a schedule that used an airplane where the business class seats converted to flat beds. Best money spent on a fight ever!
With wheelchair service you don’t have to deal with airport layouts, get priority at most lineups, and bonus, you get some company. Just make sure you request wheelchair service as you book your flights.

Having made these arrangements for my trip back home I knew I was investing in my well-being. As an extent I am sure it helped me with recovery, which at the end translated to happy results.

Getting Everything Set at Home For Recovery After a Vulvoplasty

Following the guidance from the information package I had laid down the groundwork from my return home. The laundry was done, bedding was clean and fresh when I left, and I had left already prepared and frozen meals for more than two weeks. I also had bought and prepared the supplies listed in the info package, like soap, sanitary napkins, absorbent pads, etc.

The only thing that I did contradictory to the info package was to have no one at home help me out. I returned home by myself and would be alone for a number of weeks. That was a carefully thought decision though I do not recommend it to anyone. I knew the recovery from a vulvoplasty would be simpler than that of a vaginoplasty. With all that I had prepared I felt comfortable dealing with anything unexpected, and at any time I could request help from a few close friends.

Still I Was Caught Off Guard When I Got Home

Still, with all my planning I was caught off guard in a couple of fronts when I got home. The first one I noticed was that I needed more bath towels. During recovery hygiene is most important and requires showering and sitting in the bathtub a few times a day. Especially the first few days I still had some minor bleeding, and this meant more towel washing.

The second thing I had not anticipated and wasn’t mentioned neither in the documentation nor by any of my medical team, had to do with scheduling my day. Basic things like the timing for my medications and shower and sitz baths seemed to be hard to manage on day 1 after returning home. Patients with vaginoplasties have to dilate and douche multiple times a day making their daily schedule even more complex than mine.

I was not expecting these issues because at Asclépiade they took care of the towels and schedule. The nurses made sure we got the medications (pain killers, antibiotics, anti-inflammatories, etc.) at the right intervals. On the other hand, every time we used the bath the housekeeping team would provide fresh towels, clean and prepare the washroom for the next patient.

P.S. The header image are a couple of absorbent pads that were leftovers from the early days of recovery at home. The nurse at the local gender clinic gave me some for the slight bleeding of the first few days.