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23. Any special post-operative instructions?
(These instructions may be individualized, as patient needs vary.)

1.  DIET. Regular Diet, avoid spices and alcohol for 1 week.  Increase fluid intake to 3 quarts per day for the next 3 days.  Anything in the fluid family counts.

2.  ACTIVITIES. Convalesce for one week. Out of bed by the 2nd post-op day in graduated amounts and ambulate.  Wiggle toes and move feet up and down and bend knees 20 to 100 times a day.  Avoid strenuous  activity, possibility for pelvic injury, and contact sports for 4 weeks.  No running, or extensive walking for 4 weeks.  No sexual activity until you have been medically cleared.
   
3.  MEDICATIONS. Cipro 500 mg, #14 1 twice a day for 7 Days.   (as a rule diabetic patients will be prescribed Keflex unless allergic) Try Tylenol, 2 tablets as needed for moderate pain.  Ultram, 1 tablet every 6 hours as needed for severe pain (#10).
Resume hormones on your 12th post-op day usually reducing estrogens by 1/3rd and discontinue spironolactone (if taken previously).  After being in estrogens for one month have a serum estradiol level drawn and you may wish to confer with Dr. Reed.

4.  FOLLOW-UP.   Surgery is the zero day. You may shower on the 7th day post-op
and also consider tub baths with cup of either table salt or Epsom salt for 15 to 20 minutes, 1 to 2 times a day to promote wound healing and reduce swelling.
Sutures to be removed on the 14th day. Your healthcare professional may choose to leave them in longer if there is not sufficient closure.  Catheter to be removed on the 12th  day by cutting the side arm and wait 30 seconds for 2 teaspoons of water to drip out;  gently tug and out it comes. Wear a sanitary pad to protect the incisional site and apply a dab of betadine ointment if any open areas or raw tissue. Do not pack the vagina.

5. DRIVING.  You may resume driving when you feel capable, not during the 1st week after surgery.  Have a friend or loved one stay with you for the first few days after surgery.

6.  STENT USAGE:  15 to 20 minutes, lying down on your back, 3 to 5 times daily beginning on the 7th post-operative day (always start with the narrowest stent).  Once inside the vagina, do not push down or up or you may perforate the rectum or urethra (very serious complications).  Push towards your head parallel to the floor with sustained gentle pressure, not enough to produce pain.

7.  DOUCHE afterwards with equal parts of peroxide and Betadine solution  not Betadine scrub or shampoo (povodine iodine is the generic name)  to which you add 4 parts warm water. Use the red catheter and piston syringe as instructed daily from post-op day 7 to 14 and for the next week  every other day and thereafter every 3rd day to remove jelly and cleanse but remember this does not have to be done frequently as you dilate.

8.   DILATE:  Always use a water soluble lubricant.  Dilation with a stent should be done when you are lying flat in bed over a protective underpad.  Using the narrowest of stents that goes in easily, drop (place) that stent (hand held) into the pocket preceding your vagina.  The outer web will be removed during your second stage labiaplasty.  Do not push downwards as you will soon be inside your rectum (a very serious complication).  Do not push upwards as you will be inside your urethra (urinary tube).

Using you hand,  guide the hand held end of the stent in an arc downwards while pushing the inside end towards your head, but parallel to the floor.  The stent must be advanced parallel to the floor.  Never force.  Use gentle sustained pressure for 15 to 20 minutes, 5 times a day.  Doing this patients report gains of 1 to 2 inches in a few months.

This exercise will be demonstrated to you by Dr. Reed or his staff before you leave.
If you have any questions about techniques, please ask while you are on the table in the exam room.

9.   CIRCULAR PILLOW.  Yes, please bring a circular or donut pillow (not self inflatable, pre-inflatable ok) with you so you do not sit directly on your suture line for at least 3 weeks.  Very important especially if traveling by car or plane.  Then remember to bring this back with you for your labiaplasty.  Labiaplasty sutures especially are very delicate and are not designed to withstand the pressure of your torso.

MTF SURGICAL CHECK OUT LIST (abbreviated for simplicity)

1. 2 Therapy Letters
2. Medical clearance
3. Blood work, Stress EKG, Chest X-ray
4. STOP all Estrogens and Spironolactone as mentioned above, for all MTF surgical procedures including primary vaginoplasty, revisions, orchiectomy, etc. as mentioned in # 20. “special pre-operative instructions”
5. No aspirin/products
6. Bromelain and Arnica Montana and vitamin C
7. Ted Hose (thigh high anti embolism stockings) and  underpads (CVS)
8. Must stay at one of these 2 hotels…. We recommend Daddy O Hotel, 3 stars. 305-868-4141 one block from our office, or Beach Place Miami. (305-866-3313) Ask for a room on the ground floor.
9. A female friend or loved one to stay with patient and be there on the 7th post op day when we show you have to properly use dilators (vaginal stents).
10. A physician to follow you when you return home
11. Bowel prep
12. Fax or mail Rx’s
13. Stents (dilators)
14. Electrolysis
15. Ring (circular) pillow
16. Cotton gown that buttons or snaps in the front

We would consider it a great honor to be looking after you and be assured we will show you every courtesy.

If our office may be of further service, please feel free to call.

This is a male-to-female (MTF) surgical FAQ by Dr. Harold Reed. The piece is the last of a four-part series on the procedure.

See also: Male to Female (MTF) Surgical FAQ and Checklist – Part 1
See also: Male to Female (MTF) Surgical FAQ and Checklist – Part 2
See also: Male to Female (MTF) Surgical FAQ and Checklist – Part 3
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