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A Guide to SRS

Recovery

General Information

  • I cannot stress this enough, your number one priority is making sure you do not hurt your healing vulva/vagina. Do not risk or do anything that could cause yourself harm. Measure every action you take and do it in the utmost careful way, every minor task you used to do is now much harder and dangerous for yourself.

  • Make sure to advocate for yourself while at the hospital. Ask questions and double check things. There are some nurses who work regularly in Dr Hart’s ward who are very well versed in the recovery process. However, there are also many on call nurses who essentially have little to no experience. They made mistakes, took poor care of me and ultimately was my biggest stressor while recovering at the hospital. Make sure to advocate for yourself. - Maddy

  • Do not be scared of using the call button, especially when asking for pain relief. Do not try to be “strong” and tough it out. You are entitled to and deserve adequate pain relief, you are not bothering the nurses, it is their job to care for you are paying dearly for this care. You should not be in a lot of pain, it won’t feel pleasant but you shouldn’t be in agony. Also, some people are genetically better or worse off from opiates, so keep that in mind. They might work very well for you or not do as much as they should.

  • If you underwent PIV instead of PPV you will not have abdominal incisions to my knowledge. Recovery should be less arduous.

  • Do not worry about how your vulva looks for the first 6 months, things won’t even settle until around a year and even then it only looks more natural as time goes on. The early days are especially hard to look at, do not stress yourself out about how your currently vulva looks. It will be okay.

  • Over time you will get your life back, it will take time but this period of your life won’t be forever. I promise.

Early recovery - week 1

This is hard for me to describe as I was on many drugs and in a lot of pain, this is to the best of my best memory and may not be entirely accurate.

  • Once you’re put to sleep for the surgery, it’ll feel like no time has passed until you wake up in the recovery ward.
  • You have an oxygen hose for your nose, it dries your nose out.
  • You have a machine attached to your legs that inflates and deflates, presumably this helps with blood flow and prevents deep vein thrombosis.
  • You have several tubes coming out of your abdomen and groin, these are drains.
  • You are catheterised, don’t worry about urinating.
  • You get IV antibiotics for a few days, then oral ones.
  • You can’t shower, so a bird bath (washing yourself in bed) was nice, if you have someone around get them to help you with this or perhaps the nurses.
  • I had intense abdominal bloating for days, I think it was a mix of swelling from the surgery and the air they inflate your abdomen with so they can do the surgery.
  • If your bed is too short, you can ask for a bed extender.
  • Eventually they try to make you walk again after several days. You will have an extended wheelie walker to help you. Go slow.
  • Towards the end of the week you get your dressings and drains out (day 5). Two days after, your catheter and packing (the material keeping your vagina open) are also removed. You then learn to dilate.
  • You wipe from front to back now, be very careful not to bring any bacteria or excrement forward into your vagina. Wet wipes are your friend for now, get some unscented ones if you can.
  • Your heart rate needs to be below a certain level to get out and some other checks are done before discharge. If you take ADHD medications or other stimulants you probably shouldn’t take them while you’re in hospital.
  • You also need to urinate successfully three times before they release you. This is checked by you urinating into a small container in the toilet, followed by an ultrasound to check that your bladder is empty.

Maddy - CW: What felt like SA

  • Dr Hart teaches you how to dilate right before you leave the hospital. I personally found this experience extremely upsetting. Potentially because I have issues with men.
  • The experience was as follows, Dr Hart enters, does not tell me what is happening or give me time to prepare. Asks me to open my legs and starts inserting a dilator. This caused me so much stress I had nightmares about it for months.
  • Considering that the very next day you will be doing this by yourself. I would recommend people instead to just ask for his explanation on the process, and then just do it yourself in private. Or get help from a nurse / loved one you feel comfortable with if you are struggling.

Out of hospital - week 2

  • Once you’re discharged from the hospital you’re free to leave. Then get driven to where you’ll be for the next week.
  • The only drugs you’re given at discharge are anti-inflammatories1^1. You will be more conscious now.
  • Dilating is your sole purpose for a while.
  • I had a significant amount of brown blood and other wound healing substances exiting my vagina, it looked like BBQ sauce for a while.
    • Don’t be scared of brown goo, it is normal. It’s a mix of everything from surgery (sutures, etc), lots of sloughing (dead cells coming off), and stuff from wound healing.
  • Try to do some minor walking around at this point with some help nearby. Humans aren’t designed for laying in bed for an entire week and it’s good to walk or even just be upright when you can. Do not push yourself to any kind of injury though, complications can arise because people did things too soon and too fast.
  • You sleep on your back now. Do not be tempted to sleep on your side or stay in a position where you are compressing or stretching your new vulva significantly. You really do not want to cause yourself any damage and complications because you were not careful enough. A lot of damage can be done at this stage if you are not careful.
  • During this time if something was abnormal and I couldn’t find an answer from the internet I’d email Dr Hart with a description and if needed a macro photo of the issue.
  • GP appointment - it is reassuring to have a doctor verify that everything is healing well, and that there are no issues.

My schedule during this week:

  1. Wakeup
  2. Try to eat something
  3. Dilate
  4. Salt bath
  5. Rinse lower body in shower
  6. Eat something
  7. Get to early afternoon
  8. Dilate
  9. Do something
  10. Eat
  11. Dilate before bed
  12. Salt bath
  13. Rinse
  14. Sleep.
  • Of note, I always washed with soap and water before having a salt bath particularly if I had been to the toilet. Nobody told me to do this but it made sense to do so.
  • Dr Hart recommends once to twice per day for the salt bath

In the salt bath you can VERY gingerly touch and very very lightly massage around your areas of healing. This helps to both clean the area as you are not able to wash it normally but also you can begin to understand your new anatomy. I would recommend having your nails short and filed, a fingertip is much softer to hit a healing wound with than a nail. Nails also tend to carry more microbes. You also want to keep your hands very clean when you dilate and in general.

I cannot stress this enough, your number one priority is making sure you do not hurt your healing vulva. Do not risk or do anything that could cause you harm. Measure every action you take and do it in the utmost careful way, every minor task you used to do is now much harder and dangerous for yourself.

Back home - week 3 & beyond

I struggle to remember this period, I experienced a significant iron deficiency for approximately three months following my surgery.

  • Now you should be returning home, hopefully you’ve previously set up everything you need for this period.

  • This period is basically the same as week 2, except over time the intensity and frequency of everything decreases. This includes: pain, dilating schedule, salt baths, and lack of mobility.

  • Do everything surrounding recovery to the best of your ability (within reason), everyone’s body and recovery experience is different, and you need to accommodate yourself specifically.

    • Follow the dilation schedule as much as you can, it’s important.

  • I recommend getting a blood test after surgery, specifically for iron as well as hormone levels.

  • You should slowly be increasing your physical activity as your body tolerates it. Start with slow walks of reasonable distance for your condition.

  • A while after returning home, for short periods while I was awake I would put pillows between my legs so i could be on my side for a while, this was a nice feeling

  • Your steristrips should come off either by themselves (I trimmed the unstuck edges) or with a very small amount of force. It should not cause pain.

  • After several weeks I took my own stitches out after confirming with Dr Hart by email. They were causing me discomfort and were no longer needed. I did this with a mirror, bright light, tweezers, and a small pair of sanitised needle nosed scissors.

    • If you are not up to doing this, get your GP to do this. Dr Hart uses dissolvable stitches that take an exceptionally long time to dissolve and come out.

  • Experiencing a lot of numbness around the surgical area is normal, it happened to me. They take quite a while to heal and feel normal again (a few months to a year+), don’t worry you aren’t broken.

  • You can drive again once “there is no pain when putting your foot down hard on the break… usually around the 4-6 week mark”

Others experiences

Medical negligence by nursing staff

  • Maddy was told they had to stand up the day after her surgery. A single small nurse assisted her in this process, Maddy is 190 cm and 100 Kg.
  • The nurse was not prepared for the possibility of her fainting. They stood far off to the side, she ended up fainting (as is common early after a major surgery), and he failed to catch her, narrowly missing a metal railing with her head on the way down.
  • Later that evening, the same nurse returned and suggested she try again, she didn’t argue as she didn’t want to cause issues. Once again, the nurse was alone and positioned poorly to catch her. She faints, she hits her head / upper neck on a metal bed frame.
  • This caused a scene with multiple nurses being present and an on call doctor.
  • An ECG is done, her chest is exposed in front of the male doctor and nurses.
  • An XRay is recommended by the doctor, which she does. This was an additional $300 charge she was not told about, she could not afford this at the time.

This was an overwhelming experience for her, resulting in her sobbing and feeling extremely uncomfortable, as well as causing her financial stress. All of this only 24 hours after her surgery, risking her serious bodily harm.


Maddy’s recommendation - “Advocate for yourself. If you are large like me, or generally uncomfortable with a nurse’s practices you should ask for a second opinion / request more support. I should have told the nurse to get someone else to help him while I stood up.”



1^1 Maddy was given a presecription for tapentadol at discharge. Either the discharge guidelines have changed, or the nurses really did not like me. Another woman was advised to see a GP for pain relief, so it may depend on the nurses you get.