Office: 480.657.7006

Toll-free: 866.876.6329

E-mail: info@tmeltzer.com

office ext pix

7025 N.Scottsdale Road
Suite # 302
Scottsdale, AZ.
85253

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Patient Resources - MtF
Vaginoplasty (Post-Op)

SPECIFIC POST OPERATIVE INSTRUCTIONS


POSITION AND MOBILITY

Patients will remain on strict bed rest the day after surgery. Intravenous pain
medication and antibiotics will be replaced with oral medication. Compression stockings
will be placed on your legs to help prevent clots. On the second day, you will be
allowed to get up out of bed, sit in a chair, and you can take a short walk. Patients are
encouraged to get out of bed frequently and take walks around the hospital.

Changing positions in bed will not harm you and may help you feel more comfortable.
The abdominal and pubic skin feels tight for several days following vaginoplasty, so
while you are in bed, you may find it more comfortable to have the bed in a slightly
flexed position, or have a pillow below your knees and the small of your back.

MEDICATIONS TAKEN AFTER YOUR SURGERY


ALL MEDICATIONS WILL BE ADMINISTERED BY A NURSE

While you are an inpatient in the hospital, you will be given pain medication, antibiotics
and a stool softener. If you are currently taking any other medications, bring them with
you (sufficient quantity for a two week supply). Medications will be administered and
monitored by the nurses.

(YOU SHOULD NOT TAKE ANY HORMONES UNTIL YOU ARE AUTHORIZED TO DO SO.)

WHEN PACKING IS REMOVED

You will begin:
Bacitracin ointment to be applied to incisions, perineum and clitoris.
Apply a light film, twice a day.

One of Dr. Meltzer's nurses will show you how to do this when the packing is removed.

WHEN CATHETER IS REMOVED


Your antibiotics will be changed toDoxycycline.

Please check with one of Dr. Meltzer's nurses if you are unsure how to take any of these medications.

Remember not to take any Aspirin or NSAIDs (e.g., Ibuprofen, Advil) for two weeks after surgery.

DRESSINGS AND PACKING


An absorptive cotton dressing is placed inside and against the vagina after surgery. It is common for patients to drain some blood into these dressings which will need frequent changes for the first few days. Following this, a maxi pad or similar sanitary napkin is adequate. It is common for patients to have vaginal drainage for at least a month after surgery.

The cotton packing inside the vagina will be removed on the sixth day after surgery and
you will be instructed on dilation of the vagina.

DILATION SCHEDULE

Day 1
Five times (one dilation will be in the middle of the night- this is the only day you need to do this.)
Remainder of Month 1
Four times a day
Months 2,3 and 4 ( Longer if dilation is still difficult)
Twice a day
One year postoperatively and possibly longer.
Once a day



DRAINS


Dr. Meltzer will place two drains into the surgical area at the time of the surgery. These drains evacuate the fluid that accumulates after surgery and will help reduce swelling. When the drain is put in place, the bulb at the end of each tube will be compressed to create gentle suction. As the fluid collects in the bulb it will expand. These bulbs will need to be emptied periodically. This will be performed by the nurse while you are an inpatient. The drains will be removed before you are discharged.

CARE OF THE SURGICAL SITE


Prior to the packing being removed, a shower daily and washing the area gently with soap and water is sufficient wound care. If you do not feel up to showering, you should sit on the toilet and wash the area with a washcloth, then rinse with clean water. Pat the area dry.

When the packing is removed you should continue with daily washing of the area with soap and water.

Apply antibiotic ointment to the incisions, especially on the area where the labia join at the lower side of the entrance to the vagina (perineum). This area has many stitches and can become quite sore. Occasionally, the incisions at this point open up; this is not serious, you should keep applying antibiotic ointment. The area will eventually heal. Ointment can also be applied to the stitch sites on the abdomen, and to the clitoris. Apply the ointment once or twice a day. You should use Bacitracin antibiotic ointment.

Two weeks after surgery stop using antibiotic ointment on the exterior surgical area.
Begin using an Aloe Vera ointment or gel.

URINARY CATHETER


A urinary catheter will be left in the bladder for six to seven days. After the catheter is removed, you will be able to urinate while sitting. The sensation to void is unchanged, but it may take more force to eliminate the urine until the swelling resolves. Occasionally, patients may not be able to urinate after the catheter is removed. This is a temporary problem caused by swelling around the urethra. The catheter may be replaced, and should remain for at least two more days. You can still return home as
planned, and have your personal physician remove the catheter. The urethra is shorter,
so you will be more susceptible to urinary tract infections. Therefore, it is important to
drink abundant fluids following surgery to prevent this.

CATHETER CARE


The catheter passes through the urethra and ends in the bladder where a small balloon holds it in place.

As you become ambulatory, you will have to carry the drainage bag with you. In order to prevent a backflow of urine into the bladder, you should keep the bag lower than the level of your bladder. When you are discharged, you will be responsible for emptying and taking care of your catheter bag.
Empty the bag as often as needed.

It is also an option to use a catheter plug when ambulating. The instructions for use of the plug are described below in the bladder training section; your nurse will also instruct you.

Please do not begin plugging the catheter until the instructions have been reviewed with
you by the nurse and you have demonstrated proper technique.

We advise that the plug is used only when ambulating and the bag is reattached when lying in bed unless otherwise instructed.

A daily shower, or washing around the surgical site daily with soap and water is advisable.

BLADDER TRAINING

When Dr. Meltzer or the nurse instructs you, you will begin bladder training. This will
enable your bladder to once again become accustomed to filling with urine, and
emptying on a regular basis.

Bladder training usually begins two days after surgery.

You will be given a demonstration, and all supplies needed.

1. Squeeze the yellow portion of the catheter between your thumb and forefinger and
separate it from the white tubing of the catheter.
2. Carefully insert the pointed plug into the yellow portion of the catheter tubing.
3. Place the cap over the white end of the drainage bag.
4. Keep the plug in the catheter no more than 2 hours. Do not sleep with the plug in;
always reattach the bag.
5. Drink plenty of fluids (approximately one, 8 ounce glass per hour).
6. After two hours have passed, remove the cap from the white end of the catheter
bag tubing, remove the plug from the yellow portion of the catheter, and reattach
the bag.
7. When all the urine has drained from your bladder, replace the plug and cap as
described above.
Repeat steps 1 - 7 for the remainder of the day.



BREATHING EXERCISES

Deep breathing exercises with the incentive spirometer are an important part of your recovery.
By performing the deep breathing exercises you will resume your normal breathing patterns much faster and reduce the possibility of respiratory complications.
The instructions for the breathing technique are provided with the spirometer.

VOLUME SETTING

The patient goal indication should be set at 1500.

SCHEDULE


Starting on the first day of surgery, you should perform 10 deep breaths each hour that you are awake.

You should do the breathing exercises for 3 days.

LABIAL SWELLING

All patients will have some swelling of the labia to variable degrees. Keeping ice on the
perineum for the first few days after surgery can reduce this. This swelling can take up
to six weeks to resolve. The vagina will approach its final appearance at 3 months.

ACTIVITES

The level of discomfort improves daily and frequently when people go home they are no longer taking pain medication. For the first 2 weeks following surgery, there should be no heavy lifting or straining. A
fter 2 weeks you may begin returning to your normal activities, with a few specific restrictions (see Bathing/Hot Tubs/Swimming. see Sexual Intercourse). Let your own comfort and the amount of swelling you experience guide you. If possible, you should take 4 to 6 weeks off work.


BATHING / HOT TUBS / SWIMMING

Two weeks after surgery you may take a WARM bath for no more than 10 minutes.
One month after surgery there are no restrictions on soaking baths.
One month after surgery you may use a hot tub/whirlpool.
One month after surgery you may resume swimming (pool, beach or lake).

HYGIENE

It is very important that you maintain good hygiene. You should shower or wash daily.
You should clean the genital area with soap and water.

You will be given an initial supply of sanitary napkins. Please dispose of these properly
(they should not be flushed down the toilet). Please store your personal hygiene items
in your bathroom.

When washing or wiping the genital area you should always wipe from front to back (clean to dirty).
This will avoid contamination of the vaginal and urethral area with bacteria from the anal area.

Initially, douching daily is required. A reusable douche kit will be provided and specific
instructions will be given as to when this should be started.
Please see DOUCHING INSTRUCTIONS, in this package, for more details.

Avoid wearing tight pants and panty hose for long periods of time. Friction on the
genital area can cause bacteria to be brought up to the urethral opening.

YEAST INFECTIONS


Vaginal yeast infections are occasionally a side effect of antibiotic therapy, and can be
treated topically or orally. The symptoms of a yeast infection are: an intense burning
itch of the vagina, labia or surrounding tissue; red, blotchy rash on the genital area;
occasionally a white discharge.
If you develop any of these symptoms contact our office or your general practitioner.

To avoid yeast infection, wear all cotton underwear and avoid tight, restrictive clothing
during the day and at night.

BLADDER INFECTIONS


Your urethra is now much shorter. The potential for bacteria traveling up the urethra to
the bladder, causing a urinary tract infection (bladder infection) is now much higher.


SYMPTOMS


Symptoms of a urinary tract infection are: pain and burning when you pass
urine; hesitancy or inability to initiate urination; feeling the need to pass urine
frequently and only passing small amounts; pain in the lower abdominal area
and/or mid back; blood, cloudiness or debris in the urine; fever; nausea.

If you develop any of these symptoms contact your general practitioner.

Good habits to practice to help avoid bladder infections are: drink plenty of fluids, at
least eight, 8oz glasses of fluid per day; pass urine every 2-4 hours, after sexual activity
and after dilation; avoid wearing tight clothing; always wipe "front to back".

MEDICAL FOLLOW UP


A pelvic exam, including a speculum exam should be done yearly. A prostate
examination should also be performed. This can be done by any primary care doctor or
gynecologist. It is very important that you be honest with the examining physician and
inform her/him of your surgical history.

Your prostate is not removed and it can be felt through the vagina.

It is a good idea to establish a relationship with a primary care doctor or gynecologist so
that you can get prompt attention if you have any concerns.

POST OPERATIVE DOUCHING INSTRUCTIONS

DOUCHING INSTRUCTIONS

1. Put a few drops of liquid soap in about ½ liter of lukewarm water. ( Any mild, antibacterial liquid soap may be used. A soap with no dye or perfume is preferable)
2. Draw up soapy water in the 60cc syringe and attach to the red rubber catheter.
3. Insert the tip of the red rubber catheter just a few inches into the vagina and gently push on the top of the syringe.
4. Repeat the above process with clear water.
( This rinses the soap residue from the vagina. )
5. Clean and dry your douche kit.
This is usually easier if performed in the shower.
Please use an antibacterial soap, perfume-free and dye-free is also preferable.
Reusable douche kits can be purchased at most drug stores.


DOUCHING SCHEDULE

Daily for two weeks and then as needed.

If you develop an odor or discharge, please call one of the nurses at the office.
Call 866-876-6329 or local call 480-657-7006.

GENERAL DOUCHING INFORMATION

For the first few weeks post-op you may experience some yellowish brown discharge,
which is normal. It is also normal to have sutures and debris in the discharge as the
skin of the vagina becomes accustomed to the new environment.

After the first few months you may occasionally experience an unusual discharge and
odor. This is probably due to a bacterial imbalance and can be corrected. Please call
one of the nurses with questions.

If the discharge and odor continue you should make an appointment with your primary
care physician or gynecologist.

GENERAL LONG TERM POSTOPERATIVE INSTRUCTIONS


Please read and follow these General Long Term Postoperative Instructions. Procedure Specific
Postoperative Instructions may also be included in your information packet. Please read and
follow all Postoperative Instructions.

ACTIVITY/SPORTS


We want you to avoid staining or unnecessary aerobic activity for at least two weeks
after surgery. This is to avoid bleeding, bruising, and swelling. You may resume light
activities after two weeks. Do not resume heavy activities or strenuous exercise for four
weeks. Dr. Meltzer will give you clearance to increase your activities according to the
progress of your recovery.

DRIVING

You may resume driving when you feel you are able, but wait at least two days after
surgery. Keep in mind that you must have full use of your flexes. If pain will inhibit
them, don’t drive!
You may not drive if you are taking any pain medication!

SUN EXPOSURE

If fresh scars are exposed to the sun, they will tend to become darker and take longer
to fade. Sunscreen can help. Take extra care and precautions if the area operated on is
slightly numb -- you might not "feel" a sun burn developing!

WORK


Follow whatever plan you and Dr. Meltzer have agreed upon.


SPECIFIC AS YOU HEAL INFORMATION



SWELLING

Swelling of the labia is normal, and it will take up to a month for this to resolve.
Prolonged sitting or standing can aggravate this.

The area over the pubic bone may remain swollen and firm for several months. When it
no longer feels tender you may massage the area for 10 minutes a day. This will help
the swelling to reduce faster.

SUTURES

All the vaginal sutures are self-dissolving. Some may take several weeks to fall out.
There are sutures along the labia, holding the packing in place; these will usually be
removed five days after surgery.

SENSORY NERVES


During the early phases of healing it is not unusual to have some areas of numbness of
the labia and mons from swelling. This should improve over the first few months after
surgery. Permanent numbness of these areas is very rare.

VAGINAL DISCHARGE


Brownish yellow vaginal discharge is expected for the first month to six weeks as the
skin heals and adapts on the inside of the vagina. Douching with a soap and water
douche during these early phases will reduce this. Should this return, it is usually
related to overgrowth of bacteria and should be treated with a change of the douching
solution. See DOUCHING INSTRUCTIONS, in this package, for more details.


AREAS OF DELAYED HEALING


Occasionally patients will have areas of delayed healing or ulceration. These should be
treated with an antibiotic ointment, thinly placed, and the area should heal promptly.


MEDICATIONS


GENERAL INFORMATION

The doctor and the nursing staff have given you prescriptions for your comfort and care.
It is important that you use the medications as directed unless you experience abnormal
symptoms that might be related to medication usage.

Symptoms such as itching, development of a rash, wheezing, and tightness in the throat
may be caused by an allergic reaction. Should any of these symptoms occur,
discontinue all medications and call the office for instructions. Our toll-free number is
866-876-6329 or local call 480-657-7006

Please e-mail us at info@tmeltzer.com for more information,
or call our office at 1-480-657-7006 or toll-free at 1-866-876-6329.

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