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Phalloplasty Operation Recovery Guide

Medically reviewed by Ellie Zara Ley, MD on December 16, 2024.

Phalloplasty operations are multi-stage, complex surgeries that involve multiple recovery processes. The healing timeline can be extended if a patient experiences complications or undergoes related, additional procedures: such as a hysterectomy, vaginectomy, scrotoplasty, mons resection, and/or the insertion of an erectile or testicular expanders/implant(s). It is normal for patients to experience frustration and other emotions as they recover from surgical gender affirmation. To help you prepare for your phalloplasty recovery, we have compiled a guide on the following topics:

• The recovery timeline
• Warning signs: when should I contact my provider
• The emotional recovery process: navigating postoperative depression
• Surgical complications: prevention and treatment

We recognize that it is taxing to have to wait through pain, discomfort and swelling to see or enjoy using our surgical results. This is especially the case when bottom surgery results are so tied to our sense of self, are a core part of our experience of sexual pleasure and are at the literal center of our bodies. It is difficult to have to put our usual life activities on hold while we rest and heal. We hope that this information can help you and your care team (friends, family and mental health professionals) work to prevent complications and ease the recovery process as much as possible.

If you are a current GCC patient, we encourage you to reach out to your surgical care team through our secure patient portal with any questions you may have. No concern is too small for us. We are committed to doing everything in our power to facilitate your healing so that you can feel even more at-home in your body with your surgical results.

The phalloplasty recovery timeline

Your initial hospital stay:

• After a phalloplasty, patients can expect to stay in the hospital for six nights. This is when the most amount of pain, inflammation and bruising will be experienced.
• Patients who undergo a radial forearm flap (RFF) phalloplasty will begin occupational therapy to help heal and regain mobility in their arm.

Once discharged from the hospital:

• Arrange for a comfortable recovery location (i.e., convenient access to a bathroom, minimal stairs, etc).
• Some pain and discomfort is expected and can be managed with prescription or certain over-the-counter medications.
• A healthy, low sodium diet is recommended to minimize postoperative swelling.
• Activity should be minimal to avoid any complications such as excessive bleeding or bruising.

Within 1-2 weeks after surgery:

• Some bleeding from the surgical site is expected but any excessive bleeding should be a cause of concern that should prompt immediate contact of your healthcare team.
• Swelling and bruising typically improve within 2 weeks and is generally expected to resolve within 6 weeks.
• A urinary catheter may be required for bottom surgery that involves the urethra. The catheter may stay in place for 2-3 weeks to drain any urine from the bladder to allow the area to heal. While an indwelling catheter is not painful, it may be unusual for patients to adjust to. Bladder spasms may be experienced and can be a source of discomfort that can be managed with certain medications.
• Once a patient’s forearm or thigh flap wound is healed, they will start using a silicone dressing to help with swelling and scar healing. Patients will continue occupational therapy for several weeks to advance the healing process.

Resuming physical activity:

• Lifting more than 10 pounds is avoided in the first 4 weeks (pending healing).
• We strongly recommend that you avoid doing wide leg movements when getting out of bed or getting in the car to limit the stretching of your wound.
• Exercise and more rigorous activity such as jogging or yard work can be introduced slowly and progressively after about 8-12 weeks (pending healing).

Resuming sexual activity:

• We ask patients who undergo urethral lengthening to completely avoid manual or oral stimulation for at least 3 months (or longer pending healing). Your new urethra is still healing and at a higher risk of infection.
• We encourage our patients to start out slowly and carefully and to practice clear, open communication with their partner(s).
• Patients should get their surgeon’s approval after 3 months before they start using a pump and/or silicone erectile sleeve for penetrative sex.

Warning signs: when should I contact my provider?

The following are potential warning signs that you will need more immediate medical attention. Reach out to our on-call medical staff, a local provider and/or head to an emergency room if:

• Your surgical dressings are soaked with large amounts of blood, as this may be a result of excessive bleeding.
• Your pain levels are unresponsive to medications
• You cannot keep fluids down and/or experience vomiting
• You notice yellowish discharge from your incision sites accompanied by a fever, as this can be a sign of infection
• You have abnormal swelling in your groin or lower leg, as this could be a sign of blood clots
• Your new penis is discolored or experiences changes in skin outside of the expected bruising and high inflammation that will persist for the first few weeks post-op

The emotional recovery process: dealing with postoperative depression

Reconstructive surgery is generally a transformative and positive experience. However, alongside the excitement for the future, it is important to acknowledge the potential for experiencing temporary negative emotions after surgery, commonly referred to as “post-operative depression.”

Post-operative depression does not affect everyone, but when it happens it can be confusing. It is important to acknowledge that emotions following surgery are not always universally positive at first. Some patients just experience exhaustion from their body putting its energy towards healing surgical wounds. There are many other reasons for the onset of negative emotions after surgery: impatience from not seeing your final results yet, pain, discomfort, not being able to partake in your regular life activities and having ample time for introspection while you are bed-bound. It is normal to experience temporary feelings of sadness, frustration, defeat and even regret while your body is taking its time to heal. We encourage our patients to practice compassion and patience with their bodies as they recover from surgery, to share their feelings with their support network and to reach out to us with any medical concerns that may arise.

Surgical complications: prevention and treatment

The most common complications––such as wound opening––-resolve with time and proper home care. Even then, it is normal for complications to result in temporary feelings of frustration, sadness and even regret. It is hard to experience delays in the healing timeline: prolonging when you can get back to work, sit comfortably without a supportive pillow for long periods of time, or engage in sexual activity. We encourage you to be patient with your body as it heals from surgical affirmation, lean on your support network (friends, family and/or mental health professionals) and trust that any pain, discomfort and inflammation will eventually subside with the proper care.

Any patient who undergoes urinary lengthening is expected to experience a certain level of discomfort––such as bladder spasms––while they use a catheter. Some  urinary complications that arise may resolve on their own, over time. For instance, fistulas or small leaks in the new urethra are usually discovered within the first 8 weeks after surgery. They may close over time with at-home care. Please note that urethralfistulas (urinary leaks) are not considered medical emergencies. A urinary stricture (when the urinary tract has an obstruction and patients cannot urinate) requires that patients go to their closest emergency room or urgent care service.

We encourage you to share any concerns that arise around irregular urination––like the presence of blood, increased straining, urinary retention, frequent urination or a urinary tract infection––with your surgical team and local provider(s). No concern is too small for us. We are committed to doing everything we can to support you through the difficulties of your recovery process.

Additionally, wound opening, however slight, can occur when patients make harsh movements early on that stretch the groin. A wound opening can delay the amount of time required to heal, which can cause frustration and sometimes worry in patients as they experience prolonged discomfort and delays in returning to their normal life. We especially encourage scrotoplasty patients to be mindful of this risk. Thankfully, simple wound care will resolve the issue over time. We do not suture reopened wounds from bottom surgery due to infection risk. For these reasons, we suggest that your care team help you practice patience, compassion and trust with your body as it does its best to heal.

To help manage and prevent complications, we will present you with recovery guidelines before your operation––such as mobility limitations, exercise, avoiding smoking and alcohol, and addressing your other medical conditions. Know that you can always count on our dedicated staff for support if any issue arises.