One of the things which has suprised me about my surgery in Bangkok was the limited amount of information about how the body heals and changes over time, and what to expect and when. This has perhaps been the most difficult phase as things happen but without a nurse or doctor to ask you are left with a feeling of "is this correct?" And "should i send another email to the clinic..."

So rather than starting a thread of competiton about your speed of recovery, i felt it would be a good idea to provide some insights into what has happened to each of us, And what can be done to help each other. Obviously more detailed questions will be necessary, but it should help those thinking and planning their SRS trip, especially if traveling abroad.

Traveling home from SRS with Dr Chettawut in Bangkok was an amazing experience, and is detailed in other threads. Getting back into daily life of dilation at home, cooking and eating for yourself, and trying to take time to relax... Or in my case doing too much because of sorting things at home... And not deeply relaxing enough until the body says enough.

Quick note: soul source dilator sizing are not the same as Dr Chettawuts. His #3 is the same as their #1.

How often to dilate?
Good question. In Bangkok I was dilating three times a day for the first few weeks, and then down to two sessions of one hour (#1 and #2) for the last week... But i felt that things were getting tight and so upon my return home i switched back to 3 times a day, in preparation for moving onto the next size (#3). This was really useful as it made each session slightly shorter, and the dilators came in easier...

Changing up a dilator
Take your time... The most important phrase from the surgeon and also echoed by my gynocologist (who runs a trans clinic). If the muscles are tight do not force them. Just slowly work with your body until you find a way to alow the next size to enter. And do not try to force it to full depth the first few timess!

In my case three times a day i used #1 for 10-15 minutes, #2 for 20-30 minutes and then introduced #3 for 10 minutes at a comfortable depth. This slowly increased to 10-25-25 minutes with about 5 minutes to lube up the new dilator. All told each session takes about 80-90 minutes by the time you also prepare yourself and clean up afterwards.

After a few days i found that #3 would slide to a depth slightly less (by about 1cm) than the others, and pushing more was painful. So stop! It also makes sense as the stretched skin / deformed tissues have to accomodate a dilator with larger volume so some depth may be lost.

Note: you will probably bleed in the first few days. This is normal, but also make sure to look inside your vulva to see if there are any tears in the tissues, especially on the entrance. Once the stitches start disolving the skin may not have healed enough. If this is the case try to clean the wound, let it regularly get some air, and discuss with your doctor about suitable healing creams. I tried using savlon (antiseptic cream) but this was not strong enough to stimulate skin growth... And my gyno recommended lalugen which is having a positive effect.

Note 2: keep an eye out for infections - mucus - especially if you have small external tears. This can slow down your healing or provide complications.

When to change to two dilations a day
We all want to get back to work quickly dont we... And recover those lost hours around lunchtime. This will be very much dependant upon how well you recover, but be guided by your body. If you find the dilator sticking too easily and there is plenty of lubrication gel, then it probsbly means you need to continue three times a day until it becomes easier. For half of week 6 and 7 i have found that two sessions a day are sufficient....

When to wash the labia folds
During hotel recovery we are recommended to avoid touching the soft tissues of the labia. But we were not told when to start regularly cleaning. From experience now i would say that after the first week at home the tissues are likely to be well enough healed to allow a very light soap to be used on the skin and folds. But be careful not to rub anything, if you see specks of blood stop.

Labia bleeding and erotic dreams
One night i awoke to find the labia folds and cliteral hood bleeding.
https://www.susans.org/forums/index.php/topic,172743.0.html
As the healing has progressed I think I have gained more of an insight. There are deep stitches which hold things in place, and laying on your side can cause an increase in blood pressure and make things bleed. Once slightly better healed i discovered some remains of stitches within the end of the cliteral hood, and these felt sharp to the finger, so were definitely sharp for the soft tissues.

After a silver nitrate experience in week 7 i bled again from a similar area. most likely because of straining too much during bowel movements... When the area would already be responding to the silver nitrate with higher blood circulation. Using lalugen cream to helped the healing. However i for two days i had the feeling of walking around with the arousal of the start of an erection, but no trouser snake. Sleeping was interesting as i could feel waves of movement because of over sensitised tissues, at the same time paranoid that the bleeding would return (it didnt fortunately). So at least i know things work. Ahem.

Erotic dreams, as your body is learning about its new changes, can also stimulate excess blood flow. This can in turn cause undue pressure and you may find bleeding occuring. Try not to dream, and try not to worry. If you bleed from these areas regularly then seek advice!

Mucus discharges
Another experience which started a couple of days after the cliteral fold bleeding.
https://www.susans.org/forums/index.php/topic,172946.0.html
Whether the two were related is unknown. However i was stupid enough not to take care quickly, mainly because it didnt seem a problem. I cleaned but carried on dilating and surprise, got the infection into the neo vagina. Which took regular douching with betadine solution to solve (mostly). It also infected a small tear inside the neo vagina which is taking more time to heal...

As soon as you start seeing any form of mucus try to clean with anti bacterial soap, and take care that it does not become a regular problem. Since this can easily spread within a day or two really keep a regular eye on your new skin. Especially if you sweat a lot, or have natural fluids from the tissues.

Urethra opening changes
After the catheter is removed you find your pee aim to be rather everywhere... Which is normal. Sometimes you can guide it to the right place by leaning forwards whilst keeping lumbar spine straight (not hunching). However as time passed i noticed that the surgeon had left a longer tube of the urethra which ran under the labia folds... Which had been kept in place with stitches. Over time ths piece of external tissue has bled and torn lightly until morning after my silver nitrate experience i noticed it had gone... And peeing was much better aim. There is still a lot of blood red spongy tissues which is by design to mimic a more natural woman. Of couse these changes will also be accompanied by blood, especialy when wiping yourseld clean. And also provide another opportunity for infection risk. I have sent a photo to Dr Chettawut who confirmed that everything looks like it is healling well.

Black / blood blisters
This has been my latest little escapade. I woke one morning to find a small black blood blister in the scar tissue on the perenium. It was accompanied by being very sore and uncomfortable. If this happens to you get it checked as soon as possible. Sore Black spots can be a sign of deep bacterial infection.

In my case it seems (cross fingers) to have been a small abscess which oozed a little dark water and blood. A few hours later my doctor checked it, probably a hair or healing issue, and gave antibacterial cream. It naturally popped later in the afternoon and went a more normal pink, but still oozes a little.

Douching
The clinic had recommended waiting two full weeks after returning before douching, and then only twice a week with betadine solution. However in my case the infection started just before. But be prepared that if you have tears or skin damage the betadine solution can sting, and be quite aggressive. I used betadine douche after every dilation during the infection but then dropped down to daily.

Speaking with my gyno (who runs a TG clinic including patients from Dr Suporn) he recommended not using betadine, but a more mild Vagoclyss which contains lactic acids as a more natural fungal solution. My GP treating the blister then recommended a sitzbath (sitting bath in a large bowl) with mild betadine. So everyone has their own ideas..

Book a Gynacologist  and doctor for your return
As you probably realised by now the last month has been quite eventful and it has been good having doctors and gynaecologists who have experience with transgender patients. As Mrs Izzy wrote in a different thread, it is really important that you have healthcare professionals around who know what to do. Especially as your neo-vagina is not identical to a cis-female and may need special treatment. Make sure you know, and trust these people before you travel and try to get an appointment with them within the first two weeks of your return. It will really help you relax, especially as you no longer have a daily nurse visiting!


Thats my thoughts for now. It is the end of week 7 post op and I'm sure more healing and recovery will be needed. Especially as my recovery is running in reverse, getting less mobile and much more tired in the past two weeks than in Bangkok. But this is normal, as somehow all the amazing new changes allow a kind of freedom, and then reality returns. Now i sleep much more often during the day and am really grateful for the 8 weeks sick leave.


Big thank you to Madeline B, Jenna and Mrs Izzy who helped me with their kind advice based upon their experiences.

Wow, this is detailed, and will be hugely helpful for other people!

For the interests of science... Brassard has a very specific dilation and douching regimen (how often with which dilators and when to change dilators is specified for the first year, and when to stop douching is prescribed as well), and also suggests sitz baths - which are sitting in a shallow tub of water that's been mixed with disinfectant, so that takes care of the cleaning of the labia until 2 months post-op, when a switch washing carefully with gentle soap is suggested just as you've done.

I DEFINITELY second the recommendation to have at least a GP on hand and prepared; I ended up having an allergic reaction to the anti-inflammatories on the first day I returned home, and then needed a check-up for increasing tightness and pain at about 3 months post-op, and in both cases it was invaluable to have a GP who was already briefed on the situation. (Because of the differences between the healing neovagina and the cis vagina, I didn't think it was worth finding a gyn. until it was past the "surgical site/healing wound" stage.)

I also had an orgasm in my sleep at 3 weeks post-op with no apparent damage or bleeding, but that might just be luck. (I *think* the penile inversion technique may be different in this regard, however, as none of the PI surgeons seem to warn against sexual thoughts?)

Discharge from inside the vagina can continue for up to 2 months of healing, plus the lube from dilations will make its way back out even after that. But any discharge that looks bloody or green or is foul-smelling is of some concern after the first 2-3 months; it's not necessarily serious, but it might be a vaginal infection. Brassard at least says that by 6 months or so the neovagina will have the same flora and environment as the cis vagina, and at that point we can start applying instructions intended for cis women - which makes things a lot easier, as Googling "yeast infection" and using the cis default symptoms and treatments beats needing to look for specialized info. from a trans-friendly source! (Note, do not treat a yeast infection on your own the first time, as they also tell cis women.)

As for peeing, swelling of the labia and vulva can cause the urethra to point in all different directions at first, sometimes many different places in a day. (Sheesh!) Also, it's not uncommon for cis women even to find that labia stuck together in the panties means that at the next pee, the urine gets channeled somewhere peculiar for a minute, like straight back or forward. If that happens once you *are* fully healed and the swelling is gone, don't panic - it's normal and it'll go away next time you try! Same for the fact that no matter how carefully you wipe, a drop or two may hide in the labial folds now... which is just a "welcome to having a woman's genitalia" moment.

This is a brilliant thread - might be worth a sticky, if enough post-ops contribute!

I didn't feel a need to go to a gynecologist after my surgery was done. After my surgery I followed my surgeons instructions (Brassard) like a deranged rocket scientist. I dilated with precision and used purified water (which believe it or not required a prescription) to keep everything clean. I was deathly afraid to touch anything out of fear that I would hurt myself. It wasn't until most of the swelling started going down around 6 months or so later I started exploring. Since vaginas don't come with an owners manual I had to figure out how to...ummm..make it happy. That was about a year after surgery and what a day that was . Lots of pent up sexual energy came out.

It wasn't until at least a few years post surgery and on a new job with new insurance when I started to receive the "you need a mammogram", "you need a pelvic exam" stuff from my regular doctor. I put it off as long as I could until I finally, gave in. In the end I knew I was healthy and fine. So in my case it was years before anyone from the medical profession got a peek.

One reason I credit to my post surgery recovery is following the instructions to the letter. I went this far and didn't want to mess up now that I was postie. It was an absolute pain for a long time recovering with the dilating schedule plus working every day. Boy I can still remember many of those early days that started with dilating. I experimented with how long to keep each dilator in, but in the end, without rushing, I was able to get right where I needed to be.

I kept to Brassard's commandments as well. I haven't missed a single dilation in 9 months of being post-op. But I used water from my reverse osmosis water filter, boiled it and left it to cool. And I always made sure everything down there was dry before dressing. I haven't had a problem since seeing my GP for a minor infection at 2 weeks.

This is a great thread  Thanks Mel for having such a great idea and sharing your experiences 

Quote from: Jenna Marie on September 21, 2014, 10:02:25 AM

This is a brilliant thread - might be worth a sticky, if enough post-ops contribute!

I hope so as many of us soon to be's will find it all invaluable. Thanks to those who have shared and any more posties that feel able to conribute from here on 

Hugs

Sorcha 

You have my vote for a sticky, this information is crucial.

7 days post op here so I'm still in Thailand!

This info is awesome, I'll add anything I notice as well. So did you do a skin graft?? If so how long till the grafted skin got sensation?? If you didn't I'll give an idea when I receive sensation!

If you are part of an HMO you may find the instructions about which type of doctor to go to for what are in their hands, but it is a good thing as a whole.  I was referred to a specific Gynecologist who does do surgery herself, and who has been trained to work with post surgical Trans* people when there was a question of whether I may have had Granulation or an infection.  I did have a yeast infection it turned out, but also had some nerves that were not telling me the truth about where they were!!     The information about that helped me fine tune my dilation routine by how I inserted the dilator.  No major change from the surgeon's instructions, but help in guiding the dilator over ouchy spots was great.

Thank you so much Mel for posting this. I need to know what to expect when I get back home. Today I start my dilation and Ms. C will be taking out my catheter today. Love my depth just amazing what Dr Chettawut did!

I wanted to add some additional points - not to make people apprehensive - but rather to plan properly.

Tidying and Cleaning
Are you untidy? Do you tend to leave cleaning until the last minute? We have all been there - but if you are looking after yourself really consider getting help - friends, family, neighbors - to help you with the cleaning and general maintainence of your flat / house. There will be days when you feel like superhero and others when you won't want to touch anything. Once you fall into the rutt it is hard to escape. Those lucky souls living with someone should also remember that you will be relying on them massively - so be nice to them.

If you can try to make sure you plan to have the flat / house organized, scrubbed clean, and tidy before you leave for your operation. This will help you maintain things when you return.

Feel good hobbies
Try to make sure you have some good low energy hobbies which you can undertake when recovering. Yes book reading and music is a good choice - but after many weeks you will be restless and wanting something "more". Or the steady stream of books coupled with perhaps darker / colder days can instill a sense of "not doing anything". Try to find good reasons to go walking, shopping and taking positive time for yourself. Massage (aroma, foot, head is most forgiving to the healing body).

Organise the kitchen / cupboards to avoid bending / climbing
Seems obvious right? But consider that climbing on a stool to reach a shelf - or bending down to pick up plates - might not be feasible over the healing months. Especially when the new genitals start sinking into the body (inflammation goes down).

be prepared for strange feelings as inflammation goes down
Depending upon the technique used you may find the first few weeks being very mobile... But this is reduced as the swelling goes down and the clitoris becomes rubbed by your labia. Yes it does happen, and can out pay to any idea of crossing your legs. In the worst case walking feels like constantly stimulting the tissues - and can be painful. If it comes and goes then probably nothing to worry about - if it remains more than a few days or becomes a sharp pain then seek advice from your surgeon or get a local gynocologist to have a look. It could be nothing, could be dissolving stitches, or something more nasty.

The downside to inflammation reducing is that you may find your mobility goes down for a period of time. It is important to be aware of this so that you don't plan to do too much in your recovery months.

Talk with your therapist!
Keep your therapist in the loop with your feelings and thoughts. Post operative depression is a real problem for many people - even the strongest - and comes in many faces and disguises. You may be feeling fine and suddenly crash - and friends may only see the brave face / mask of "yay it's all done!". A good therapist can help you spot these tendencies before you are aware of them. Or you may feel that things are too much and it is good to have a place to ask for help. And there is nothing wrong with that!

Especially keep your eye on your sleeping habits. If you find sleeping hard / or only in short segments - then it can quickly become chronic insomnia - and the reasons need to be explored professionally.

This is a huge one: Stock up on toilet paper, or wet tissues. 

You'll need tons of it. At least double what you would buy before surgery. I think I am going buy stock in toilet paper companies. Sheesh...

PinkCloud : Oh, that's a good one. And make sure it's *soft* toilet paper.

I also used baby wipes to clean up after dilation, etc.; more expensive than TP but less expensive than "feminine wipes," and intended for very delicate skin since it's meant for babies.

this advice is helping me alot.
also Im finding that I can use a little less lube if i sprinkle some water in there when the jelly that I use startsto get sticky halfway through dilating.

I should have avoided using any sort of stairs for the first 10 days after surgery...

My house is a two story, so that's not great, but most of those 10 days I probably wouldn't be home anyway.

Quote from: veritatemfurto on April 29, 2015, 09:46:22 AM
this advice is helping me alot.
also Im finding that I can use a little less lube if i sprinkle some water in there when the jelly that I use startsto get sticky halfway through dilating.

I should have avoided using any sort of stairs for the first 10 days after surgery...

Brassard actually had stairs built into his recovery residence on purpose, because he thought it was good for people to get the exercise by the time they moved over there (typically on day 3). Admittedly this is with penile inversion, but we all definitely climbed those stairs dozens of times a day with no issues.

well, about the stairs thing-
I had a hematoma develop at the bottom where my majora connect to my perineum. It popped shortly after the last session of my third day of dilating. now the area is a big annoyance by oozing all the time, especially going on stairs.

It is better to be safe than sorry.

Such a great idea girls! so I would like to make 2 questions the first one is; when are the Chettawut  girls liberated to have sex ( how many weeks after op )? second question 😊 Does  doctor Bassard   performs PI? if yes does it look ok and are the feelings also ok?  I know  those questions can sound a bit stupid but I'm in my moment to decide what will I do. 20 minutes from where I live in a clinic there is a doctor who performs PI, he is not famous but has a lot of experience he makes SRS for more than 10 yeas and if I decide to do with him I don't pay cause the insurance covers it but it is a 2 steps OP the second happens 3 months after the first operation but it is really close to my place, and I few days ago I talked with doctor Scharf  ( Germany ) he seems to be the best in these part ( or the  hole ) Europe but maybe I will have to pay a lot and a lot of money. He performs a combined PI method with wonderful results  ( like 7, 8 inches, self lubrication, natural looking and he claims he preserves much more nerves and for a full sensitive clitoris and labia minora ) he is a dream to me but I will have to pay tons and tons of money travel 2 and half hours only 3 days in the clinic and some days in a hotel nearby. I have heard many girls which did the PI and are very pleased with the results, so girls when you can tell me something which can help me to decide my self would be wonderful . thanks all for your time.

Brassard does do penile inversion, though these days most modern doctors who say they do (including him) supplement the depth with a scrotal skin graft.

I have posted a longer review of him somewhere around here, but I have adequate depth, am easily orgasmic with great sensation both in the vagina and the vulva (and the clitoris is too sensitive to touch directly), and the aesthetics (looks) are good enough that a gynecologist (doctor who specializes in female reproductive system) accidentally certified that I was born with a vagina until I told her otherwise. I also self-lubricate, though it works the way it does for some cis women in that I get a little wet when aroused, very wet when penetrated, and a LOT wet at orgasm.

Personally, I think any of the experienced PI surgeons do a great job, and so do the Thai surgeons. So if you have the opportunity to get a talented PI surgeon for free or almost, that seems like a good reason to decide on him.

Quote from: Brasileira on April 30, 2015, 07:13:14 PM

When are the Chettawut  girls liberated to have sex ( how many weeks after op )?

Dr Chett told me 3 months so to be that's 13 weeks but some will say 12. I'm not going to rush into anything not even playing by myself as the longer you leave it the more healed you'll be 

Hope that helps

Hugs

Sorcha 

Thanks girls  😊 I also have a strong feeling that I should go for PI  cause it is also said that the healing process is also faster.