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Sex Change (SRS)

    Post-Operative Care

    During the recovery period, after each dilation session:
    1. Wound Care the wound should be washed gently with Hibiscrub (pink colour) or with betadine solution  in the shower followed by douching while seated in the toilet:
     -1. douche solution(proportion) = 5-10 ml (cc) of Betadine solution mixed with 1L of
water or until the container is full
     -2.  insert the douche to full depth, squeeze, and hold tightly the container;
     -3.  while holding tightly the container, extract the douche;
     -4.  keep the wound dry and apply Betadine solution with cotton balls; and
     -5.  apply Kemicitine ointment with a cotton applicator. If there is some bleeding, press or apply pressure with a dry cotton ball to the site for 15 minutes. During the first weeks after surgery, feminine knapkins (tampons) should be changed several times per day due to normal vaginal bleeding during recovery.
      After one month of SRS operation you will be required to start applying Premarin cream to your neo-vagina. Apply two times a day to soften your neo-vagina. This would generally take around six months.
    After Care
    Before being discharged from the hospital to your hotel, the nurse will teach you how to take care of your vagina and prescribe some more medications. The stiches will be removed after 7- 10 days. And you will be able to return home.
    2. Dilation
    During recovery in 3 rd day hotel, the patient must follow patient instructions, including:
    -1. Dilating is the most important thing you can do to ensure the success of your surgery.
If the patient does not dilate responsibly, this can result in the shortening of depth and width of the newly made vagina because of the scar contracture.
    -2. Failure to dilate properly can result in serious injury. You will be instructed to gently dilate into the right direction after the vaginal packing is removed.
    -3. Dilation can be painful for the first weeks, but is essential for developing maximum depth and ensuring post operative functioning of the neovagina.

    Insertion the dilator

    1. Before starting, relax the muscles and Semiflex your knee.
    2. A condom is placed over the dilator, apply KY-jelly and insert slowly and keep it in for about 15-30 minutes, finally clean as previously directed and apply the antibiotics ointment over the stitching and any area of fresh wound.
    3. Start with the smallest dilator and progress to the larger diameter provided.
    4. Do not skip dilation even if it is painful. Failure to do it may result in partial or total collapse.
    5. Rinse out the lubricant after dilation and apply an antibiotic ointment or Betadine solution until the wound is completely healed.
    6. One month after SRS operation you will be required to start applying Premarin cream to your neo-vagina. Apply two times a day to soften your neo-vagina. This generally lasts around six months.
    Intercourse:
    After the 4th week post op, you should be able to engage in neo-vaginal intercourse. The neo-vagina will need some form of lubrication. In general, patients may have sexual intercourse after they successfully dilate the neo-vagina to the last size of the vaginal dilators. Sex partners should wear condom and apply lubricant inside vaginal cavity during neovaginal intercourse in the 1st month to prevent trauma effect from inadequate lubricant. After 1 month intercourse can be done without condom but lubricant still has to be used.

    Return to female hormones:
    Patients can resume taking oral female hormones in 2 month after surgery but the need for female hormones is less than prior to surgery.

    Medical certificate:
    You will receive documents certify you have successfully undergone sex reassignment surgery.

    Insurance and Legal issues
    Insurance carriers may specifically exclude transsexual treatment as they do aesthetic surgery. Legal name change and birth certificate amendments are accomplished according to the laws of the particular state or country. Patient can return to female hormones as before surgery after two months. You should consult your endocrinologist to re-adjust the dosage. A sudden change in hormone levels, for some individuals, may result in the fluctuation of emotion.

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