Different Steps of Bottom Surgery: From Preparation to Full Recovery

Bottom surgery is the most delicate and complex step of the gender reassignment process, and recovering from that can take weeks or even months. Those who decide to undergo this operation must prepare their body and mind for it; for example, they should adjust their diet plan, get medical and psychiatric checkups, have their internal organs checked, and get the necessary permits from a psychiatrist and the court . In the following text, we explain the different steps of bottom surgery, from preparation to full recovery.

Why It’s Important to Know the Steps of Bottom Surgery

Just like any other major operation, bottom surgery can have long-term side effects and a long recovery period. Also, some patients might need multiple surgeries to achieve their desired results. All being said, every patient must have detailed information about the steps of bottom surgery and how to take care of their body and mind afterwards. This helps them make a better decision about the type of surgery.

Sometimes, a different surgery or a noninvasive treatment is chosen based on the patient’s expectations and the doctor’s discretion. Also, when patients know how long the recovery will take, they can better plan their daily life, work, and school activities.

How to Prepare for Bottom Surgery

All patients must take medical and psychiatric tests and get necessary approvals from the expert witness (the specialist trusted by the court) . The psychiatric evaluation process takes at least one year. If the patient does not change their mind about having the surgery, the following steps are taken:

●    The psychiatrists’ and the specialists’ evaluations are reviewed once again.

●    The patient takes hormonal tests, blood tests, and imaging scans.

●    The patient and surgeon discuss the goal of the surgery, the type of procedure, and the expected results.

●    Preparing the body with a nutritious diet and a healthy lifestyle.

Reviewing the psychiatrist and medical evaluations

After getting necessary treatments and examinations, a formal letter is issued. This document must be signed by a psychologist, a psychiatrist, and an expert witness. In fact, the letter confirms that the person is authorized to undergo gender-affirming surgery.

Taking Physical Tests

Before starting the treatment, the patient must take different physical tests, including imaging of the internal organs, blood tests, hormonal tests, and other related evaluations. Such tests are necessary to measure the female or male hormones and check the organs involved in the surgery.

Determining the Type and Purpose of the Surgery

Trans men undergo phalloplasty to have a male genital, and trans women undergo vaginoplasty to have a female genital. Note that in this step, the medical team chooses the type of gender affirmation surgery because the operations vary, and the patients don’t have enough knowledge to choose the best one.

Adjusting the Lifestyle and Diet

Having a very high or low BMI, smoking and drinking, a poor diet, etc., can interfere with the operation and recovery period. Therefore, the patient must optimize their diet and lifestyle before undergoing the bottom surgery.

What Happens during the Bottom Surgery

Depending on the target gender, the bottom surgery is done in one or more steps. Trans women should only undergo orchidectomy (to remove one or both testicles), penectomy (to dissect the penis and spermatic cords), and vaginoplasty/vulvoplasty (to create a neovagina). Fortunately, all these procedures are done in one session.

However, bottom surgery for trans men has two steps; first, the surgeon must remove the uterus, fallopian tubes, and ovaries (hysterectomy). Then, they must perform phalloplasty, vaginectomy, scrotoplasty, and other procedures to create a penis and a natural-looking scrotum.

How Long Does the Operation Take?

The exact time of bottom surgery depends on the medical team’s expertise and the patient’s health condition. In general, phalloplasty for trans men usually takes about 4 to 5 hours, and for transgender women, vaginoplasty takes almost 4 to 6 hours.

What Happens in the Recovery Room?

When the operation is finished, the patient is transferred to the recovery room, where he/she is monitored 24/7. In the PACU, the nurses:

●    Check the patient’s vital signs

●    Administer appropriate doses of pain medication

●    Place drains and catheters to remove excess fluids

●    Change the gauze and bandages on time

What to Do after the Bottom Surgery?

You have to rest at home for at least two weeks after the surgery. During this time, you should take all medications prescribed by your specialist and report any warning signs (such as high fever, severe pain, unusual bleeding, etc.) to your doctor. Here are the most important things you should do for a couple of days after the operation:

●    Have a nutritious diet, rich in protein and fiber.

●    Take vitamins and supplements.

●    Avoid eating food that causes nausea, vomiting, bloating, or constipation.

●    Do not smoke cigarettes and drink alcohol.

●    Massage the operated parts as instructed.

●    Use cold compresses to prevent bruising and swelling.

●    Use warm compresses a few days after cold compresses to ease the pain.

Tips for Taking Antibiotics and Pain Relievers

Bottom surgery wounds usually take a long time to heal, so they are more likely to be infected. Therefore, you should take the prescribed antibiotics (such as amoxicillin and clindamycin) according to your doctor’s instructions.

Painkillers are a great help after the bottom surgery; however, taking too many of them, like ibuprofen, naproxen, tramadol, etc., can have adverse effects on your body. If you have unbearable pain, ask your doctor to adjust your medications.

Sitting and Sleeping after the Surgery

It is recommended not to rest for 24 hours after the surgery. Small movements, like getting out of bed or walking slowly around the room, can prevent blood clots. On the other hand, moving too much, sitting for long hours, and lifting heavy objects are prohibited for two weeks, as they can rip the sutures and cause bleeding.

Visiting the Doctor and Getting Checkups

You can get out of the house almost two weeks after the bottom surgery, but the full recovery takes six weeks. During this time, you should visit the doctor and get checkups frequently. The doctor instructs you on how and when to use dilators (for trans women) and compression garments (for trans men).

Common Side Effects and Warning Signs

Needless to say, if you choose a skilled surgeon and prepare your body for the bottom surgery, you will face fewer risks and side effects. However, if you notice any of the following warning signs, contact your doctor as soon as possible:

●    Infection or bleeding

●    Stitches opening up

●    Loss of sensation in the genital area

●    Urethral narrowing in FTM patients

●    Urine incontinence or fluid buildup in the vagina in MTF patients

Emotional and Psychological Effects

Bottom surgery affects both your body and mind. Many patients face psychological and emotional challenges after the operation that might bother them for life. Identity struggles, adjusting to the new body, depression, stress, anxiety caused by social reactions, mood changes, irritability, feelings of isolation, and stigma are only some of the psychological issues patients may face after the bottom surgery. Managing and overcoming these challenges requires time, effort, and continuous support from a therapist.

Urinating after Bottom Surgery

Feeling pain or burning during urination in the first few days after the surgery is completely normal. However, urinary incontinence and retention are not normal, and you should see your doctor to treat them. In some cases, the patient should use maxi pads until full recovery. Later, the doctor may also recommend bladder training (scheduled voiding) and Kegel exercises to strengthen the muscles that support the bowels and bladder.

Having Sex after Bottom Surgery

Heavy activities can put pressure on the lower body and strain the sutures; therefore, you should avoid them for 6-8 months after the bottom surgery. Sexual intercourse is also a heavy activity and must be avoided for weeks or even months, depending on the doctor’s discretion.

FAQs

1) Should I quit smoking before bottom surgery?

Yes. Smoking impacts your overall health and can interfere with surgery and the healing process, so you’d better stop smoking at least a few weeks before the operation.

2) Which medications should I mention in my medical history?

If you take certain medications, such as antidepressants, anti-ulcer drugs, and antifungal medicines, you should tell your doctor before undergoing the surgery. These medications can affect hormone levels and may disrupt the treatment, so taking them requires the doctor’s permission.

3) Can I choose the type of bottom surgery myself?

No. The medical team chooses the best type and method of surgery after examining you.

4) How long does full recovery after bottom surgery take?

Depending on the type of procedure, it takes about 6 to 8 weeks to fully recover from bottom surgery. Of course, you can resume your daily life within two weeks only if you don’t put pressure on your body.

5) Which medications should I avoid before bottom surgery?

If you drink herbal teas or take blood-thinning medications, you must stop using them before the surgery because they interfere with anesthetics and may cause bleeding during the operation.

6) Do I need hormone therapy before the surgery?

Yes. Depending on the condition, the doctor may prescribe hormone pills/shots to increase feminine hormones in transgender women and masculine hormones in transgender men.

7) Will I still enjoy sex after bottom surgery?

If the genitals’ nerves are not damaged during the surgery, you will still enjoy intercourse. However, the level of sensation can be different from person to person.