We Need to Talk about Wound Care in Transgender Women Healing From a Vaginoplasty

By: Matt Hopper

A lot of transgender women who undergo a vaginoplasty report being frustrated with the health care system and lack of competent practitioners who can provide quality care for gender-affirming procedures (medical procedures that affirm a transgender person’s gender identity).

These procedures, such as hormone therapy, “top” surgery (i.e. mastectomy, breast implants, etc.), or “bottom” surgery (i.e. phalloplasty, vaginoplasty, etc.), are deeply important to the transgender individuals who choose to undergo them; medical gender affirmation has been shown to reduce mental health risks and improve quality of life in this population.

Yet seeking medical gender-affirming procedures frequently results in discrimination and patients are limited by a lack of competent providers and insurance coverage options.

During my second clinical rotation I cared for postoperative vaginoplasty patients; my job was to assess and care for their urinary catheter and surgical wound. After a vaginoplasty, a patient’s wound dressing must be kept in place for no less than five days and cannot be removed or replaced for that entire time. The wound dressing is a latex condom filled with gauze and a tightly wrapped gauze “brief”—think of it as a very tight homemade diaper wrapped around the abdomen, buttocks, and vagina. When patients have a bowel movement, nurses remove the stool and clean it as best they can.

Keeping a soiled dressing on after one—or multiple!—bowel movements presents a serious risk of infection to the patient’s surgical wound. Just imagine if a patient has a bowel movement on day two and must maintain the soiled dressing throughout the rest of their hospital stay. It also directly compromises the patient’s dignity, which further denigrates their trust in the health care system.

There are so many incredibly skilled, experienced, and competent people—who are committed to providing gender-affirming care—that schedule gender-affirming procedures, educate patients, conduct surgeries, and help patients recover. But there are gaps in research—particularly in postoperative care.

Up to 30 percent of transgender women who have undergone a vaginoplasty suffered from some form of infection related to the procedure, yet current research does not offer recommendations for wound-care improvement.

Studies show a lack of research on best practices in postoperative wound care and the current practice does not allow for proper drainage or wound assessment. It leads to infection and other complications that can cause vaginal prolapse, wound dehiscence (ruptures along the surgical incision), or even the need for corrective procedures. And maintenance and care of the surgical wound post vaginoplasty is critical; if healing is delayed, it can complicate the necessary dilation exercises and impact the sensitive tissue around the vagina.

As a result, some patients are taking more responsibility for their recovery.

A transgender woman with an acute vaginal infection after her second vaginoplasty (her first failed due to infection, among other factors) presented to the emergency department I worked at as a nurse student extern. Over the course of her assessment, she told me how, in her postoperative state, she independently restricted her intake to prevent bowel movements. She did not want to soil her dressing, as was the case during her first vaginoplasty. Listening to her experiences, I was completely in awe of her strength, persistence, and ingenuity. Despite numerous complications during her medical transition, she tirelessly advocated for herself and her community in pursuit of equal access to quality gender-affirming care (culturally competent care that affirms a transgender person’s gender identity and attends to their physical, mental, and social health needs).

As more providers become competent with gender-affirming surgical procedures and more insurance companies start to cover costs, more transgender individuals will seek this health care. For transgender women, a vaginoplasty can be one of the final steps in a long, expensive, and difficult medical transition. And, according to my patients, it can be lonely.

Here’s three ways we, as nurses, can help:

Hire transgender nurses! We can also hire clinical staff to train health care practitioners to provide culturally competent care for LGBTQ+ people.
We can advocate for information systems and electronic health records that are inclusive of LGBTQ+ people.
Especially for public health nurses, encourage local and national transgender communities to share their stories. When trans lives are visible, it helps trans health care interventions succeed.

This blog is a part of the “Dialogues in Health Equity” series by the Health Equity Faculty Interest Group. They are committed to decreasing health disparities experienced by local and global communities by promoting social justice and health equity through nursing practice, research, education, and service.

Dialogues in Health Equity:

ABOUT THE AUTHOR: MATT HOPPER

Matt Hopper is currently a student in the MSN (Entry into Nursing) program, an executive board member of the Gertrude Stein Society (the LGBTQIA student group serving the schools of nursing, medicine, and public health), a student nurse extern in a local emergency department, and a research assistant on a multi-site study measuring LGBTQ Awareness Training for Nurse Residency Programs led by Executive DNP student Suzanne Dutton, MSN, GNP-BC. He plans to advance his education by earning a DNP/PhD. Matt’s interest include mental health and health equity for LGBTQIA populations.