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Postop Phalloplasty:
Perineum Concerns

Perineum: the area between the anus and the back of the scrotum.


I have an open wound. What do I need to know?

  • The second most common open wound in the perineum is in front of the anus. It is typically small and shallow and will usually resolve and close with wound care, nutrition, and daily to twice daily ointment. If it doesn’t heal with skin, and granulation tissue (pink tissue that bleeds easily) develops instead, silver nitrate topical treatment (done in the office) may be required.

  • This wound can open up with tension (hard bowel movements, not gently sitting from a standing position, etc). Avoid tension to prevent the wound from getting bigger and use stool softeners regularly; miralax is the preferred stool softener.

I have perineal pain. Is this normal?

  • Pain after surgery is expected. It should reach a peak within a few days and thereafter remain stable and slowly improve. This pain may worsen with activity and improve with rest.

  • Pain is not normal if the following is noted:

    • The pain progressively worsens.

    • The pain is associated with worse swelling and/or redness.

  • Prolonged perineal pain/discomfort:

    • Some patients will notice itching or discomfort several months after surgery. This is common if it is intermittent (off and on) type pain that occurs randomly or with activity. The severity of symptoms should resolve over time. If they don't resolve, notify your surgeon.​

    • Pain with sexual activity is similar: it is normal if there's no pattern of worsening; it is not normal if it progressively worsens or is associated with swelling. 

  • Contact your surgeon should you notice abnormal symptoms.

Perineal fullness after vaginectomy. Is this normal?

  • There are glands near the opening of the prior vaginectomy site that are removed during vaginectomy. These are called Bartholin's glands. However, these glands may regenerate or do not get removed fully during vaginectomy, allowing the perineum to fill with fluid or mucous over time (usually 6 months and later). Retained mucosa from the canal can also cause this. This is not normal and will often require surgical intervention.

  • There are other glands called Skene's glands that are inside the urethra. The are analogous to the prostate gland and secrete fluid during sexual activity inside the urethra. If there's a fistula to the perineum, this fluid may accumulate there and present similar to retained mucosa or Bartholin's glands. Surgery would be required in this situation.

  • Contact your surgeon should you notice abnormal symptoms to discuss management.

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