Granulation tissue

Granulation tissue is the raw, bright red, bumpy tissue the body grows to fill a healing wound. It is the normal machinery of repair. It becomes a problem when it overgrows at a suture line, because then it bleeds, weeps and takes over the healing instead of finishing it.

Where you'll meet it

After vaginoplasty, most often somewhere between the second and third month, at the join inside the canal or along the suture lines of the vulva. It turns up in a large share of people, and it is one of the two or three things that most reliably frightens someone who has been told their recovery is going well.

It is mentioned on the peritoneal page too, for the same reason. Any surgically made canal has a healing join inside it.

What is actually happening

Healing skin fills a gap by growing new tissue packed with tiny blood vessels. Under a microscope it looks granular, which is where the name comes from. Under a lamp in a clinic room it looks like a small red or pink lump, shiny and slightly raised, and it is full of vessels with nothing covering them.

That is why it bleeds at the slightest contact and why it weeps a watery, sometimes pink discharge. The bleeding is alarming out of proportion to its seriousness. It is not an infection, it is not a sign the operation failed, and it does not mean you have done anything wrong with your dilation.

What it does mean is that a spot has decided to keep building rather than to close over. Left to itself it can sit there for months, and that is the reason to treat it rather than wait.

How it is treated

In a clinic room, not an operating theatre. The usual approach is silver nitrate applied on a stick to the spot, which chemically burns off the overgrowth and lets the edge heal across. It takes a couple of minutes, it stings rather than hurts, and it often needs repeating over two or three visits. Some surgeons use a steroid cream instead or as well.

This is routine work, and it is the single best argument for having a plan for follow-up close to where you live if you have travelled for surgery. Somebody has to be able to look at it. If you had your operation abroad, ask before you fly home who will handle this, and get the answer in writing rather than as a reassurance.

Why people panic about it

Because the first sign is usually blood on a dilator or on underwear, weeks after the bleeding was supposed to have stopped, and the internet's first suggestion for unexpected bleeding is always worse than this.

The useful distinction is between a small amount of blood with contact, which is the usual picture, and fresh bleeding that does not settle, fever, a foul smell or new pain. The second group is a call to your surgeon's team the same day. The first is a clinic appointment in the next week or two.

Why it's on this site

Because it is common, harmless, entirely treatable, and almost never mentioned on a clinic website. That combination is exactly what makes recovery frightening. A complication you were warned about is an inconvenience. The same complication arriving unannounced at week nine, when you are alone and the bleeding has started again, is something else.

If you know the word before you need it, you will recognise it, book the appointment, and get on with the rest of a recovery that is going fine.

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