Caregiver Guide

By Nick Peplow·Gender-affirming surgery coordinator

Last reviewed 12 October 2026· How this site is researched

If you are reading this, someone you care about is having surgery and you have offered to look after her. Thank you. You do not need medical training. You need to be there, be practical, and know when to pick up the phone. I have coordinated patients and their carers for over ten years. The carers who cope best all do one thing: they write everything down, from doses and times to dilation sessions and questions for the next check.

What you are signing up for

The clinic will give you its own instructions. This is what each operation typically asks of you:

• Vaginoplasty. The biggest job. Usually four to six nights in hospital, with a urinary catheter and vaginal packing for the first several days. Then two to three weeks of steady help while she learns to dilate and gets back on her feet. Light help for some weeks after that.
• Facial feminization. About a week of real help. Swelling peaks around day two or three, and after forehead work it can close the eyes for a day or two. She may need guiding around the room.
• Breast augmentation. A few days of heavy help, then lighter support for a fortnight. She cannot lift or reach overhead, so you do the lifting.
• Orchiectomy. Usually home the same day. A few days of rest and help with errands.

Talk beforehand about what she expects and what you can give. If you cannot take three weeks off, say so now. Arranging a second person for the second week is easy before surgery. Halfway through the first week, it is much harder.

Before surgery

• Read the surgeon's post-op instructions yourself. On day one she will be foggy from anaesthetic, and you will be the one remembering.
• Save the clinic's daytime and out-of-hours numbers in your phone. Write them on paper by the bed too.
• Go through the pre-op checklist together. Agree which jobs are yours: usually food shopping, laundry and the lift home.

If you are going with her to Bangkok or another city, the trip adds its own jobs. Travelling for surgery covers them.

At discharge

This is the most useful half-hour you will spend. Ask the nurse to show you, not just tell you, the jobs you will help with. Then ask:

• Which medication, what dose, how often, and for how many days?
• When may she shower, and when may she sit normally?
• What is the dilation schedule, and what is normal to see?
• When is the first follow-up, and who removes stitches?
• Which number do we call at 2am, and does someone answer?

After vaginoplasty

This is where your help matters most. Her surgeon's team will teach her everything. Your job is support, not nursing.

The catheter and packing. For the first several days there is usually a catheter, and the vagina is packed with gauze to hold its shape. Most of this time is spent in hospital, so nurses handle it. If she comes out with a catheter still in, keep the bag below bladder level and the tubing free of kinks. Empty it before it is two-thirds full. Wash your hands before and after. If nothing drains for a couple of hours and she feels full or crampy, call.

Dilation. Once the packing is out, she will dilate several times a day, usually three or four sessions at first. Each takes fifteen to thirty minutes plus cleaning up. It is uncomfortable early on and very routine within a few weeks. What helps:

• Set alarms and keep a simple log of sessions
• Clean dilators, then lay out lubricant, pads and towels before each session
• Give her privacy, and keep the room warm and quiet
• Bring a drink and something to watch afterwards

Do not judge her depth or technique yourself. If she is worried about either, that is a question for the clinic. The dilation guide explains the schedule and why it matters. Sticking to it protects her depth for life.

Hygiene. Some discharge and light spotting are normal for weeks. Surgeons usually advise washing with clean water or a gentle douche once allowed. She will go through pads quickly, so keep plenty in stock. Change bedding often.

Sitting. Sitting directly on the area is sore for weeks. A soft ring cushion helps. Help her get up and down slowly. Short walks every few hours lower clot risk and help her bowels.

After facial feminization

• Keep her head raised on two or three pillows, including at night, for the first week or so. It brings swelling down faster.
• Cold compresses in the first two or three days, if the surgeon allows them.
• Soft food she can eat without opening wide: soups, eggs, yoghurt, smoothies. After jaw or chin work, the surgeon may set stricter rules.
• Help keep incisions clean exactly as the clinic shows you.
• Remind her the swelling is temporary. Many patients find the first mirror look hard. Within weeks it settles, and the results are worth the wait.

After breast augmentation

• She should not lift anything heavier than a kettle, or reach above shoulder height, for the period the surgeon sets. That means you do the shopping, laundry and high shelves.
• She will wear a support garment or surgical bra day and night. Help her in and out of it. A second one helps while the first is washed.
• Help her sleep on her back, propped up.
• Some surgeons give a band to sit above the implants. Follow their instructions on it exactly.

When to call the clinic

Call the clinic, or go to emergency care, for:

• A fever at or above the clinic's threshold, usually 38°C / 100.4°F
• Spreading redness, heat or a bad smell from a wound
• Sudden, tense swelling on one side, which can be a bleed
• Bleeding that soaks through dressings or pads
• After vaginoplasty, no urine passing, or heavy bleeding during dilation
• Chest pain, breathlessness, or a swollen, painful calf. These can be clots. Do not wait for a callback; go to emergency care
• Vomiting that stops her keeping fluids or medication down
• Pain that gets worse instead of better after day three

If you are unsure, call. Clinics expect these calls and would rather have one at 2am than a problem left overnight. This is general information, not medical advice, and her surgical team's instructions come first. See complications for what each of these looks like.

Looking after yourself

• Sleep when she sleeps in the first days.
• Let others take shifts. You do not have to do it alone.
• Get outside for an hour a day once she is stable.
• If it is hard for you, emotionally or physically, that is allowed. You can be fully supportive and still find it tiring.

Small things that help

• Keeping dilation supplies stocked without being asked
• Treating dilation as ordinary, because it is
• Not asking how she feels every twenty minutes
• Being openly happy for her. This is something she has wanted for a long time.