Pain Management

By Nick Peplow·Gender-affirming surgery coordinator

Last reviewed 12 October 2026· How this site is researched

Fear of pain stops a lot of women from booking, and after more than ten years in Bangkok hospitals I can tell you most are surprised how manageable it turns out to be. Here is what each operation feels like, what you go home with and when to call. I am not a clinician, so nothing here is a dose or a schedule: the plan that counts is the one on your discharge sheet, and any change to it goes through your surgeon.

What it feels like

Vaginoplasty and peritoneal pull-through. Pain is usually well controlled in hospital, and most people are surprised it is less than they feared. What they notice more is pressure and fullness from the packing, swelling across the whole groin, and the discomfort of lying still for days. Once the packing is out, the early dilation sessions are the sorest moments of the day. Sitting is uncomfortable for weeks, and a ring cushion helps.

Orchiectomy. A sore, bruised ache in the groin for a few days. Most people need little more than paracetamol after the first couple of days.

Breast augmentation. Implants placed under the muscle feel like a heavy weight on the chest and a tight band across it, worst when you get up from lying down. Placement above the muscle and fat grafting are lighter, though the fat harvest site often aches more than the breasts.

Facial feminisation. Mostly pressure, tightness and swelling rather than sharp pain. Forehead work can bring headaches for a few days. Jaw work brings stiffness opening the mouth, and a rhinoplasty brings a blocked nose that bothers people more than any pain.

Voice surgery. A sore, scratchy throat, like a bad cold, for about a week. Neck operations add a tender incision and painful swallowing. Throat lozenges and cool, soft food help more than people expect.

Body work. Liposuction feels like the day after a hard leg session, and the compression garment helps. Hip and buttock implants make sitting and lying on your side sore for a few weeks.

In hospital

For bigger operations, pain relief starts before you wake up. Depending on the operation and the hospital, that can be a nerve block, local anaesthetic placed during surgery, or a patient-controlled pump that gives a small, capped dose through your drip when you press a button. By discharge you will have moved onto tablets, and the nurses will usually have given you at least one round so you know how they affect you.

What people are typically sent home with

Most discharge sheets I have read are some combination of the following, with doses and timings your surgeon sets:

• Paracetamol (acetaminophen), usually on a regular timetable rather than only when it hurts
• An anti-inflammatory such as ibuprofen or celecoxib, if your surgeon is happy with it. Some hold these back for the first days because of bleeding risk
• A short course of an opioid such as codeine or tramadol, for pain the regular medicines do not cover in the first days
• A stool softener or laxative, because opioids and bed rest constipate almost everyone, and straining after genital surgery is the last thing you want
• Anti-nausea tablets for the first day or two
• Sometimes an antibiotic, or an antiviral after lip work for people who get cold sores

Regular medicines at set times, with the opioid kept for the gaps, is the pattern most sheets follow. Pain caught early usually takes less medication to control than pain that has already built up. Write the times on paper or set phone alarms to match the sheet.

What goes home in the bag varies by country and hospital. In the Bangkok hospitals I work with, it usually holds paracetamol, an anti-inflammatory and tramadol. If you are flying home with medication, keep it in its original packaging with the prescription or a hospital letter, and check your home country's rules, because some restrict codeine and tramadol at the border.

Hormones around surgery

Many surgeons ask you to pause oestrogen for a few weeks around bigger operations because of clot risk, and some do not. Follow your own surgeon's instruction on when to stop and when to restart. Restarting late can bring mood dips and hot flushes that people mistake for something else.

Opioids

Most people I have seen through breast or facial surgery have stopped the opioid within a few days. After vaginoplasty it is often a little longer. Using what you were prescribed is not weakness, and pain that stops you walking, coughing or sleeping slows recovery.

Opioids do not mix with alcohol, sleeping tablets or other sedatives, and you should not drive while taking them. If you have a history of substance use, tell your surgeon and the anaesthetist before the operation so the plan can be built around it. Leftover tablets go back to a pharmacy.

What helps besides medication

• Short, frequent walks, which ease stiffness and lower the risk of clots
• Ice packs wrapped in cloth for facial swelling, in short spells, if your surgeon allows it
• Sleeping with your head and shoulders raised after facial, breast and voice surgery
• A ring cushion for sitting after genital surgery
• Front-opening tops after breast surgery, so you are not lifting your arms
• A painkiller half an hour before the early dilation sessions, if your surgeon agrees

Nerve pain and itching

From around week two, many people get itching, zaps, burning patches and oversensitive skin near the incisions, and after vaginoplasty around the clitoris and labia. It is nerves regrowing and is usually a good sign, but it can be maddening at night. Time is most of the answer. Check with your surgeon before adding anything, including an over-the-counter antihistamine.

When pain is a warning sign

Call your surgeon, or go to urgent care if you cannot reach them, if you have:

• Pain that is getting worse after day three instead of better
• Sudden pain, swelling or tightness on one side, after breast or facial surgery especially
• Pain with spreading redness, heat, pus or a fever
• After vaginoplasty, being unable to pee, or new pain in the rectum

Chest pain, sudden breathlessness, noisy breathing after neck surgery, or one calf swollen and painful is an emergency. Call an ambulance. Complications covers the rest.

Pain you cannot control with what you were prescribed is a reason to call in itself. Do not raise your own doses. Surgeons would far rather adjust the plan on day four than hear about it at the two-week appointment.

How long it lasts

Most people are off regular painkillers within one to two weeks of breast, facial, voice or body surgery. Vaginoplasty runs to two or three weeks, with dilation sessions the last thing to stop hurting. The recovery timeline has more on what each stage feels like.