Infection

By Nick Peplow·Gender-affirming surgery coordinator

Last reviewed 27 September 2026· How this site is researched

A wound infection can follow any operation. After most FTM procedures it's uncommon, and when it happens the gap between a week of tablets and a lost graft, a removed implant or a return to theatre is mostly how fast someone spots it. This page covers what infection looks like, what normal healing gets mistaken for, and when to call or go to hospital.

Normal versus not

Healing incisions are meant to be a bit red, warm, swollen and sore. Drain sites and graft edges ooze thin pink or straw-coloured fluid. Bruises turn yellow and green and spread downwards with gravity. Itching starts around the second week. A thin pink line hugging the edge of an incision is normal too.

Infection is a change for the worse in a wound that had been settling, most often between about day three and day ten, though an implant can become infected weeks or months later. The rough rule is that healing gets better every day and infection gets worse every day. If you're unsure, take a photo in the same light at the same time each day. Comparing two photos shows spreading redness far more reliably than memory.

Signs of a wound infection

• Redness spreading outwards from an incision, drain site or graft, especially if it's moved in a few hours
• The area getting hotter, more swollen or more painful after it had started to ease
• Pus, meaning thick, cloudy, yellow or green discharge, as opposed to thin pink or clear fluid
• A new bad smell from the wound or dressing
• A closed incision opening up
• A temperature of about 38°C or higher, chills, sweats, or feeling shaky and unwell
• After bottom surgery: cloudy, smelly or bloody urine, burning when you pee, or pain in your back or side below the ribs

When to call and when to go to hospital

Call your surgeon's team the same day, with a photo if you can, if:

• Redness is spreading, or a red streak is running away from the wound
• There's pus or a foul smell
• Pain, heat and swelling are increasing instead of easing
• You have a fever or chills
• A wound has opened
• A nipple graft has gone red, wet or smelly around its edges; nipple necrosis covers the overlap
• The skin over an implant (chest, jaw, cheek, testicular or erectile) is red, hot, thin or newly tender
• After bottom surgery, you have any sign of a urinary infection

Go to an emergency department, or call an ambulance, if:

• You have a high fever with a fast heart rate, fast breathing, confusion, cold or blotchy skin, or feel faint. These can be signs of sepsis, and it needs treatment within hours.
• Pain around the wound is severe and out of proportion to what you can see, the skin is going dark or blistering, or it feels crackly when pressed. That's rare, but it's the kind of infection that spreads fast.
• After phalloplasty, the phallus changes colour, going pale, dusky or dark. That's a blood-supply emergency with the flap rather than an infection, and it can't wait.
• After bottom surgery, you can't pass urine at all. The stricture page explains what to tell the staff.

If you're away from your surgeon, get seen locally and message the surgeon at the same time. Don't wait for a reply first. Many of the patients I've coordinated through Bangkok hospitals were back home when a wound turned, and the ones who did best had the surgeon's contact details, the operation summary and a list of their medications ready on their phone. A local doctor with those can start treatment the same day.

How it's treated

Most wound infections are caught early and treated with a course of antibiotic tablets and more frequent dressing changes. The team may swab the wound first to see what's growing. Which antibiotic and for how long depends on the wound, on the swab and on what else you take. That's why a leftover packet from a drawer, or a friend's, is a bad idea even when it looks like the same thing.

A pocket of pus, an abscess, usually needs releasing as well as antibiotics. That can mean opening a short section of the incision and packing it, or drawing the pus off with a needle, often in clinic. An opened wound heals from the bottom up over a few weeks and tends to leave a wider scar.

A deeper infection means antibiotics through a drip in hospital, and sometimes a return to theatre to wash the area out. That applies to a large collection, spreading infection in the tissue, or infection around an implant. An infected hematoma or seroma (a pocket of blood or fluid) usually has to be drained before antibiotics can reach it.

Implants

An implant has no blood supply of its own, so bacteria that settle on it form a film antibiotics struggle to reach. Plan on the basis that an infected implant comes out, and a replacement waits months until the tissue has recovered. Erectile implants carry the highest risk; that page gives the published range for phalloplasty patients, which is several times the rate in cis men. Jaw and cheek implants placed through the mouth, pec implants and testicular implants carry lower but real risks. Every surgeon I've watched handle a suspected implant infection wanted the patient in the same day, because early treatment sometimes saves the device.

By procedure

Top surgery. Infection is uncommon. The usual sites are drain exits, the ends of the incisions towards the armpit, and nipple grafts. Sweat trapped under a compression vest doesn't help, so keep the skin dry and change dressings as instructed.

Hysterectomy. Infection can show in the small keyhole wounds, in the bladder after the catheter, or at the top of the vagina where it was closed (the vaginal cuff). A cuff infection can appear a week or two out, as pelvic pain, a fever or a discharge that smells, and needs prompt treatment.

Metoidioplasty and phalloplasty. More wound surface, more joins and urine running past healing tissue all raise the risk. Urinary infections are common while catheters are in and in the weeks after they come out. Infection at the donor site on the forearm or thigh can cost part of the skin graft there. Infection near the urethra raises the chance of a fistula or stricture, so teams treat it early.

Facial surgery. Incisions inside the mouth, used for jaw and cheek work, sit in a mouth that isn't clean. The mouthwash and soft-food instructions are there to keep those incisions closed over the bone or implant.

Reducing your risk

• Wash your hands before touching dressings, drains or catheters, every time.
• Follow the showering instructions exactly, including when you can first get the wound wet.
• Keep dressings dry and change them on schedule.
• If you're given preventive antibiotics, finish the course.
• Keep blood sugar controlled if you're diabetic, and don't use nicotine. Both weaken healing in the wound.
• Eat enough, with protein at every meal. Wounds are built from it.

Afterwards

A wound that was infected usually ends up with a wider or more raised scar than it would have otherwise. That's the main lasting effect of a minor infection. Scar care and, once everything has healed, a revision can address it.

This is general information, not medical advice. Whether a wound is infected, and what to do about it, is for someone who can see it.