Pain Management

By Nick Peplow·Gender-affirming surgery coordinator

Last reviewed 27 September 2026· How this site is researched

I'm not a clinician, and nothing on this page is a dose or a schedule. The medication plan that counts is the one on your discharge sheet, and any change to it goes through your surgeon.

What it feels like

Top surgery. The main sensation is a tight band across the chest, like a binder a size too small, plus soreness at the sides and under the arms where drains come out. The centre of the chest is often numb. Coughing, laughing and getting up from lying down hurt most in the first week. Many surgeons inject long-acting local anaesthetic or do a nerve block during the operation. It can make day one feel easy and day two or three worse as it wears off, which is expected rather than a setback.

Hysterectomy. Cramping and abdominal soreness, plus an ache in the shoulders from the gas used to inflate the abdomen during laparoscopy. It's odd, harmless and usually gone within a few days. Walking moves it faster than lying still.

Metoidioplasty and phalloplasty. More pain, for longer. After phalloplasty the donor site on the forearm, thigh or back is often the sorest part, more than the phallus itself. Catheters can cause bladder spasms, a sudden cramping urge to pee, which surgeons treat with a separate medicine rather than more painkiller. Tingling, burning and electric-shock sensations are common for months as nerves regrow.

Facial and body work. Mostly aching, pressure and tightness from swelling rather than sharp pain. After liposuction it feels like the day after a hard leg session. Jaw work adds stiffness when opening the mouth.

In hospital

For bigger operations, pain relief starts before you wake up. Depending on the procedure and the hospital, that can be a nerve block, an epidural, or a patient-controlled pump (a button that gives a small, capped dose of painkiller through your drip). By the time you're discharged, you'll have moved onto tablets, and the nurses will usually have given you at least one round of them so you know how they affect you.

What people are typically sent home with

Most discharge sheets I've read are some combination of the following, with doses and timings the surgeon sets for you:

• Paracetamol (acetaminophen), usually on a regular timetable rather than only when it hurts
• An anti-inflammatory such as ibuprofen, naproxen or celecoxib, if your surgeon is happy with it. Some hold these back for the first days because of bleeding risk, or avoid them if you have kidney or stomach problems
• A short course of an opioid such as codeine, tramadol or oxycodone, for pain the regular medicines don't cover in the first few days
• A stool softener or laxative, because opioids and lying around constipate almost everyone, and straining after pelvic surgery is the last thing you want
• Anti-nausea tablets for the first day or two
• Sometimes a muscle relaxant for chest tightness, a bladder antispasmodic if you have a catheter, or an antibiotic

The pattern most sheets follow is regular medicines at set times, with the opioid kept for gaps. The reason surgeons write it that way is that pain caught early usually takes less medication to control than pain that has already built up. If you're worried you'll lose track, write the times on paper or set phone alarms matching the sheet.

What goes home in the bag varies by country and hospital. In the Bangkok hospitals I work with, the bag usually holds paracetamol, an anti-inflammatory and tramadol; from what patients have shown me, US discharges more often include a stronger opioid such as oxycodone. That is an observation, not a recommendation for either. If you're 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.

Opioids

Most people I've seen through top surgery have stopped the opioid within a few days. After phalloplasty it's usually longer. Using what you were prescribed isn't weakness, and toughing it out doesn't make you heal faster; pain that stops you walking, coughing or sleeping slows recovery.

They don't mix with alcohol, sleeping tablets or other sedatives, and you shouldn't drive while taking them. If you've been on them more than a short while, ask how to come off them rather than stopping on your own.

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, not into a drawer.

What helps besides medication

• Sleeping propped up on a wedge or pillows, which eases chest pressure and makes getting up easier
• A small pillow held against the chest or abdomen when you cough, sneeze or laugh
• Ice packs wrapped in cloth, for short spells, if your surgeon allows it. Grafts, flaps and numb skin can't feel cold burns, so ask first
• Short, frequent walks, which reduce stiffness, gas pain and the risk of blood clots
• Front-opening tops, so you aren't lifting your arms
• A cushion for sitting after genital surgery, and heat on the lower back, which takes the strain of sleeping upright

Nerve pain and itching

From around week two, many people get itching, zaps, burning patches and oversensitive skin near the incisions. It's nerves regrowing and is usually a good sign, but it can be maddening, especially at night. Time is most of the answer. Gentle tapping or rubbing near the area, rather than scratching it, helps some people. There are medicines used for nerve pain and for itching, but check with your surgeon before adding anything, including an over-the-counter antihistamine, because some interact with what you're already taking.

When pain is a warning sign

Call your surgeon, or go to urgent care if you can't reach them, if you have:

• Pain that's getting worse after day three instead of better
• Sudden pain, swelling or tightness on one side of the chest, which can be a hematoma
• Pain with spreading redness, heat, pus or a fever, which suggests infection
• After bottom surgery, pain when peeing, not being able to pee, or urine leaking from somewhere new; see fistula and stricture

Chest pain, sudden shortness of breath, or one calf swollen and painful (which can be a clot) is an emergency. Call an ambulance; the complications page lists the other emergency signs.

Pain you can't control with what you were prescribed is a reason to call in itself. Don't raise your own doses. Surgeons would far rather adjust the plan on day four than find out at the two-week appointment that you spent a fortnight in pain.

How long it lasts

Most people are off regular painkillers within one to two weeks of top surgery, hysterectomy, facial or body work. Phalloplasty is more like several weeks, with nerve symptoms going on far beyond that. Chest wall pain that's still there months later is uncommon and worth raising at follow-up. The recovery timeline has more on what each stage feels like.