How soon after you have undergone FTM or FTN top surgery can you engage in sex?
As of this point in time, there is scant information on the subject online and it is likely that it is rarely discussed during consultations for top surgery.
It is an interesting question though one that I am rarely ever asked. Maybe it is because it is too embarrassing to ask.
It could be that in light of the transformational outcome from gender affirming top surgery, this is not even on one’s radar.
Or perhaps, it doesn’t matter what is recommended, patients will do whatever they want to do – post-surgery consequences be damned!
Having Sex Soon After FTM or FTN Top Surgery is Not a Great Idea
For several reasons, it doesn’t take an Einstein to conclude that having sex (whatever that is) soon after surgery is not a wise choice.
What is soon?
Is that 2 days? Five days? A week after surgery?
How about later the same day as your surgery?
Seriously!
Yes.
I actually had an FTM patient who underwent gender affirming top surgery with the double incision mastectomy and the free nipple graft approach Feeling so good after the surgery and being in the mood, he decided to have sex that same night – just hours after surgery.
The good news is that he felt so good right after surgery that sex was on his mind. Being the consummate but tactful professional, I didn’t ask him how that went.
However, I can tell you the consequences of his actions – the bad news. He immediately developed active bleeding and developed a hematoma in his surgical sites and had to be taken back to surgery to evacuate the hematoma (accumulation of blood) that developed as a result. This clearly was an avoidable situation and surgery.
So yes, you can theoretically do what you want and ignore recommendations, guidelines or common sense, but it will be at your own risk – health, financial and surgical results.
Some of the consequences of engaging in sex too soon include causing active bleeding, developing a hematoma, fluid accumulation, wound separation and ultimate scar widening and partial or total permanent loss of the nipple-areola grafts. Some of this may be related to the elevation of blood pressure that occurs with sex – precipitating bleeding. Then there are body movements and external friction which can sabotage the grafts, incision repairs, etc.
What Kind of Sex are We Referring to Here?
There are virtually countless actions that can be considered to be sex. Furthermore, it can involve one, two or more individuals.
For the informational purposes intended here we are going to just lump all these behaviors into the generic term “sex”. Certain actions will be far more problematic and riskier to the surgical sites than others. It should not take too much thought to figure this out and weigh the risks.
Research and Recommendations
What does research say about when you can have sex after FTM or FTN top surgery?
Nothing!
There is no valid research that I am aware of specifically citing when you can engage in sex following top surgery. And for many reasons.
You may, however, be able to get recommendations from your plastic surgeon. A few practitioners have also posted their thoughts on this online. Of course, a lot of non-professionals, including those who have had the procedure before, will offer their two cents on the subject such as on Reddit and elsewhere.
The bottom line is that there is not one right answer here as it depends on several variables.
There are wrong answers, however, like doing it the same day that you had your surgery!
Risk versus Reward
How soon that you can engage in sex following FTM or FTN top surgery basically boils down to risk versus reward.
You can have sex early in the postoperative period (versus later on) but you do run a much higher risk of causing complications, especially bleeding. In procedures where the free nipple graft is involved, there also the risk of its healing getting disrupted, having it get pulled off or impairing its blood supply resulting in its partial or complete.
The longer you wait to have sex (weeks), the lower your risks will be.
Since the results of your FTM or FTN top surgery will be long term – like the rest of your life – you likely want to place more importance on this versus the short-term pleasures of sex.
What are the Professional Recommendations?
General recommendations from some plastic surgeons that are posted online range from around 10 days to 3 to 6 weeks. There is more support for waiting 4 – 6 weeks after top surgery before having sex. Variables of health, healing, procedure type and other factors can and should affect this number.
What Do I Recommend for My Patients?
My recommendations are based on science, the nature of wound healing and individual factors such as health, diet, healing quality, procedure technique and genetics. This critical thinking in making such recommendations is not just unique to top surgery in my practice. It also applies to many other procedures that I do.
I am risk averse here. That is, I want to minimize the risk of my patients developing a complication and possibly needing to have an additional procedure that otherwise should have been avoidable. If waiting an extra 2 weeks can substantially lower that risk, I’m all for it. Most of my patients would likely agree.
Maybe!
In general, my recommendations for most FTM and FTN top surgery patients is to wait at least 6 weeks before engaging in sex. By 8 weeks, the risk for untoward issues should be very close to zero. There are some individuals who may need to wait only 4 to 5 weeks but there will be still be an increased risk for complications.
Again, there is not necessarily one absolute right answer to this question. I recommend what makes the most sense for my patients and from what I have learned from experience and have seen from over 40 years of being a plastic surgeon.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
