A scoping review of douching practices following gender-affirming vaginoplasty: toward standardized guidelines

Introduction Postoperative care following gender-affirming vaginoplasty (GAV) plays a crucial role in ensuring optimal healing and long-term outcomes. Because a neovagina lacks self-cleaning properties, some surgeons recommend douching to prevent debris build-up, manage odor, and minimize risk of stenosis. There is currently no widely accepted standard of care regarding douching after this procedure. Given the differences in practice across institutions, a scoping review was conducted to consolidate existing recommendations and facilitate the development of clinical guidelines. Objectives Our objective was to conduct a scoping review on GAV douching care recommendations. Methods Five databases (PubMed, Embase, SCOPUS, Cochrane, and Medline) were queried using keywords. Information regarding timing of douching initiation, frequency, solution, and equipment was collected. Additionally, geographic origin and medical specialty were recorded. Findings were summarized to highlight recommendation patterns. Results Of the 20 articles screened, 10 met inclusion criteria. Timing of douching initiation included postoperative day (POD) 5, POD 10, or within the first two months. Douching frequency recommendations for full-depth vaginoplasties varied widely, with the most common being at least once a week but less than daily (40% of studies), followed by daily (30%), twice daily (10%), and none (10%). Douching solutions also varied, with water (50%) and soap (50%) being the most common, followed by vinegar (30%), povidone-iodine (20%), saline (10%), and commercial products (10%). Douching equipment was only mentioned in one study, which introduced a novel dilator-douche device. No clear pattern emerged across medical specialties or geographic regions. Conclusion This review highlighted inconsistencies in postoperative GAV douching recommendations, underscoring a lack of evidence-based recommendations. The variability in these recommendations is largely independent of specialty or geography, suggesting current practices are primarily surgeon-specific. By naming these inconsistencies, this article establishes a foundation for future work aimed at developing standardized guidelines and minimizing postoperative complications.