What might these look like and what can we do about them?

Great question.

Infection is usually accompanied by swelling, discharge, painful dilations, and possibly bleeding.

There can be a lot of overlap, as you can hear with the presentation of hypergranulation.

So this really emphasizes the importance of the physical exam.

If you are concerned about infection, it can be helpful to remember that the culture and sensitivity testing for infection of a neovagina is a bit different than that of a natal vagina.

Namely, on the requisition, you write up with it.

What tips do you have for us to manage her hypergranulation?