Missing home

I miss my pets, my bed, my chosen family, my chair, and my mountain. I just want to be healing at home instead of stuck in an overpriced Airbnb in a strange city just because Seattle doesn’t have trans bottom surgeons.

When we talk about trans health equity, a big part of that is easy access to care instead of driving halfway down the coast (or across the state at best) and spending exorbitant amounts on housing to get the care we need.

Revision post op

Just had my first revision surgery post op where I was really hoping to get the catheter out. Sadly they want me to keep it in a week longer to give the urethra more time to heal. I also have a yeast infection. Otherwise I seem to be healing well though I do have to stay on top of separating the wound at the base of my vagina to make sure it doesn’t heal together like last time. They also gave me tips on how to better manage my pain without opiates.

The team at Mozaic Care are all so wonderful. I hate that I had to have a revision because my original surgery healed weird but I am glad I get to see more of them. Right before surgery when I was waiting for my operating room to be ready I told them about my first orgasm and both surgeons were so excited. One even gave me a hug on the spot.

Update after surgery

The surgery appears to have gone well though it was a little more extensive than originally planned. While they were in there they discovered a hole in my urethra which explains why I was dribbling after I peed. They stitched it up so now I have a catheter and a pee bag tied to my leg for the next week.

The pain hasn’t been as bad as the first surgery but it’s enough that I have to stay on top of pain meds. I haven’t been sleeping well because I keep waking up when they wear off. And it’s painful to sleep on my side right now because that puts pressure on the stitches.

I’m pretty out of it because of the meds so as I’m mostly zoning out and watching bad TV. Hopefully soon I’ll start improving.

Revision surgery day!

Today is my revision surgery on my vulva! The surgeon is going to be modifying my clitoris area to make it easier to access my remaining nerve bundle, removing some scar tissue at the opening of my vulva, and removing excess skin that grew around my urethra that causes me to dribble after I pee. I’m simultaneously glad to get these annoyances dealt with and scared that something is going to go wrong with the surgery or recovery to further damage my ability to orgasm. Fingers crossed everything goes and heals smoothly!

Full orgasm!

I did it! 1 year and 7 weeks after bottom surgery I finally had a full orgasm! I’m not sure what the magic formula was this time but I was trying out a new toy my partner got and a new topical cream that includes Viagra.

It definitely feels very different than my old parts did. It comes on slowly and has a more sustained high point and headiness to it. And I forgot just how wonderful all the happy hormones are that come with it.

I’m excited to have more of them and find out what works. And maybe someday I can get there on my own.

Mini Orgasms

Finally a year after my bottom surgery I’m starting to have mini orgasms! I had the first one about a week before my surgery anniversary but I wasn’t sure what it was and I just had three more last night.

They feel like small crests of pleasure but nothing compared to what I was used to before surgery where there is a Big Bang and I’m done. I do come away from sex feeling happy and satisfied though instead of the disappointment and frustration of the last 9 months.

I was hoping for a lot more out of my first orgasm but at this point I’ll take anything I can get. Hopefully my revision surgery will make it a little easier to achieve and they continue to grow in amplitude.

1 year post surgery

I came back to San Francisco today for my 1 year post op for my vaginoplasty. There are a few things that have been annoying me so my surgeon and I decided together to do a minor revision surgery later this year. It should only take 3 weeks in town this time and 6 weeks of healing.

For the trans people reading along, the issues I’m fixing are:

  • The opening to my vagina is a little constricted by a flap of skin at the base that she is going to trim back so I can take bigger partners
  • My urethra has a little diversion that makes it hard to wipe thoroughly and often I leak a little when I stand up
  • My clit fell off during recovery but the underlying nerve bundle is still there under the skin but it moves around and makes it hard to get off. She’ll make a more distinct clitoral area and pin the nerve bundle in place so partners can pinpoint it easier.

Hopefully this goes well and helps me finally achieve orgasm. Fingers crossed!

Graduated from Pelvic Therapy

Today I “graduated” from pelvic floor physical therapy. Based on the referral of a fellow trans person, I was able to find a great place near my suburb where the provider seemed knowledgeable about trans neovaginas. She was great and helped me learn to differentiate between just activating the “quick” muscles and activating the deeper, longer holding muscles. For the past couple months I’ve been doing a lot of work to learn to activate them along with my core muscles more instinctively.

It was definitely weird at first because it involved “internal cueing” where she would hold a finger inside me to tell me if I was doing it right. There were also these fun adhesive sensors that go near your asshole that can tell you how strong you’re contracting. A very interesting experience overall but a useful one.

The original reason I went in was because I was having urinary leakage after peeing and I think we’ve determined that it was a physical problem. There is a little pocket by my urethra that tends to hold in a little urine after peeing and I basically needed to learn to wipe effectively since my labia are pretty large.

Anyway, that’s all probably TMI but hey, that’s what this blog is about!

9 Month Post-Op

This week marks 9 months from my bottom surgery and I just had a post-op check in with the surgeons office. Overall healing has gone well other than the very notable exception of my clit falling off. Dilation is easy now and I can go down to every other day if I want. I’ve gone though all the sizes they gave me and even ordered one bigger. I managed to get all the granulation tissue (bleeding spots) to heal up and there hasn’t been any discharge for several months.

I do still have some urinary leakage after peeing which is annoying so I’ve started going to a pelvic floor physical therapist and I’m doing kegel exercises at home. Having a physician put their finger in your vagina every week certainly takes some getting used to! I’m hoping it also helps with sex because I can get up to the edge of orgasm but I still can’t crest that peak which is eternally frustrating. The doctor says that’s still within the realm of normal but I’m at the average time that it usually takes so I’m getting more anxious about ever being able to fully enjoy sex.

Now that me and my partners are fully vaccinated I get to start dating again. I’ve been seeing someone new I met online during the pandemic and after 8 long months we finally get to touch each other this weekend. I’m definitely nervous about having sex with someone new when I haven’t even figured out my own new body parts yet but they’re trans too so I’m sure they’ll understand. I’m just glad that the waiting is over.

BMI Cutoffs are unscientific and harmful

As I’ve written about before, BMI (Body Mass Index) is an unscientific concept that is often used to deny trans people life-saving surgeries. It is treated by far too many surgeons as medical fact, despite the vast body of evidence that it is wildly inaccurate, scientifically useless, and never intended by the creator to be used on an individual basis.

Recently, the only surgeon in Washington State, Geoffrey Stiller, formerly one of the few surgeons who would accept fat patients, updated his policies quietly to exclude people over the arbitrary and oft-used cutoff of 35 BMI. That means that at least two people close to me are now being denied gender affirming surgery without so much as a notification about the change. So I wanted to take the opportunity to share some scientific research recently published on the topic.

  1. Recent research shows that there is no correlation between BMI and surgical complication rates in trans people in either vaginoplasty (bottom surgery) or mastectomy (top surgery)
  2. “Obesity” (aka normal body variation) is very common in trans people seeking surgery (26% at Mount Sinai) and did not change despite efforts to lose weight prior to surgery
  3. BMI is not an empirically based method of denying gender-affirming surgery

Trans people should not have to bear the burden of educating providers about our care but all too often we are put in that position anyway. So next time a surgeon tells you they won’t perform surgery because of “policies”, please feel free to use this research to push back on them. Even if you don’t win a single conversation, hopefully you will plant a seed and prompt them to actually read the scientific literature on the topic. I found these articles with only a cursory review of the topic and I’m not even a doctor.

Citations

  1. Ives GC, Fein LA, Finch L, Sluiter EC, Lane M, Kuzon WM, Salgado CJ. Evaluation of BMI as a Risk Factor for Complications following Gender-affirming Penile Inversion Vaginoplasty. Plast Reconstr Surg Glob Open. 2019 Mar 13;7(3):e2097. doi: 10.1097/GOX.0000000000002097. PMID: 31044103; PMCID: PMC6467628.
  2. Rothenberg KA, Gologorsky RC, Hojilla JC, Yokoo KM. Obesity is Not Associated with Complications or Revisions after Gender-Affirming Mastectomy in Transgender Patients. Plastic and Maxillofacial Surgery. 2019 Oct 1;229(4):sup1. doi: https://doi.org/10.1016/j.jamcollsurg.2019.08.494
  3. Martinson TG, Ramachandran S, Lindner R, Reisman T, Safer JD. HIGH BODY MASS INDEX IS A SIGNIFICANT BARRIER TO GENDER-CONFIRMATION SURGERY FOR TRANSGENDER AND GENDER-NONBINARY INDIVIDUALS. Endocr Pract. 2020 Jan;26(1):6-15. doi: 10.4158/EP-2019-0345. Epub 2019 Aug 28. PMID: 31461357.
  4. Lisa M. Brownstone, Jaclyn DeRieux, Devin A. Kelly, Lanie J. Sumlin, and Jennifer L. Gaudiani. Transgender Health. ahead of printhttp://doi.org/10.1089/trgh.2020.0068