bottom surgery

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

Quirky Vagina

Good news! I went to see the urologist today about what I was worried could be a urethralvaginal fistula and she was able to determine that there’s nothing wrong, I just have a harmless little cul-de-sac that splits horizontally from my vagina towards my clitoral area. Turns out my vagina is quirky in more than one way. I’m so relieved!

The only thing she recommended was that I go see pelvic floor physical therapist to help improve some of the minor incontinence issues I’ve been having. That should certainly be interesting!

Yet another post-surgical complication

Content warning: medical shit below

I’m so tired of having to worry about my new vagina and whether something is wrong. I really wish I had just been born with the right hardware in the first place so I didn’t have to think about it all the time and I had something I could rely on to work properly.

Yesterday I went to the doctor because I was worried that I had a vaginal tear. And while it turns out it probably isn’t a tear per se, it could potentially be a fistula to my bladder. I have to go to a urogynecology specialist to confirm. It’s also possible that it is just a harmless little pocket in my vagina that just healed weird but either way, it is likely something that will need yet another surgery to fix.

I also keep having bleeding from this granulation tissue right next to my vaginal opening that I am going to have to treat with silver nitrate for a few weeks until it clears up. But unfortunately, the treatment makes it bleed more, a lot more, in the short term while it heals. It is really scary to go to the bathroom and see blood literally dripping from your vulva after you pee. Luckily I have a whole set of homemade flannel pads that my partner made for me so I don’t have to use up a million disposables during this process.

I still haven’t been able to orgasm yet, though worrying about hurting your parts and whether you’re going to start bleeding isn’t exactly conducive to relaxing into it either. And the combined effect of all of this is incredibly frustrating. I just want things to work right! Is that too much to ask for?

Anyway, thanks for listening to me vent.

5 Month Post-Surgery Update

It’s hard to believe it’s already been 5 months since bottom surgery. Though then again, it is very easy to believe it has been over 5 months since I’ve orgasmed because I can definitely feel that frustration.

I had my “6 month checkup” a little early yesterday. The doctor is impressed at where I’m at and reassures me that it is totally normal to not have orgasms until 9 months (which feels like forever!). I’m now at the biggest size dilator they gave me after surgery and I’m planning on buying an even bigger one soon to open up more options for toys and partners.

The one concern is that I’m still having some bleeding sometimes when I turn up my toys too high near my clit area. She had me send her a photo and confirmed that it is from some leftover granulation tissue that is persisting. I talked to my PCP about it and she is prescribing me some silver nitrate to apply to the area to heal it over. I also have a steroid cream to apply to aid healing. It’s a relief to know it’s not because of trauma I’ve done to the area but just tissue that bleeds easily and is treatable.

Other than that, I just need to keep practicing and hope that the orgasms come soon. I have 2 more checkups at 9 months and again at 1 year (hopefully in person). By that point I should be fully healed and just need to keep up on dilation once to twice a week.

Trying to have patience

I’m still trying to have patience and I’m beyond frustrated with the pace of nerve healing and sensation. But there are a few areas I’ve made progress.

Last night I tried out vibrator number 5, a simple slimmer model I bought specifically for this stage of healing, and it seems to be a hit. No orgasm but I felt closer than I’ve been and I learned that being able to move it in and out easily is important for me which is easier with this style.

The missing part of the picture is definitely the clit area. It feels like there is a void where there should be a something important. But last week when we tried to wake it up with the Hitachi magic wand, we overdid it and made it bleed so I have to let it rest for now. It is has been bleeding on and off so I don’t dare try the other new toy I got, a clitoral suction vibrator. Hopefully soon the nerves there will wake up. I am terrified that they were damaged when my clit fell off and that they are dead cells. But again, all I can do is wait and keep trying.

But the other exciting thing I did last night was upgrade finally to the largest size dilator that I was given. It’s exciting to finally be there and once I get used to it, it opens up a lot more toy possibilities as well as the option of PIV sex after this pandemic is over. There is apparently an even bigger size I can special order if I want but most people stop after getting to this level.

Trying to orgasm

Content Warning: Talking about sex

I got my new rabbit vibrator in the mail today so I decided to try again to see if I can orgasm or at least feel pleasure. The last time I tried having sex with my partner 2 weeks ago I could barely feel anything.

I was disappointed to find that even though I got a toy that was smaller than my old favorite, I still couldn’t insert it all the way. But I was able to get it far enough in that I could feel the vibration internally and externally. I played with myself for quite a while but sadly I couldn’t reach orgasm. The good news is that I can definitely feel it now and it feels great internally, though not much sensation in my clitoral erogenous zone yet.

I’ll keep trying because the vibration is supposed to help the nerves wake up but I think I need to go up another size on the dilator if I want to use penetrative toys made for more elastic vaginas. I’m definitely disappointed but less so than last time I tried so I’m trying to recognize the progress. Hopefully it doesn’t actually take me the full 9 months to orgasm because I’m already pretty frustrated after 4 months without that release.

Week 12 Update

I’ve reached the end of my intensive healing period! The 12 weeks of no baths, hot tubs, or lifting is over and I can now go down to only dilating once a day. That also means I’m back at work full time now.

Unfortunately the healing is by no means over. I tried having sex and I could barely feel my partner’s fingers at all. The nerves haven’t woken up yet so I have no sensation and it is going to be a lot longer before I can find out how/if orgasms work now.

I have my final post-op appointment in San Francisco tomorrow where I’ll ask about the nerve healing and find out if that is normal. I also still need help figuring out if my clit is just hidden or if something happened to it during healing. The doctor can seal off my granulation tissue at that appointment to keep them from bleeding frequently which will be great.

I’m very nervous about flying during COVID but hopefully the plane will stick with their 2/3 full protocols. I’ve also read some heartening reports about how masks are really working and cutting down on transmission even when there are confirmed cases on board.

I’m glad I can start returning to normal life a bit more but I’m frustrated sexually and hoping that the nerves wake up soon. My biggest fear about getting this surgery has always been that I would be in the tiny fraction of people who have complications that prevent orgasm. My doctor has tried reassuring me but she really can’t do much until she sees me which makes this flight worth the risk. Fingers crossed that I get some answers that calm my anxiety.