gender affirmation surgery

3 Month “Graduation”

I had my final post op appointment in person today and got some confirmation and a little reassurance.

I was correct. The tip of my clitoris did in fact fall off. My freak out was totally warranted and it wasn’t normal.

The good-ish news is that my nerve bundle is still intact just under the skin and I should still be able to orgasm, though it may take another 6 months to regain enough feeling for that to happen. The lack of sensation at this point is completely normal. Eventually I’ll just have an erogenous zone there where a clit usually is, it will just be harder for people to find.

I am definitely disappointed. I feel simultaneously like I haven’t fully processed it and that I kinda did process it several weeks ago when it happened. But as long as I can eventually orgasm, this surgery will still have been worth it. The reduction in dysphoria and the euphoria I get from being able to pee properly are a significant improvement. I just wish I didn’t have to be the one with the weird complication.

Otherwise I’m healing well. They treated the granulation tissue spots with silver nitrate and sent me home with a cream that will clear them up so they stop bleeding. I’m making good progress with the dilators and hopefully it should be smooth sailing from here other than waiting to have orgasms. Crossing my fingers that those eventually work right.

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.

Week 11 Update

I’m in the final week of the 3 month healing period and it seems to be smooth sailing right now. The tightening seems to have ended and I may try going up to a new dilator size today. There hasn’t been any bleeding from the granulation tissue for a few weeks now but I’ll get those chemically burnt off (painlessly) next week at my final post-op appointment.

My only concern is that I still can’t feel any kind of definition on my clit which has me worried that either something happened to it during healing when that tissue fell away or that she just didn’t build a very useful one. Not much I can do about it now other than fret because that’s who I am.

Next week I can finally take baths, go in the hot tub, lift things, and have sex again. It has been hard to remember the last couple weeks not to lift things because I’m feeling better now. I also get to go down to dilating once a day instead of three times and return to full time work. I feel like I’m ready for work now but I still have to spend so much time dilating and I’ve been enjoying sleeping in.

The part I’m really not looking forward to is being on a plane during a pandemic… Wish me luck in not catching anything!

9 Week Update

This week has been pretty uneventful. The only thing going on with healing is that things have tightened up and lost their elasticity temporarily. Luckily I was warned that this would happen and make dilation more difficult and so far it isn’t as bad as they made it sound. Once this is over, I think I’m ready to move up to the next size dilator.

Other than that, healing is going well and it’s starting to feel more like a normal part of my body instead of something new and unfamiliar. 3 more weeks until I can start exploring it more!

How much does surgery cost?

It is going to depend a lot on your insurance plan and where you decide to get surgery but let me share a bit about what my expenses were.

  • 2 Pre-Surgical Consults in San Francisco with flights for 2 people and 5 nights in a hotel – $1,000
  • Comfortable ground floor lodging for 1 month in San Francisco for the pre-op appointment and 3 weeks of recovery on AirBnb – $3,300
  • Lodging and gas to drive to San Francisco from Seattle and back – $400
  • Takeout food during recovery (we splurged a bit on comfort food) – $1,200
  • Medical supplies and copays – $200
  • Flight back to San Francisco for a 3 month recheck – $200

Total = $6,500

I am very lucky that I didn’t have any large deductibles and copays since I met my out of pocket max both years. This was obviously a much more comfortable recovery than most people can afford and I am extremely grateful to my friends who donated almost $4,000 to help make this happen. I also didn’t have to bear all the expenses myself since my spouse paid for a lot of the food.

Did my clit just fall off?

Content warning: gross medical shit below

Healing from this surgery sure has been a wild ride! Last night I had the fun experience of having all that yellow tissue that had formed where my clit should be just fall off in my hands. There wasn’t any pain or blood but a fairly large piece of… stuff? just came away.

Naturally, being the anxious person I am, I freak out that my clit must have just shriveled up and fallen off. I legit thought that and it made it very hard to fall asleep. I messaged my surgeon though and this morning she got back to me and said that it is normal (!) and this is just the exudate falling away.

I still am not entirely convinced since that whole area is still numb and swollen and I can’t tell where my clit actually is. I also have quite a few areas of granulation tissue that keep bleeding that I need to get treated. So I just decided to switch my 3 month post-op back to an in-person clinic visit instead of a virtual follow up. That means spending an extra $200 to fly to San Francisco again and risk COVID exposure on the plane. But I need that peace of mind to have someone look at it and tell me that everything is fine.

Week 7

The mantra I have to keep chanting to myself is “Healing is not linear.”

Content warning: Gross medical shit below

It’s been 6 and a half weeks since surgery and while the exterior of my labia look great, the interior is still a mess. My clit is still obscured by yellow tissue that is apparently called exudate and while it is apparently normal for this stage, it looks disgusting. I have a lot of the brownish proteinaceous discharge which means I’m going through a lot of pads. And I have some granulation tissue on my inner labia that bleeds easily.

On the upside, dilation is going easier now that I’ve gotten used to the new size. I’ll give it a couple more weeks and then upgrade again. I also talked to my primary care doctor yesterday and she assures me that this is great healing for this stage. I am so grateful to have a doc who is one of the most knowledgeable people about neovaginas in the city.

My mood has been pretty down still and while it’s not as bad as the day I think I had my period, I’ve had a hard time finding ways to get through the day. The mood lighting from the smoke in the air definitely doesn’t help and it is triggering my Seasonal Affective Disorder early. To help, I got back on OKCupid and I’ve been chatting with a lovely trans woman. I know I can’t meet anyone new right now but it feels good to start planning for the future.

I also started back at work half time which is where I’ll stay for the rest of my 12 week healing period. It is exhausting to even do 4 hours a day of computer work but it is nice to feel useful and talk to my coworkers again.

Anyway, that’s where I’m at right now. Healing is not linear.

Post Surgery Blues

I really didn’t expect week 5 to be the hardest week. I guess I expected that by now I’d be in the clear mostly but healing isn’t linear.

When I graduated from the surgeon’s care, she warned me about a phenomenon called the “post surgery blues” that usually hits around the 2 month mark. It is caused by all your body energy going into healing and depleting the brain’s reserves. So eventually you hit a wall and your brain is starved for happy chemicals.

I’m not sure if that’s what’s happening early but it sure feels like it this week. It could be just my period hitting but today I’m constantly on the verge of tears and anxious about everything. Yesterday I was tired all day and I woke up at 4 am and couldn’t fall back asleep for over an hour this morning. My brain kept fixing on all the things that could go wrong.

What if I’m dilating my urethra accidentally? I have had a dribbly stream when I pee lately. What if my blood clot has actually moved and I’m tired from it being in my lungs? What if I caught COVID in the ER lobby?

Then this morning I cleaned my new bits and discovered that my clit is yellow and swollen and doesn’t look right. So I messaged my doctor and anxiously waited for that response. Turns out it’s very normal for this phase; enough so that she has slides on it for her presentations. That doesn’t mean I’m not freaking out though.

Everything hurts this week and it sucks. I’m sure it will get better but for now all I want to do is complain and cry. That’s the full answer to how I’m doing this week.

Blood clot warnings

When I started estrogen 2 and a half years ago I got the standard lecture about how hormone use (including birth control pills) can make you higher risk for a serious thing called “deep vein thrombosis.” Basically blood clots in your legs that can cause pain and swelling and potentially move to your lungs and cause serious damage or even death. I listened to the symptoms and for awhile, I was pretty conscious about any of the signs. Every time I have a hormone check I get asked if I’ve had any leg pain but it’s become so normal I barely think about it anymore.

Fast forward to surgery and I get those warnings again. Having a surgery and the resulting inactivity puts you at higher risk of clots which is why they have you stop hormones ahead of time (causing hot flashes) and only restart after you are walking again. I once again thought I took in the symptoms and was aware. I tried very hard to walk every day to avoid it.

Then comes time to drive home. Long travel and inactivity is another risk factor so we made sure to stop often and walk around. We made it home a week ago now and I thought I was past the worst risks. And I let my guard down.

Monday morning I woke up with my calf hurting. I didn’t think much of it and honestly thought I had over extended it in my sleep. But it was bad enough pain that I was limping. Well the pain didn’t go away. It got better at points but every morning it was hurting again. Still I didn’t connect the dots.

Finally today I posted complaining about my shitty week and a couple friends pointed out that it could be serious. So I reluctantly went to the ER. It was very crowded and took me nearly 2 hours to be seen and almost as long to get an ultrasound. But they confirmed what I was increasingly getting anxious about. I had a couple blood clots in my calf.

I’m now on blood thinners to get rid of the clots and I’ll likely be ok without any permanent damage. But it could have been so much worse.

So please, heed my warning and get leg “cramps” checked out, even if they don’t swell. Especially if you have any risk factors.

Graduation

Last Thursday I had my “Graduation Day” from the surgeon’s care. Or “Vag Grad” as I call it. The final in person appointment with Dr. Wittenberg went really well and I seem to be healing great. Her staff were all so wonderful and excited for me.

Immediately after the appointment we hit the road and 13 hours later over two days of my partner driving, we made it home. I am so thankful to be back in my own space and much more comfortable in my own bed and recliner. Today I even managed to cook a family dinner for my house.

As nice as San Francisco is, I really wish that Seattle had trans surgeons here. It added a LOT of expense and really decreased my comfort to have to go that far away for surgery. I live in a major city with one of the biggest trans communities and it’s still baffling to me that we don’t have anyone in Western Washington.

So if you know any surgeons in training, please tell them that Seattle has a huge demand for bottom surgeons. The trans folks here could save hundreds of thousands of dollars every year that we could invest back in our community instead of trading funds back and forth for out of state surgeries. Trans people deserve health equity and access locally.