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.

3 Weeks

Today is my 3 week mark from surgery and last night the itching started in strong. I know that means the scars are healing but the urge to scratch is very overwhelming and distracting. I checked with the surgeon’s office and sadly there’s nothing I’m allowed to put on them. So for now I just have to grit and bear it and hope it passes soon.

The past few days have had a lot more ups and downs than the second week. The area around my clit swelled up and I’ve had a lot more discharge and pain. I think it’s all within the realm of normal from what I can tell and it seems to be receding but it was scary to worry that something was going wrong.

I am so paranoid that things will turn septic and I’ll lose the area. I know that risk is rare (<2%) but it still scares me. I’m sure everything is fine but I have to keep reminding myself of my check up report from last week.

Only 3 more days until my “graduation day” and I get to travel back home! I can’t wait to be back in my own bed and fancy recliner chair. It will make the rest of recovery much more comfortable.

An old friend

When I look at my reflection in the mirror and see my groin where once there was a different set of genitals, I don’t feel like what I have now is new. It feels like the restoration of something that was always there, hiding underneath. Like the last 32 years were an anomaly and now things are how they were always supposed to be.

That’s why we call it gender confirmation or affirmation surgery, not “sex reassignment” or whatever BS that cis doctors came up with. I didn’t have anything reassigned. I had them rearranged back to how they should have developed in utero. The way that matched my brain and who I actually was.

Peeing now similarly feels very “right” and natural where it always felt so unnatural and weird the old way. Sure, it’s more convenient for peeing in the woods, but it never felt right and for a long long time I didn’t know why.

Things are finally how they are supposed to be and it’s hard to describe how much of a difference that makes for my brain.

3rd Post Op

Today I had my third post op appointment with the surgeon. They were amazed at how well I’m doing. The swelling was a lot less than they expected, I was really clean, and there was barely any wound separation. Apparently I’m doing everything right.

I also got my catheter out (again) and had to do the horrible pee test. They filled my bladder with saline and in order to leave without a catheter I was supposed to pee into a bucket to measure that I got it all out. Last time I couldn’t do it and I almost thought I couldn’t do it this time. It feels so awkward to just pee while sitting in an exam chair surrounded by stirrups.

This time, after trying for an awkwardly long time, I asked to try it on a toilet seat to see if it felt more natural. So they brought one in on one of those hospital carts and I was able to pee almost immediately! My hunch was correct that it was the setting, not the swelling or learning new muscles that was the problem.

It’s such a relief knowing I’m doing things right and I’m doing so well. And to finally be free from the catheters. This week is about continuing to clean and ice and start weaning off the gabapentin. I also need to walk more which means getting to know our cute San Francisco neighborhood better.

Week 3

Cleaning, dilating, douching and icing is pretty much a full time job. I’m trying to stay on top of the swelling and keep infection at bay. The pain is pretty easy to manage though my back pain has increased with all this laying in bed.

I spend all this time tending to my new vagina and holding up a mirror to it. And yet, it still doesn’t feel real. I think because I haven’t gotten most of the sensation back yet and can’t use it for what it’s meant for, it hasn’t fully connected to my brain. I can’t wait for late October when it will supposedly be healed enough to test out.

Week 2

The second week of recovery is so much better than the first! Last week I could barely walk and I was drugged up all the time. This week I am mostly off narcotics and able to walk around the apartment without too much pain.

Monday I went in for my first post op appointment where they took off the horrible bolster that was sewn to my groin. The massive stitches holding that down were by far the worst part of recovery and made walking very painful. I still have healing wounds from where it attached to my thighs.

The reason the bolster existed though was to apply pressure to the area and hold in the packing in my vagina. They took all that packing out as well as the large catheter and cleaned up the area.

Next was the pee challenge. They needed to make sure I could pee on my own before I went home. Unfortunately I didn’t pass the test. It may have been due to the swelling but I also wonder if it was the pressure of trying to figure out a new way of releasing muscles while sitting in a medical chair instead of a toilet. So instead they put in a smaller catheter with a cap instead of a bag to carry around. So now when I need to pee, I just remove the cap and let my bladder drain.

Now without the pressure on the area from the bolster, this week is all about keeping the swelling at bay. It is pretty much a full time job to constantly be switching out ice packs in between dilation three times a day. I also alternate Tylenol and Advil to reduce swelling and manage pain.

Speaking of dilation. They gave me this beautiful multicolored set of dilators. I start with the sherbet orange one and three times a day I put it in my vagina to maintain depth and width of the new skin grafts. I have to hold it there for 10-20 minutes so I do it while I watch tv.

The dots are to measure depth and the bend is to help get past my pelvic bone. Eventually I can start widening by working up in size. There is no goal width other than my own usage. It’s kinda like gauging up your ears and wearing the right size to maintain the width of the piercing.

For the first 3 months I have to dilate 3 times a day. Then I reduce to once a day until month 6, then 3-4 times a week. After 9 months I go to my long term maintenance schedule of 1-2 times a week for 10-30 minutes. I also follow a similar schedule for douching to clear out dead skin cells.

As you can probably tell, having a neovagina requires some work and the healing process is long. But for me it is totally worth it. It is so wonderful to finally be able to look at my new pussy and see past the swelling to what it will eventually look like. And it’s a beautiful thing.