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!

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.

How I knew I needed Surgery

Content Warning: I’m going to talk explicitly about sex in this post.

How did I know I needed surgery? It is a question I get a lot in different forms and it’s a good question, particularly for other trans people to ask each other.

My earliest inklings were from when I first learned what vulvas were. I was immensely curious as a child so I secretively turned to my local library and sex education websites to find out what women had that made them so amazing and supposedly so different. That’s when I found out the beauty that was the human vulva, vagina, and especially, the magical clitoris.

What was initially curiosity quickly turned into an obsession. And I doubt it was the same kind of obsession that my cisgender peers were starting to have as their libidos awakened. It crept into my psyche and my dreams. It wasn’t long before I was having both sleeping dreams and daydreams that involved strong, powerful women with both penises and vaginas. Because to me, the peak of human achievement would be having the best of both worlds. This was before I even knew that trans or intersex people existed.

It took me years of suppressed queerness before I finally admitted those dreams in group therapy as an early adult. And in the meantime I went through phases of hyper-masculinity as I tried to reconcile these desires to experience a vagina that kept pestering my brain. When I first had oral sex with a woman, the obsession only grew.

Eventually I finally got enough exposure to trans people that I realized I was one too. Not out of peer pressure like the media tries to paint it, but from seeing examples of people like me. I started out slowly and it took me awhile of my social transition before I decided to take any medical steps. You can see a lot of that progression if you read the early posts on my blog.

I had a lot of hesitation about starting estrogen because I was worried it would change how my already anxious/depressed brain worked. But once I started, I knew I could never go back. After the initial adjustment period, my brain had never felt more “right” and like I finally had the right operating system installed. But it did fundamentally change how I experienced sex.

I have always been hesitant and anxious about using my penis. But after starting hormones, there was some significant rewiring of my nervous system that took place and changed how I felt sensations. Suddenly an appendage that felt like a blunt tool now felt like a fine tip brush. It honestly felt like I imagine an inverted vagina would feel with a clitoris on the tip. My sensitivity increased immensely and I also lost all desire to use it for penetrative sex.

I had already started to think about surgery but my initial explorations had all been about whether or not it was possible to have a vagina and a penis simultaneously. I thought for sure that’s what I wanted because that’s what all my dreams still involved. I scoured the internet and couldn’t find anyone except naysayers who claimed it was anatomically impossible.

Finally, the first surgeons started to do what they called “penile preservation vaginoplasty” and my dreams were vindicated! Except ironically, by the time I discovered that, I was beginning to realize that it wasn’t what I wanted. I came to understand after almost 2 decades of dreaming that that form was more about what I was attracted to, not about what I wanted for myself.

Once I finally accepted that I wanted a vaginoplasty, the rest was just about getting through the medical gatekeeping. Last year when I went for my consult, I was sure that it was what I wanted. Now I am 120% sure and for months now I have been counting down the days (12) until I could finally achieve what I’ve secretly desired for so long.

I’ve been trying to decide for a couple years now if I am asexual or if I just have a low libido and as I think about life post surgery and all the sex I can have uninhibited, I think I finally have my answer. I just needed the right parts!

I’m in the home stretch now and I’ve started taking the pre-surgical meds. The Gabapentin is making my brain a bit hazy and I’m rather scatterbrained so hopefully this blog post makes sense. But in 6 days I pack up the car with my partner who will be my caregiver and her partner who lives with us and we drive down the coast to San Francisco.

12 more days!

Insurance approval

I know to most cisgender people this doesn’t sound significant but I just got word from my surgeon’s office today that I got insurance approval for gender confirmation surgery!

This is one of those things that should be a normal occurrence. But for trans people, we have had to fight so hard for generations to get these surgeries covered by insurance that it is still a big deal for us to have these basic rights. I remember not that long ago when my friends were going to Thailand because that’s the only way most people could afford to get surgery out of pocket. And because of that legacy, there are still so few surgeons in the US that even those of us in major cities like Seattle have to travel out of state and incur huge expenses to get these surgeries.

It’s also significant because of the amount of medical gatekeeping we have to endure to get there. I can’t think of a single procedure where a cis person has to get more than one letter of support. But most trans people require 3 letters from MDs, therapists, and PhD level psychiatrists to get this insurance approval.

For me, I got these letter last fall because I was told the surgeon was going to ask for insurance approval in late winter. But they waited too long to submit paperwork so I had to go get the letter updated because they needed to be within 6 months. Which meant that the first time around I got an insurance denial which was scary even though I knew why.

The point of this story is, if you have the authority to be a medical gatekeeper for a trans person, PLEASE make it as smooth as possible for them. There are a variety of reasons that trans people don’t want surgeries and shouldn’t need them to transition. But for those of us who do, we are usually overwhelmingly sure that this is what we want. So don’t make it harder for us than it needs to be. Trust us to be the experts on our own experiences. And if you get asked for a perfunctory piece of paper, just sign it.

41 days until surgery!

I’m down to less than 6 weeks before gender confirmation surgery and I’m so nervous! I’m not anxious about the surgery itself other than a natural concern about the rare complications. I’m nervous that something will happen between now and then to prevent me from getting the surgery. Because the idea of delaying it sounds like torture. When I did my consult a year ago, I was ready. And now I am wishing I had started the process sooner.

I’ve done literally everything I can do. I’ve bought medical supplies, collected comfortable clothing for the recovery, changed our original flight plans to a roadtrip, booked an accessible AirBnb, and even scheduled my pre-op bloodwork. But my brain can’t stop focusing on all the things that could go wrong.

What if there’s a new wave of COVID-19 cases now that we are re-opening businesses prematurely? What if I get sick right before surgery? What if I get down there and find out that the hair removal wasn’t sufficient because I missed 2 months due to COVID shutdowns? What if the doctor says that my weight is too much of a problem since I’ve put on 20 pounds in the last year?

The last one is the one I hate the most. I’m a very fat positive person and generally I don’t care about my weight. But last year I had a bad experience with Dr. Satterwhite when I consulted with him and he was hyper-focused on my high BMI. He claimed that if I gained any more weight it would be “unsafe” to do the procedure. Thankfully Dr. Wittenberg, the surgeon I ended up choosing, told me that they are more like guidelines for optimal results which I absolutely agree with, but my brain is still anxious about it. Fatphobia is one of the few remaining socially acceptable forms of overt discrimination.

In the end, there’s not much I can do about it. I know all the data about how fad diets don’t work and can cause more medical issues than they solve. And luckily the nutritionist/therapist I’m working with agrees and is helping me balance my food in a way that feels appropriate to me. But the voice of that fatphobic doctor still haunts me. I also wonder how many fat trans people he’s turned away and made believe that they can’t get surgery.

On a more positive note though, my job is being super supportive. They have hired new permanent and temporary staff to take on my workload while I’m gone with enough time to train them before I go. So now I know I can leave even in the midst of a busy period of running COVID research studies and know my work is in good hands.

Currently I am hoping to be able to return to at least part-time work after 6 weeks which is the minimum time my surgeon recommends. Since we are completely online now it should be more accessible. But there is a potential that I may need the full 12 weeks before I’m lucid and off pain meds.

For housing I was lucky enough to find a basement apartment owned by a gay couple to rent that not only is ground floor but has a kitchen and even AC! It was very expensive at $3,400 but it’s centrally located in San Francisco so I can easily make it from the hospital and to my follow up appointments without sitting in traffic. I’ll be staying for a full month since I need to arrive 5 days prior to surgery for my pre-op and stay for 3 weeks after for post-op check ins before I’m cleared to travel. I’m really hoping that I can handle the 800 mile drive home without too much pain since I don’t feel very safe about airports right now.

I’m in the final countdown period and I am so excited! Thank you to all my friends who donated over $2,500 to make this happen. And I couldn’t do this without the support of my wonderful spouse who will be my caretaker after surgery. I guess you could say it takes a village to make a vagina.

Bottom Surgery is still a Go!

I’ve been on edge ever since this pandemic started because I have been so worried that my bottom surgery this summer would be postponed. But today I got confirmation that I can re-start laser hair removal to prep the area this weekend. And based on what the surgeon’s office has said, I think I should still be able to get enough of it in by July 29th to head down to San Francisco for my August 3rd gender confirmation surgery.

I’ve changed my plans and instead of staying with a friend-of-a-friend, I will be staying in an Airbnb so that we can maintain social isolation. My spouse and I will also be driving down instead of flying because as asthmatics, airports are a pretty big risk. And I don’t know what the visitors policies will be like at the hospital during my 3 days there after surgery. But damn am I glad that it is still happening.

Lately all the little things have been bothering me because my body just can’t wait to get this finally resolved. I am grumpy about having to use my hands to pee. And I hate everything about my balls. But it is only 68 days away now! I am almost there.

Going Through the Motions

Being in transition for me feels like everything in my life is temporary. For the past 2 years I’ve been taking all these steps to try to feel like a normal human. This week is my two year anniversary of being on hormones and I’ve also had my braces for over 2 years now as I get my bite corrected. I’ve been getting hair removal all over my body and preparing for bottom surgery. I’m been doing all the necessary things to treat my gender dysphoria and address other medical problems that I’ve been putting off for when I had good health insurance. But all these things just feel like going through the motions in hope that on the other end I can rejoin the real world and live the life I actually want.

Many days I feel like a ghost, like an interloper from another plane of existence trying to navigate a world that isn’t built for me. I feel like I can interact with the real world but I’m not a part of it yet. Like I need to somehow “earn” my way into that life by doing all the right things. And in the meantime my life feels ethereal and temporary, like it could all be washed away by a really bad day.

And now with all of the Seattle area on lockdown for this COVID-19 pandemic, life feels even more temporary. It’s hard to make plans not knowing how long this will last. And scary to know that my surgery date could be effected.

It’s not that I’m afraid of dying; in fact that’s partly the root of the problem. I don’t feel any attachment to living because most days I feel like I never actually have. I’ve never fully lived the life I want as the person I want to be yet so I have no stake in protecting that. The only thing that keeps me going is the hope that after all this transition work, I can actually have that life. I don’t know if it will be better or feel more real, but it’s the only anchor I have to reality right now.

And now that I’ve lost a lot of my routines and physical interactions, even more of my life feels unmoored. I feel like I’m adrift in a world that is panicking and chaotic while I sit here at home mostly feeling numb. I keep saying that I’m ok but if I’m honest I’m not really. I’m spending most of my time dissociating by playing video games to fully immerse myself in a different reality. A reality where I have achievable goals and can actually go out and kill the bad guys and save the day. Don’t get me wrong, the video games are essential to my survival right now. But they are also part of this temporary feeling where the real world isn’t real to me.

I’m not sure when these pandemic measures will all end but I keep holding on to the hope that I will still be able to have surgery in August. And that surgery gives me some grounding in my body and in the real world. Because I do want to live. I just don’t know how to yet.

Barely surviving

I’m going to say some things that might sound scary but let me be absolutely clear that I have no plans to commit suicide or anything drastic like that.

 

I’m sick and tired of barely holding on to life. I’m exhausted from just surviving and it’s hard to see a path to a place where I’m thriving.

Now I know part of that is my seasonal depression talking. I’m on three meds now to try and control it but the best I have at the moment is “not as bad as it was.” I’ve tried messing with them but it’s a dangerous proposition when I’m in the midst of it. The last dosage change I tried put me at too high a risk for suicide for me to continue.

And part of that is the mental and physical exhaustion of being disabled. My back and neck always hurt and that background pain is draining. And then there are periods like the weekend I just had where a seemingly simple task like assembling and hanging a medicine cabinet puts me in 24 hours of acute pain. And it’s demoralizing to know that you can’t even do basic things anymore.

Another part of it is trying to exist in a world that wasn’t built for me. Our westernized society still doesn’t know how to be inclusive of trans folks even on the most basic level. Even queer community makes it hard to be recognized if you are outside the binary gender construct we all take for granted. And when you can fight for decades for the most basic human rights and have those stripped away in just one politician’s term, it’s pretty demoralizing.

But the biggest part of it is the dysphoria I have around how my body is gendered. I have been on hormones for 2 years now and it has helped a lot, but I still can’t look in the mirror most days and see myself looking back. I see a face that looks hopelessly masculine to me, and I hear a testosterone shaped voice come out of my body that can be fun to perform with but still feels like a form of drag to me.

I want so badly to be ok with the body I was given, but that’s not how dysphoria works. I can do all the body positivity building I want and all that helps with is my weight. There is still a misalignment of who I know I am, and the body that others see. I walk around daily in a shell that causes people to make assumptions about who I am. And even when those assumptions are right, it usually means they are focusing on the wrong things.

At this point I feel like I am just barely clinging on to hope that bottom surgery will alleviate enough of this feeling that I can relax even the tiniest bit. I don’t know for sure if it will, but I also don’t know if I could keep going if I don’t try. So for now, I survive.