And then it was done. The quiet joy of waking up with a vulva

My long awaited date with gender-affirming bottom surgery

Trigger warning: this post contains descriptions of surgery, bodily functions, and other gory things about what it is like to get a sex change operation.

My dear readers, thank you so much for following me on this journey.  It has been an incredible ride for me, some of which I have shared with you.  Life transforming, and your comments and sustenance have made a world of difference to me.

On March 19^th, at 7:30 am, the little boy who dreampt of being a girl ever since he was conscious that there was something different than boy called girl, had his dream fulfilled.

At noon the previous day I had taken something which was to empty me, but which did not do much other than give me a tummy ache.  My dearest beloved friend arrived and we went for a walk together, and I showed her where she could find a good cup of coffee, do some basic grocery shopping, and just helped her orient herself.

I took something to make me go to the bathroom right before going to bed.  And we were both tucked in by 9:00 pm.  At midnight, I shat myself.  Thankfully, I was wearing pyjamas, so nothing ended up in my bed.  It was gross.  Really gross.  All I can say is thank goodness I had been shifting to a mix of fasting and broth.  I showered, threw my pyjamas in the wash, and went back to bed totally naked, and spent the rest of the night in blissful sleep.

We were both up at 5, and I dressed in the very loose fitting clothing I would leave the hospital in, so as to carry as little as possible, and were there by 5:45.  We were sent to the wrong waiting room and waited for a bit until someone asked, and realised we were in the wrong place.  She said, “you don’t have to wait, you go straight to surgery,” and directed us to the lift.

I was met by a nurse who asked my friend to wait in the lobby while she took me in to prep me.  That meant taking all of my belongings, and getting me naked, taking my earrings, belly ring, dressing me in a beautiful lavender coloured paper gown, taking my vitals, and hooking me up to an IV.  The best part?  She attached a heater blower to a whole in my gown and it blew wonderful warming air all over me.  I get cold so easily, and the IV was cold fierce, so this was a relief.

The anaesthesiologist came in and asked me a hundred intimate and personal questions that were relevant to him, and every answer was ‘no’, including had I ever had anaesthesia before.  And then bid us farewell, “I’ll see you upstairs.”

A few minutes later my surgeon pulled back the modesty curtain and sang out “Happy V-Day.”  She talked with me and my friend, my dearest support person, promised to call her from the OR when all was done, and then said, I’m going to go upstairs and make sure we are ready for you, while my favourite nurse will bring you along shortly.  It was 7:15, exactly the time she had promised she would see me.

The nurse who had undressed me asked if she could escort my friend out, but my friend said she would find her own way out, got up and left.  As she walked away, the doctor’s favourite arrived, took over, and wheeled me to the elevator.   She was a wacky Chinese-American nurse wearing a colourful head scarf who spoke with an excited, jovial accent that left me understanding little.  The surgery floor was different.  It was much more brightly lit.  The walls were white, everything was stainless steel, and equipment oriented, and then we went into the operating theatre.

I can’t be sure of how many people there were in there, but it was between 6 and 8 people who were operating and assisting, three doctors, two of who were my surgeons and the anaesthetist plus a posse of helpers.

My doctor was like an orchestra conductor.  She patted the surgical table on which I had been pulled alongside, “crab walk over,” she said as scuttled from the gurney to the operating table.  The nurse was thanked and she wheeled away the gurney.  My surgeon stepped to my side, taking my hand as she directed the others, “it’s a bit like a formula one pit stop for surgery,” she joked tenderly.  I looked up at the two enormous disk lights like shimmering silver above me, felt her small, delicate hand in mine, sensed all the people around me attaching electrodes or monitors to my body.

“Are you ready?” she asked looking into my eyes, and I said “yes”, and the next thing I knew I was waking up in recovery.  My surgery lasted 5:30 minutes.  There were two surgeons involved, the second surgeon operated the robot which went in through my abdomen.

The parallels to giving birth and being a woman echo inside of me.  I did have a baby in that operating room, but the baby was me, a full-grown woman.  Only she has (I have) so much to learn about what it means to be a woman.

What they do down there

The operation I had is known as a Peritoneal Pull-Through Vaginoplasty.  This is relatively ‘new” though the procedure it is based on, the Davydov Procedure has been performed since the 1940’s for women born without vaginal canals.  It involves harvesting tissue from the abdominal cavity, a mucosal tissue which holds the organs, creating a sleeve out of it, and then folding it down and passing it through a new cut in the pelvic floor.  This becomes the neovagina.  They suture closed the harvest site.

There are a couple of distinct advantages of this approach compared to the tried and true and still leading method called the penile inversion, which essentially involves turning your bits inside out and using scrotal and penile shaft skin to create the vagina.  First advantage is that the peritoneum is mucosal epithelial tissue, so it looks and acts like the pink vaginal tissue that women are born with.  The second advantage is that it leaves the surgeon with the skin of the penile shaft and scrotum to fashion labia out of.  Third, is that there are no skin grafts, meaning that all tissue used is just moved about, repurposed, but never disconnected from its original blood supply.

While this method is growing in popularity, it is still not so widespread because of the sheer cost and the complexity of the operation.  In the West, that is why this operation always has two surgeons, as operating room time is the limiting factor, and the longer you are under anaesthesia, the longer the recovery time (rule of thumb is one week for every hour).  In Thailand, the two doctors capable of doing this method operate solo with assistants, so operating times are much longer.  Both produce excellent results.

To perform this operation, the doctor begins by marking you with a pen to show where the incisions will go.  The pattern follows a ‘W’ cut, with the outer branches going up along the inguinal canals, and the other shorter/inner cuts go across the scrotum to the base of the penis.  With this opening, the doctor is able to perform a bilateral orchiectomy, castration, the removal of the balls and the tying off of the inguinal canals.

A cut running from the centre point of the ‘W’ to the head of the penis and then around the crown then allows the surgeon to dissect the penis itself.  The erectile tissue is removed and discarded with great care taken around the nerve and blood vessel bundles that run through the core of the penis.  The head of the penis is made smaller and is fashioned into what becomes the tip of the clitoris, and the nerve bundle is tucked up into the mons pubis.  The skin of the shaft is used in part to construct the inner labia, the clitoral hood, and the graft suture area between the peritoneum, ie. entry to the new vaginal canal, and inner labia.  The scrotal skin is used to fashion the labia majora, and these are then stapled or sewn to the inner labia and underlying skin.  It’s hella complicated.  I’m still not sure I fully understand it despite having watched so many videos of it.

It is a miracle, and one which I am so grateful to have had.  I have waited so long.  It is the only operation I have ever had, only time I have ever been in a hospital other than to watch my mother die, or my father to recover from a head-on collision from a drink-driving incident in a Ford Pinto—he was the drunk one and still managed to blame the other driver for the fact that my father was driving on the wrong side of the road.  He’s just lucky that his car didn’t explode.  What is wild is that so often drunks don’t get as badly hurt as non-drunks in accidents because they don’t have control over their bodies.

Waking up

I woke up gently to the world.  The sweet voices of nurses who came and administered to me were like angels emerging from the fog.  They checked my vitals and then wheeled me to a lovely corner room with great views over the city.  The first day of Spring.  It was bathed in sunshine and absolutely beautiful.

My friend, my love came to me.  I recognise the sound of her decisive gait as she clicked down the hall to my room and swept in.  Flowers, gifts, and joy.

I have the scars on my belly that are not dissimilar to a c-section, only slightly higher.  And I will be bleeding from my vagina for at least a month.  Some trans sisters report bleeding for even longer.  I am glad for the blood, glad for its symbolic parallels.

I felt good.  No doubt this was down to the drugs, there was no pain, and down below, there was a feeling that I can only describe as ‘right’.  The weight and bulk of having male bits were gone and yet I had no sense of missing anything.  And in fact, much of this is true.

I get these occasional electric jolts from my clitoris, and I know that’s what it is, because it feels like what the increasingly sensitive tip of my boy-dick felt like, only it became too much for me as a guy and is already in that place as a transwoman.

I am taking a pain killer specifically designed to numb nerve pain, thank goodness, because these jolts are real.  The good news is that they tell me that my clitoris is alive and waking up.  My trans sisters say, however, that I will be into a month of feeling like my clitoris is having paper cuts.  Ouch.

My belly is the only part of me that hurts.  It is inflated from all the air that they pump in to do the abdominal surgery…so they can see better in there, and this has to be gradually re-absorbed into the body and farted or burped out.  Not very pretty.  And the same goes for my gut which is in a state of full-on rebellion from the inactivity (not being fed), being fed nasties designed to empty it completely, and then being put on antibiotics.  I am fast-tracking biotics as well, however, so the fight back begins.  I am told, however, that it takes a year to rebuild the gut micro-biome, so I am at a higher risk of getting sick now, so will be masking up more often.  Glad I brought some pastel pink masks.

I guess painkillers don’t address this kind of hyper-bloating pain.  My vulva feels fine.  Not numb, just not hurting, and not lacking in anything.  It just feels ‘right’.

I was amazed at how good I felt.

Being hungry and my “weird” cravings

I also became very hungry quite quickly.  What did I want to eat most?  Pineapple.  I asked for it, and they had it, and thus began my every meal switchover from hospital food to my choices, which were boiled eggs, pineapple, undressed salads, and steamed broccoli.  I did eat the manicotti with tomato sauce but squeezed out the cheese filling.  They were initially concerned with my selectivity and that I wasn’t eating their meals, but when they saw that I ordered in copious quantities of Pho broth, and drank it down alongside these other things, they were fine.

And my appetite surprised me as I had told myself I would just have broth after.  And I would have, but the broth that I ordered in or had from the hospital was too salty, and salty is not good for healing.

I just didn’t want to poo, didn’t want to risk constipation, which is a common side effect of the pain meds I was taking.  And sitting down to poo, to avoid those just-in-case situations, to avoid the fart that becomes a total release of things you weren’t expecting…I found myself apologizing constantly to the nurses for things that hadn’t happened, and they were so sweet and kind.  “Oh don’t worry about that, we’ll just clean you up.”

On the second day, my surgeon sent instructions to them that I was to get up and walk.  She is a known toughie.  But my blood pressure was very low, 85/50, and my heart rate was ranging from 36 to 55, also low.  So they wanted me to take it easy getting up.  It was tough.  Putting my bed upright too far put pressure where I didn’t want it, right into my vaginal canal, as the stuffing that was still inside me was very much present.  I could not sit comfortable, so balanced on one cheek, lowered my legs to the ground, breathed for a bit, let my light-headedness clear, and then stood, held onto the wall, breathed, contemplated walking, and then concluded it was not safe.  “Walk in place,” the nurse suggested.  And I did, and she said, “good job,” and then I returned to my bed and slept for three hours.  Before I dozed off I asked if we could try again later.

The second time around I managed to walk 30’.  Out of my room and into the hall, and then back again.  I again slept three hours.  Before conking out, I again asked if we could do it again, and at nighttime I was able to make two laps around the ward.  I was exhausted but elated and slept beautifully all night long.

Why so important?  Discharge was scheduled for the next day and they won’t let you go until you can prove you are steady enough on your feet to make three unassisted laps of the ward.  There was some discussion about when I was leaving, as the hospital makes more money the longer I stay, and also decrease their liability.  The doctor wanted me home and convalescing on the premise that I will heal faster there by not being interrupted and woken, poked, and prodded.  I wanted to please my surgeon.  Are you surprised?!

I asked her, “do we all fall in love with you?”  

“Oh, you’ll love me for a day, and then hate me for a year, and then you might just love me again,” she replied with a smile.

I feel to my bones a gratitude for her competence and expertise in this highly complex field, knowing that gender affirming surgery is specilised, but also that there are so few doctors who are really, really good at it, and how as a community we are so underserved, blocked out of healthcare, so when someone as talented as my surgeon makes this her lifes work, I am truly humbled.  I know that things don’t always work out, and that something as mundane as keeping ice packs on my vulva 24/7 for the next month is so critical that if I don’t do it the swelling might get out of hand and my stitches could pop, and then you have to wait a year for it to heal completely before you can even discuss a revision.  So I am following the instructions I am, given by pretty much whoever gives them, to the letter.

Discharge

Two days post-op and I was up early, asking the nurse if we could walk.  And when we did, I was able to make it around three times without any difficulty.

There were consequences to my impending discharge.

“Could you possibly help me to brush my teeth and shave?” I asked the nurse.

“You can do it,” she said.  “I’ll get your stuff, but let’s see you come over to the sink and do it by yourself.”

“Aww,” I mewled, “but I like being a baby.”

“But you’re a big girl now, you walked around the ward, I saw you, you can do this.”

Still, she and the others were really sweet helping us pack extra diapers, bed pads, gauze underwear (worn over the diaper to hold the ice packs in place), empty ice packs.  “We’re going to throw all of this out, so you might as well take it.”

They brought a hard plastic wheelchair to the room for me to sit on and I’m like: “I can’t sit on that.”

“We’ll put our stuff on it, and she can keep you from falling,” my friend said about the ‘transport person’ who would help us get into the car we had ordered.  We ordered an extra-large car and an extra helpful driver and were obliged by that and a day of brilliant sunshine and nourishing rays.  As it happened, I knelt on the floor of the car facing backwards and hugged the seat as this was the most comfortable, and we cruised on home.  The driver helped us bring everything in, and my friend held me while I walked up the stairs and then into the apartment and straight to bed.  And into bed I went and fell straight asleep.

I am well and filled with joy.  Thank you for reading.