Female Archetypes: The Sister.  Post-Op and the Road to Recovery.  Dilation

The Day my Sister Became My Sister

Trigger warning: this post describes some aspects of the trans-female anatomy and what is involved in getting and caring for a neo-vagina.  Blood.

My surgeon doesn’t like us staying long in hospital.  She pushes for discharge only after 2 nights of hospital stay.  That kind of freaked me out when I first learned, as I had assumed for the longest time that I would stay 5/6 nights, as seems to be the most common.

She does it for two reasons.  We get better rest at home.  We eat better at home.  At least theoretically.  But this is why they major on the importance of a support person, and why they take the time to speak to that person independently before that person has to face the enormity of care that it requires.  I don’t have a single support person, but a sequence of them, and I am sharing about their differences, as I did with the Den Mother.  They do all share a common thread, however, and this is the archetype of all care people, the Mother.

The second reason is that when they operate on you, they stuff you like a sausage with something called vaginal packing.  This is just gauze.  But it is really in there, so much that it creates a near constant sensation of needing to pee and needing to do #2.  If you stay in hospital, they will typically remove this on the day of discharge, and teach you to dilate, the subject of this post.  This seems to be one of the most challenging and fraught periods of the sex-reassignment-surgery process.

In trans circles the general narrative is that electrolysis is the worst part of transition.  For me, though awful, it was not.  That might have been due to the sick sense of humour of my electrolysist.  But the seriousness of dilation, its importance, makes it a potential rival.  In either case, the consequences of not doing it are severe.  If you don’t do electrolysis properly, you will end up with hair growth inside the vagina.  That can cause all kinds of complications, and believe me, if it sucked zapping those hairs one by one before, doing it in a gynaecologists’ chair with a speculum wedged inside you, is no walk in the park.  This applies to the vast majority of M2F sex change patients, who opt for the standard penile inversion.  In said operation, you essentially turn the penis inside out, so any hairs that might have been present on the shaft will end up inside you, and the use of scrotal tissue to create the entrance to the vagina and the first inch or so, will mean that any hairs still left there, will similarly be introduced to the neo-vagina.  In the case of peritoneal pull-through, the operation I had, there is no use of skin of any kind to create a canal—all my tissue that is on the inside of my body, is tissue that has always been on the inside of me body.  So all that pain I went through, has meant less in the telling, though was necessary anyway as I don’t want any hair in my labia…but I guess you can imagine that it is easy to deal with the stray hair that might be left as it will be easy to spot.

The second reason that my surgeon likes to discharge early is that she likes to leave the vaginal packing in longer.  Her thinking is that ‘I don’t want to disturb the wound site, the canal, the labia, and want to keep them safe and sealed for as long as possible.’  So instead of the five days or six days I might have had more typically, it was 8 days from surgery to my out-patient visit to have the packing removed, bandages removed, catheter removed, and to begin dilation.

They asked for my support person to be in the room.  Gulp.  When they told me this, I called her immediately and made sure she would be okay with it.  I have had a sister for most of my life.  But yesterday, I found out what it meant to have a sister for real.  I knew what was coming.  I had no idea whether my neo-vagina would look like the bride of Frankenstein, whether blood would come pouring out of me, whether I would cry, squeal, who knows.

As it happened, we walked into the room, there was a gynaecological chair, stirrups, a big pad across the seat, and this open bucket instead of a seat cushion to capture what might come out.

“Strip down to the bandages and have a seat,” the nurse’s assistant said indicating the chair, “I’ll be right in.  It was scary looking.  Institutional.  Plus, she was not being friendly.  Somewhat considering the translation of her name is “hope”.

I did, and sat like that, waiting.  My sister sat next to me, set behind, but at my side.  She gave my arm a squeeze and asked if I was all right, and I looked at her and started to cry, “I’m scared.”  The nurse came back in.  Little miss frosty pants.

I asked her a question.  I can’t remember what it was.  Doesn’t matter.  She cut me off, “we’re going to be doing a lot of listening today,” she informed me.  Gosh.  Didn’t get that question answered.  But the nurse came in, and her attitude suddenly changed.  The nurse was cool with my questions even when she didn’t answer them—“I’ll get to that in a minute.”  She was incredible thorough, patient, had great bedside manner.  I already had a massive crush on her, and now it was magnified a hundred-fold as she removed my bandages, cleaned me up, showed it to me for the first time, and taught me how to dilate, then taught me how to care for it over the coming weeks until my next appointment.

Do you know that magic trick where the clown just keeps pulling the scarf out of his/her hand and it just keeps coming and coming and you don’t know how.  Well, that’s what its like to have vaginal packing removed.  Only it felt really weird coming out, as it rubs against both urethra and rectum as it goes.  Hurt?  Not sure.  I had taken an oxycontin an hour before my appointment.  But it was one of those kinds of sensations from inside the body intead of on the surface, a kind of thrumming, thumping feeling as if the endless length of bloody gauze was being dragged taut across a drum, and perhaps it was: my pelvic floor, which of course now has a hole in it where my neo-vagina is.

After that, she trimmed some stitches—its amazing how they are all going to just be absorbed by my body and dissolve, though some take a really long time, and others not.  And then we talked about dilation.  First rule, “don’t dilate your urethra.”  I would have thought this is impossible, but given the swelling, apparently not.  The rest was about how to guide it in and get it in all the way, to breathe into it, how long to keep it inside, 30 minutes, etc.

I was a champion at finding the hole.  I guess I was born to be a girl after all.  We did it three times, and then she asked if I thought I could do it by myself at home.  I said ‘yes’.  She suggested that I might want to put a suitcase on my bed or something similar so that I could get my legs up high as she had them in the chair.  Definitely put a pad down for the blood, and she warned me that not just blood might come out.

As it happened, my bleeding levels have been very low.  I have yet to soak through a pad.  IO change them a lot.  I’m burning through them quite quickly, but most of the blood seems to be coming from the sutures rather than from the canal itself.

She taught me how to douche, taught me how to wash my vulva, how to wipe it, how to wipe my bum—yes, we need to go back to real basics.

And then it was time to remove my catheter.  I had never had a catheter before.  I am bemused by those who have a sexual fetish for these things.  I didn’t enjoy carrying a piss bag around for days on end.  Or trying to figure out how to put my underwear on and get the bag and tubing through correctly.  I often got it wrong.  The sensation of peeing, too, was often just burning without the relief.

Strangest of all?  When one of my caregivers would empty the bag, not only would it make the satisfying sound of release as it was poured in a stream into a beaker, but it would also create a vacuum through the bag and tubing to my actual bladder, pulling on it, and giving me the real sense of relief that comes with peeing.  

“I want you to cough for me,” the nurse said, “and not some dainy little cough like,” and she gave a dainty cough or two, “but a real cough, something like this,” and she gave a hearty cough.  “Can you do that,” she asked, and I was just going to show her and see if it was good enough, so gave a good cough, thinking I could do harder, but out she slipped the catheter just then in one of those fool-the-kids tricks that always seems to work on me.  I looked at the long, rubber thing that had been inside of me, a little bloody, and thought of what a cruel little device it is.

“Ouch,” I said.  

“Yeah,” she acknowledged.  My sister rubbed my arm.  “You want it out,” she said, “but in order for me to let you go home without a catheter, I need to make sure you can pee.  Worst case I will put a smaller one in, but you will still have the bag.  And then lord knows how, but with real practice and a syringe, she proceeded to squirt saline solution directly into my bladder through my urethra.  “I’m going to squirt 250 ml of saline into your bladder, and it might feel like you are going to burst, but don’t worry, you won’t, you can take much more, only this is coming in fast and directly, so you aren’t used to it.”  It was fine at first, but by the fourth bottle of it, I was seriously feeling like I was going to pop.

“Oh G.” I moaned.

“If you can pee it all back out again, all 250 ml, then I can let you go home without a catheter, but if not, I need to put one back in again.”

“Can I have some privacy,” I said.  Such a strange thing to think/say given what all three of the other women in the room had just been witness too, but a lady has to have her moments…

“Of course,” they said, and all marched out together.  I had peed it all out before the door had even closed, but thought it unseemly to call out and say ‘I did it’, so waited for 10 seconds.  They all traipsed back in.

“Good girl,” the nurse said.

“Yeah,” I said, “my first pee.”  This was the thing I was most afraid of.  That I wouldn’t be able to control it, neither whether nor when.  She demonstrated live how to wipe myself, demonstrated live how to spritz myself with hydrogen peroxide water spray, how to pat myself dry.

“That’s it.  Anything else?” she asked.

“I don’t think so.”

“Then you can get dressed.”  

“Thank you.”

“Hope” helped me get dressed.  Then we went home with a few new items on the checklist of essentials.

I closed myself in my room, turned on my dilation playlist, got everything arranged and dilated for the first time.

I suppose it was relatively easier as I had just had the packing removed, but I didn’t find it difficult.  Not that time, nor the next few times.  It is mildly uncomfortable at moments, like when it first goes in, and when you are finding how deep you can push it.  But overall, I found the experience intensely spiritual.  Beautiful even.

And this feeling has only increased.  I listen to the music I have been learning ballet to.  My headspace is very similar.  And the stretches I have done for dance are so similar, those which open the hips, that I find the echoes of the feminine that I wished to be as a little boy who dreamt of being a ballerina, of the adult mid-transition trans woman who signed up for ballet classes and loved the blend of workout, grace, and strength, and this post-op trans woman getting to know her neo vagina and her new body as all one thread.  It is beautifully symmetrical.

In my bedroom I have erected a shrine to the Divine Feminine.  In it I have placed some crystals which I believe evoke this, including my own signature stone, a clay model of a vulva, and various other knick-knacks and dewdads that speak to me of this.  I take mindful breaths before I begin.

I did try once to watch an iPad while I was doing it, as had been suggested on one chat thread.  But I lasted about 30 seconds.  I just wanted to be with my own dreams and thoughts, my own body, as I absorbed the sensation and felt myself surrender to this object inside of me, to this becoming woman, to my vagina, to my vulva, to my body.  And after, on the toilet, I realised that women are so much more of the earth and by the earth than I ever considered as a man.

And to think I have had a sister right under my nose for all these years and never really knew what it meant to have a sister.  And I’m glad it was her who was with me during the ordeal, seeing me at my most vulnerable.  No matter how much I love the other women who are caring for me, it is to the sister that one feels safe to turn.  And she was more than there.