summary & pictures
first, this write-up owes considerably to my primary caretaker, who has been with me day and night through the recovery process. I would not be able to be half as thorough if not for her incredibly detailed notes while I was incapacitated in the hospital and I would not be half as well & healthy if not for her patient & attentive care. I cannot adequately express my eternal gratitude to her.
second, I am including pictures of my reconstructed genitalia here and I’m not posting from an alt. if you’re not trans or, especially, if you know that you’re going to find these pictures arousing, I ask that you just not click these links. your curiosity about the procedure and process are better satisfied by this info document published by OHSU, which includes images that explain the process of reconstruction and depictions of what the resulting anatomy looks like. these graphical recovery pictures are included because there’s no comprehensive experience report from a trans person who has underwent this procedure by these surgeons online. pictures of the recovery process are critical for these experience reports but many of the trans women who post them, especially on reddit, report that posting these pictures leads to solicitation and sexual harassment in their inbox. I’m posting this here on hexbear mainly because I’m loathe to post this on reddit - fuck that place.
one month ago, I had Laparoscopic Peritoneal Vaginoplasty (LPV), sometimes called Peritoneal Pull-Through Vaginoplasty (PPT) in the trans community, with Dr. Geolani Dy and Dr. Blair Peters on 2021-12-08. Dr. Dy operated the robot that dissected my abdominal wall, pulling a flap of peritoneal skin down and shaping it into most of my vaginal canal, anchoring it to the shortened penile-scrotile skin tube that’s typical of the older Penile-Inversion Vaginoplasty (PIV) approach. Dr. Peters reconstructed my external genitalia, forming a vulva with labia major and minora out of scrotal and penile skin respectively, shaping the glans of my former penis into a clitoris, and forming a clit hood out of my foreskin. despite being only a month into the healing process, I am very happy with the aesthetics of my new vagina, so far, despite the still-prevalent swelling that makes it a bit hard to see what things will look like after they heal – you really only get a sense of this after staring at hundreds of surgical timelines. I’m considerably less happy with my care during the recovery. most of the problems I’ve had can be attributed to covid, the holidays, and staff shortages, but a couple are just poor care. especially trying, has been pain management – it’s left a lot to be desired, especially following such a major surgery. once out of the hospital, it became incredibly hard to actually get ahold of my doctors and, at times, I’ve felt abandoned.
with a bit more distance from the difficult and painful bits - especially as I, more and more, get to just experience my body, rectified of a problem that has been causing me incredible pain from birth – I’m able to say with certainty that I’m glad I underwent the procedure with the team at OHSU. I hope they’ll take my feedback in the spirit it’s intended - to reduce the suffering of future patients.
results
these photos are graphic, extremely NSFW - they include oozing, open wounds on top of the fact that they are obviously of my reconstructed genitalia.
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immediately post-op, just prior to bandaging by the surgeons
I’ll edit these in when the surgeon’s office sends them to me. they apparently can’t find any of my surgical photos.
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1 week post-op: 1
I’m unbelievably swollen in this picture so I can’t actually pull my labia majora open to show the internal structure yet – pain, lack of tissue flexibility, and lack of space all stop me from doing that.
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3 week post-op: 1
just including one picture from above here to show what the top structure of my labia minora and clitoral hood look like in 3D. that gets lost in the later pictures from head on. honestly, one of the best things for my dysphoria since the bandages came off has been to just touch the place where they all come together. that feels almost surreal.
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the internal structure is well-visible here. first, there’s a lot of wound separation. I have more than is typical but it should all heal without issue. second, the pink mass in the middle is the urethral plate, not my clitoris. urethral tissue was used to line the inside of my labia minora and the entrance to my vaginal canal as I lacked adequate material to line it all with the inner lining of the penis. my clitoris is above the urethral plate, hidden by the clitoral hood and by a bunch of mucous-y discharge (the sticky, white stuff). I wish I had more prominent labia minora but that’s really my only aesthetic complaint at the moment.
surgery timeline
I began seeking surgery after changing my health insurance in summer 2020. I cleared insurance hurdles and received their approval to choose a surgeon in 1/2021. this didn’t come easily, though. they first tried to force me to get an orchiectomy prior to seeking a vaginoplasty for a while but suddenly dropped this. I later found out that the only reason they’d dropped this was another trans woman who was seeking surgery at the same time – she fought them tooth and nail to force them to do what they had to do and approve her surgery. I was the silent beneficiary but it meant that they artificially delayed her authorization after agreeing to give it until after my own, such that she was lucky to have the surgery scheduled for just one month after my own (yesterday, in fact) – this despite the fact that she’d started seeking surgery months before me. we learned of each other online as we both selected the same surgeon and posted about it on /r/TransgenderSurgeries and quickly learned of Kaiser Permanente’s attempt to force us both to have a surgical procedure that was medically contraindicted – I barely had enough material for the vaginoplasty as is and an orchiectomy would have led to my scrotal skin atrophying during the wait for the vaginoplasty.
KP in my region does not have any staff surgeons who can perform vaginoplasty yet so they provided me a list of 3 surgeons that they treated as in-network. one was only known for performing trans masc surgeries, one was a relatively unknown plastic surgeon with no documented results in trans circles, and the last was OHSU where Dr. Daniel Dugi and Dr. Geolani Dy performed vaginoplasties. Dr. Dugi had a long trackrecord which had started spotty but looked solid in recent years while Dr. Dy was a newly graduated resident of NYU’s residency program where she’d helped perform a new vaginoplasty procedure developed there – laparoscopic peritoneal vaginoplasty. the new procedure was a modified version of one developed for cis women, born without a vagina, and is widely sought after at the moment because it results in a vaginal interior that’s indistinguishable from a cis vaginal canal – the internal (peritoneal) skin undergoes conversion in it’s new environment and develops into cis-typical vaginal mucosa. moreover, the surgeon who trained Dr. Dy (Dr. Rachel Bluebond-Lagner) is widely respected in the trans femme community – wait times to see her at NYU for a surgical consult are currently two years minimum. so despite not having a ton of results from Dr. Dy that I could look at directly, I selected her for my surgery and saw her for a consult at the end of 5/2021.
between Dr. Dy, her Physician’s Assistant (Dorian Scull), and one of her residents, they filled in a lot of the gaps in my knowledge about the procedure. there’s a lot of incorrect stuff floating around in trans circles that I had to sort through and interrogate with their help before I felt comfortable scheduling my procedure. I had begun hair removal in 12/2020 and, by the time of my consult, Dr. Dy was confident that I had cleared the 80% hair removal threshold and so I was able to schedule surgery immediately. they intially gave me a date of 2021-09-30 but called me in August to reschedule that because of an administrative error, securing the date for the OR. my new date was 2021-10-13 and this time they also scheduled all my other pre and post-op appointments. however, this was not to be, either. covid spiked in Portland through August and September and my procedure was cancelled by mid-September. I didn’t hear back from OHSU until mid-October when they rescheduled my procedure for 2021-12-08. I cannot underscore how much these schedule disruptions affected me. not only was my entire life on hold around this event but it also made clear to me just how much I needed this procedure done ASAP – the delays signficantly impacted my mental health.
the rest
what follows is a detailed breakdown of the whole recovery process that will hopefully help other trans femmes who undergo this or a similar procedure; and especially those considering the same surgical team at OHSU. I’ll include these as top-level replies to this post to avoid character limits.
supplies
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surgical/post-partum mesh underwear (disposable)
you’re gonna be bleeding through gauze pads so don’t ruin perfectly good underwear with blood, pus, discharge, etc… make sure to get these 1-2 sizes larger than you normally wear because you’re gonna be unbelievably swollen for a bit.
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oversized undewear
once you’re no longer bleeding through undies, it doesn’t make sense to keep wearing disposable panties but your regular panties are invariably going to be way too tight and painful. make sure you have a pack of oversized undies for use until swelling goes down.
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lube
you’re gonna need a lot of this while dilating. after some research, it seems that lube like Good Clean Almost Naked (green tubes, you can sometimes find them in pharmacies or definitely online) does a better job of maintaining vaginal flora. that’s important if you don’t want to be douching for life and you’re gonna be putting a lot of this stuff inside your body for the first few months. you will also need surgical (bacteriostatic) lube for the first week or so, while you might have open wounds internally.
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post-partum cooling pads
these are disposable ice packs that go in your underwear, made for women who have just given birth. they do in fact need to be disposable because you’re gonna bleed all over them. these are expensive so they’re mostly only feasible for the first week or so post-surgery, when the swelling is at it’s worst. get a reusable ice bag and fill it with ice to help with the swelling on the pubic mound.
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wet wipes
dear god did I go through wet wipes quickly. cleaning yourself each time you use the bathroom is an exhausting experience and you really don’t want to miss anything. you’re also gonna be cleaning up a lot of blood, pus, mucus, and discharge so toilet paper ends up being too drying. wipes with witch hazel on them are especially nice because they keep everything feeling calm down there, even when there are semi-open wounds due to stitches dissolving before wounds have entirely closed.
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gauze rolls
super important. these are way cheaper than menstrual pads when you buy them bulk and if you make a liner out of them by carefully layering the roll, you can expose a surface of clean gauze by rotating the bloody gauze to the back of the liner.
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4x4 gauze pads
these need to be the kerlix type cotton weave that have a habit of sticking to things. cut one in half and stick it in between your vulva lips as a wound dressing and change it every time you pee, shower, or dilate. this way, you’ll catch a lot of the discharge on the bit of gauze inside your vagina and get way more mileage out of your underwear liners (whether you’re using gauze rolls or a menstrual pad). you can also cut these from a gauze roll if you get the appropriate type - this might be cheaper overall. the surgeon will instruct you explicitly to do this if you get wound separation or tissue necrosis but it’s cut down so much on the speed with which I’m going through underwear liners that I think it’s worth mentioning even in lieu of medical indication.
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vaginal health probiotic
get a solid one to take after surgery. it’ll be a while before your vag can support the normal flora that are supposed to be there (lactobacillus, mainly) that keep the canal slightly acidic and prevent all kinds of infections.
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chux pads
especially important during dilation and also while you’re still figuring out how to keep from getting discharge through your underwear. I manage to get a half-week out of each pad before it’s consumed too much bloody lube to reuse so you’ll need a bunch of these.
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hibiclens
the surgeon’s info packet lists this as an item to bring but the anesthesiologist gave me wipes to use at home the night before the surgery and then more wipes when I got to the hospital to do it all over again. so check with the surgeon’s office to see if you actually need this.
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donut pillow
hasn’t been particularly useful for me but everyone says it’s super helpful for sitting. maybe mine just sucks (the actual hole is smaller than the part of the body that’s all swollen and painful) but it’s been easier for me to stick a shirt/jacket under my tailbone or to sit cross-legged when there’s enough space.
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peri-peri bottle
fill with saline and spray down the surgery bits like you would for a piercing, in theory. in practice I haven’t actually used it much because it’s not healing like a piercing. even when there’s bleeding, it’s through stitches or from under healing skin, and being diligent about wiping everything clean with wipes and keeping up with careful maintenance of the dressings has been easier for me to coordinate, especially because the swelling makes it hard to actually open the lips and spray. I only have two hands! I’m also in the habit of hopping in the shower after bowel movements so it hasn’t been helpful there either, but if you’re not this may be useful for you as a hand operated bidet.