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.
post-hospital recovery
- Buy lots of gauze rolls for leakage. they’re cheaper than menstual pads and you’re going to need to change them every single time you pee. even if you don’t have a UTI, you’re going to be peeing a lot because of inflammation in the surrounding tissue reducing the size of your bladder. I was peeing basically every time I drank anything for 3+ weeks.
- they only gave 5 days worth of oxycodone but the prescription bottle says “for 2 weeks”. this was wholly inadequate. they’ll refill this prescription on request but it’s actually really hard right now to get a hold of either Dorian or any of the other doctors - the admin staff are really dropping the ball, presumably due to understaffing and the patient load really ramping up.
- bring lots of wet wipes! you’ll need to thoroughly clean your new vulva and all the surrounding tissue each time you pee (which, again, is really fucking often). I went through 4 full packages of wet wipes in 2.5 weeks, mostly at the start when everything was really numb and I wasn’t sure where all the urine was going. as I’ve started to be able to feel everything down there, I’m using wipes much more slowly. toilet paper is too drying to use effectively while you’re still bleeeding / wounds are still closing.
- bring loose disposable underwear (look for surgical incontinence underwear). you’re gonna bleed through pads during the first week out of the hospital because of how much blood and discharge you make, especially overnight when you’re not getting up to pee and change the pad. you can cut down on this a lot by sticking some gauze inside your vulva and over your canal and changing that every time you pee – they had me do this for wound separation but it’s incredibly effective at avoiding bleeding on everything.
- they told me they were sending me home with a prescription for the new antibiotic for the UTI but the pharmacy had no clue what I was talking about. it took me 24 hours and multiple phone calls/messages to get ahold of Dorian in order to get this resolved - staff kept telling me they’d let him know and he’d call me back but it just didn’t happen. meanwhile, my UTI flared back up. I eventually got through to him by being a complete fucking bitch to their staff, at which point they had me hold and put me through with his assistant. he called me back about twenty minutes after that.
- coming out of the hospital, they cut the pain meds from 15mg of oxycodone every 4 hours + Dilaudid as needed (on top of tylenol + an NSAID) to 5mg of oxycodone every 6 hours “as needed” – about 1/3 the opioids in 50% more time, literally 5 days post-op. they also reduced tylenol from 1000mg every 6 hours to 750mg every 6 hours and replaced the IV NSAID (torridol [sp?]) with 600mg of ibuprofen taken every 8 hours! this was wildly inadequate for those first 5 days out of the hospital and I ended up switching to an equivalent dose of naproxen (aleeve, stays in your system longer so taking it every 8 hours doesn’t leave you in pain for several hours a day) and bumped tylenol back up to 1000mg. when I complained, they added a muscle relaxant to help with spasms which really reduced discomfort/pain during dilation but did very little for the pain caused by swelling/my skin feeling like it was going to burst or the pain along the stitches – the most common source for me overall. this pain medication regimen still did not work for me and I wound have been significantly more comfortable if they’d given me 10mg of oxycodone every 6 hours for those first 5 days. after that point, the swelling came down and the 5mg of oxycodone became genuinely sufficient.
- however, the oxy prescription promptly ran out after those first 5 days. between the trouble getting the antibiotics prescription and a literal week of trying to fight with the hospital over pain meds, I was just exhausted at this point. I just started taking way too much aleeve and tylenol to manage my pain until I saw Dorian, the Physician’s Assistant, in person for my first follow-up 4 days later. I ended up 50% over the maximum dose of tylenol and aleeve which risked liver, kidney, and stomach damage, but I got myself to just barely comfortable. this was what finally got through to Dorian at the first follow-up and he finally just asked me what I needed to manage the pain and told me he’d just prescribe that. I asked for a full week’s worth of oxy and he agreed. he called me 30 minutes later to walk this back by adding gabapentin instead, and reducing it to 5 days worth of oxy.
- gabapentin worked really well for incision pain in the hospital but they didn’t send me home with any. they ended up giving it to me a week and a half later at the first post-op appointment as a way to reduce the pain med prescription they were giving me from 1 full week’s worth of meds to 5 days worth.
- I have wound separation along the incision lines on the bottom of the labia majora after 2 weeks. this complication is extremely common, occurring in 50-80% of cases. the stitches along the inside of the labia majora have also begun to separate by a month post-op. I have more wound separation than is typical but the doctors don’t find this concerning. weirdly, even while totally off of the opioids, it doesn’t sting to put soap on this open skin or to pee over it.
- I’m a side-sleeper and I’ve found that when I have adequate pain meds, I can put a knee pillow between my thighs and sleep on my side just fine. there’s a bunch of stuff online saying post-op you’ll have to sleep on your back for the whole recovery. this was true while bandaged up in the hospital but once those came off, the real problem is that your labia majora are really swollen and pushing on them can hurt. but if you’re adequately medicated and have enough spacing from a pillow, you can sleep on your side just fine. OHSU’s vaginoplasty info packet also says the same – if sleeping on your side is most comfortable, do that. OTOH, I’m not sure that sleeping on your front is a great idea. the whole lower abdomen/groin region (like where you grow pubic hair) is very swollen post-surgery and no amount of pain meds makes pressure there comfortable in the slightest. I’ve only been able to roll onto my stomach occasionally around a month post-op, once the swelling came down considerably.
- after the first follow-up (two weeks out of the hospital), it became a lot easier to get adequate pain meds, especially after I had a bunch of bleeding and an infection scare immediately afterwards (right before Christmas, when everyone was off). getting the pain under control meant I could actually sleep all the way through at night – something that didn’t happen, at all, prior to the third week out of the hospital. it meant I could be comfortable through the day but being high constantly really started to get under my skin – makes it really hard to think.
- starting the third week after the surgery, I stopped needing to nap constantly so I started taking my ADHD meds again. this meant I had a bunch of mental energy and I kept trying to be active but would consistently pay for it over the next several days as the swelling and pain would ramp back up – at least once it meant a whole week of significantly increased pain. my physical endurance remains very low a month post-op. even half a mile of walking remains taxing and detangling my hair in the shower still leaves me pretty wiped by the time I’m done (my hair loves to mat). I’m working on slowly increasing my exertion so I can hopefully get back to normal activity soon.
- peeing is a bit harder than prior to surgery, even a month post-op, presumably because of the swelling. it takes noticeably more pressure to get the stream going. I haven’t had any trouble maintaining a consistent stream from the start, though I know many other girls have had issues with spraying until the swelling went down.
- sitting cross-legged is extremely comfortable once the bandages are removed and the stitches dissolve/relax enough to make it viable. it keeps pressure off your labia both from below and from your legs pressing together. if this position pulls at stitches for you, don’t do it, obviously, but I’ve personally found it to relieve a lot of pain.
