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.
-
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.
-
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.
-
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.
-
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.
dilation & sexual function
- Buy surgical lube by the tube not packet – you’ll need it for a couple of weeks and the packets are both wasteful and annoying.
- get a pH-balanced lube to dilate with going forward and get a lot of it. like way more than you think. pH-balanced is important because you want to maintain an appropriate environment for the flora and fauna that eventually help maintain your vaginal health without constant douching. I’ve also been taking a daily (oral) vaginal health probiotic to try and get the right bacteria seeded there as soon as possible, immediately after I stopped taking antibiotics. I’ve been pretty quickly rewarded – I discovered that I wasn’t quite cleaning my dilators thoroughly enough because the towel I was using to wipe the water off them post-soaping ended up developing the fishy odor that vaginas typically have. I haven’t attempted to directly smell my vagina yet.
- dilation was, for me, at it’s hardest by far for the first few sessions when the last half inch or so felt like poking an exposed nerve. I don’t know if I simply lost that half inch (any dude who complains about my vaginal depth can fuck right off – no one else’s pleasure was worth bearing even a tenth that much pain) or if I desensitized that nerve but it no longer hurts anywhere near so bad. at various points over the last month, I’ve felt a similar but not nearly so intense sensation with shooting, referred pain into my abdomen, but it hasn’t just left me sobbing the way that first time did. I was straight up afraid to dilate for a bit and could barely get myself to do it.
- size dilators up carefully. I experimented with one size larger than I could handle a bit too soon and suddenly caused a whole lot of bleeding – like 15 minutes of fast and bright blood that ended up all over the floor. that said, I’ve been able to size up dilators pretty quickly and easily – in fact, I’ve kinda found that trying to get the next size dilator to depth is a great way to make the current one totally comfortable and easy. so 1 month after the surgery, I’m mostly on the orange dilator and getting it to depth without too much difficulty. I wouldn’t call leaving it in for 45 minutes quite easy yet but it’ll be there in a couple of days if my previous experience is anything to go by.
- I dilate 2x/day for 45 minutes instead of 3x/day for 30 minutes and have from the start – the surgeon is fine with this. I can also start skipping sessions once I’ve gotten the orange dilator comfortable and consistently easy. “easy dilation” here means the target dilator gets to depth in <1 minute. I know a lot of women struggle to get the dilators to depth after 10s of minutes but I’ve either totally failed to get a dilator to depth (i.e. I’m not ready to start using it for time yet) or gotten it in within 5 minutes at most and typically within 2-3 minutes even when struggling. the PA expects that I’ll be down to 2 dilation sessions a week by one year post-op, consequently.
- one thing that’s helped me move up dilator sizes relatively quickly has been to steal an active stirring technique from Thai surgeons. never, ever rotate a dilator post-insertion - but you can stir the dilator, once fully inserted, about it’s deepest point. this stretches the neo-vaginal canal, massaging any scar tissue and keeping it from developing further, as well as helping larger dilators feel comfortable sooner.
- while my clit is overly sensitive to direct touch when not aroused, I recently found out that, when sufficiently aroused, both use of a vibrator and light stroking with a finger were totally comfortable. in fact, it’s easier to tell while masturbating that there has in fact been some loss of sensation - it felt a little numb when stroking with my finger, like a faint echo of a pins and needles feeling, and I had to turn the vibrator up a bit higher than I’m used to. this doesn’t totally surprise me. I’m only a month post-op and there’s a bunch of stuff that ought to hurt but just doesn’t - like open wounds that don’t sting when soaped. so I’m fairly confident that the lost sensation will mostly return. and honestly, I was hoping for a bit of sensation loss in this area, so I won’t mind if it doesn’t - what’s there now is just a little short of ideal for me and I’m able to acheive orgasm.
- I also have no clue how inserting something into my vagina is supposed to feel sexually stimulating. yes, my prostate is now above my vaginal canal so, when aroused, I should be able to get prostate stimulation during penetration, but I haven’t been able to get close to that aroused. dilation is my primary association with putting things in my vagina – it’s somewhere on the edge of being painful at least some of the time so putting something in there for pleasure doesn’t make any sense yet. presumably once I get the orange dilator totally comfortable and easy over the next couple of weeks, that will change. keep in mind, though, a lot of early dilation involved putting things in my vagina and feeling pressure on my bladder and rectum (void both before dilating) – both have largely moved out of the way at this point but I still associate dilation with feeling really gross.
