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.
This is incredible and I’m so happy for you. My egg cracked recently and this is all a lot to take in, but I love my trans comrades.
:cat-trans:
what does this actually feel like?
I’m not sure I’ve seen anyone actually describe their internal and sensory experience of what it’s like to have a part of your body reconstructed, where the old parts are largely still present but in a radically altered configuration, and especially how that experience has evolved through the recovery process. so hopefully this sheds a little light for the curious, whether trans or cis.
when I woke up after the procedure, the surgical team had wrapped me in tight bandages, with a catheter inserted into my urethra so I didn’t need to pee until after bandage removal. so my brain’s machinations to maintain a coherent & consistent model of my moment-to-moment experience utterly fascinated me. I knew my penis was gone but most of the nerves involved were still telling my brain they were there and rather unhappy, whenever pain meds were inadequate. so while I couldn’t see and touch my new parts, my brain just decided my dick was still there, just floating over the bandages. I didn’t have the same problem with my scrotum as I could touch the outside of the bandages and feel my new labia minora. I’ve heard trans women describe this feeling as the world’s worst tuck, but that’s not really right for this version of the procedure. it didn’t feel like my penis was now squished into my body. and because moving and triggering new sensations - especially after the bandages came off but while the swelling was too intense to allow access to my labia minora or clitoris - meant that I’d experience entirely contradictory sensations moment to moment, my brain amazingly tried to keep up by just teleporting my virtual penis around, still floating over and just inside my vulva. as the swelling came down, I was able to actually touch my inner labia, clit hood, and clit, and this mostly got rid of the floating penis sensation. but, y’know, I’m not sure my brain is quite ready to give up that ghost just yet. somehow, part of me is still convinced the old parts are still there - I’m reminded of this fact when I unconsciously move muscles in my pelvic floor that corresponded previously to movement in my old genitalia and now correspond to… I have no clue. but my automatic awareness still includes all of my old and new genitalia.
ok, sorry if I’m the only one who finds that utterly fascinating. brains are wild and however much we feel like we’re in control of them, that our knowledge of the world guides our beliefs and actions, and that our experience is coherent and reliable, our unconscious and automatic minds can willfully ignore reality, however nonsensical the alternative.
and it’s this shred of insanity my dysphoria now clings to, trying to trick me into forgetting that I remodeled my body to better suit who I am. remember, kids - dysphoria is a lying, insane bitch that’s trying to destroy you. don’t listen to her; kick her in the teeth, instead. eat your brain worms before they eat you.
my brain amazingly tried to keep up by just teleporting my virtual penis around, still floating over and just inside my vulva
:trans-specter:
ok, sorry if I’m the only one who finds that utterly fascinating
No this is super cool!!!
our unconscious and automatic minds can willfully ignore reality, however nonsensical the alternative.
yeah my brain insisted I was a man for years. Also the amount of weird excuses that have tried to pop up as to why I couldn’t possibly be trans.
remember, kids - dysphoria is a lying, insane bitch that’s trying to destroy you. don’t listen to her; kick her in the teeth, instead. eat your brain worms before they eat you.
Thank you sis, working on it.
:stfu-terf:
I really hope your dysphoria continues to dissipate as you settle into this new upgrade!
:meow-hug:
hospital stay:
- Anesthesiologist did great. no harm or strain on vocal folds; mild swelling alleviated within 24 hrs. I let them know I was a singer and that was enough to get careful treatment.
- pain med problems began in post-anesthesia unit. my memory of this is foggy but I remember them slowly giving me pain meds one at a time while I came in and out of consciousness and complained about how much pain I was in. it took them about an hour and a half to get the pain under control, as they refused to give me adequate meds until each previous medication had time to take effect and I got separate authorization for each new pain med. they started me on tylenol, then an IV NSAID (toradol), then (finally!) 15mg of oxycodone, and lastly morphine. I received authorization at this point for morphine at this point, in addition to 15mg of oxycodone every 4 hours. at the time I barely understood what was going on. in retrospect, this was the start of a whole host of problems with access to pain meds - they started literally minutes out of the OR.
- I noticed in the post-anesthesia unit that my right foot was numb and that its condition wasn’t noticeably improving while I was there, for a total of about two hours. one of the surgeons, Dr. Blair Peters, came to check on that while I was there, and helped get me auth then for the morphine when he realized I was in significant pain. this will be a recurring theme through my hospital stay - the doctors expected me to be given adequate pain meds to keep me comfortable and the nurses ignored them and minimized pain meds as much as possible.
- VP patients are kept in singlet, closed-door rooms during the whole hospital stay – they have 3 of these on the floor. my support person was given a cot to stay in the room with me. while covid restrictions are in place and visitors are restricted, this is important - the hospital only allows one visitor PER DAY. we later learned that because the support person was sleeping in the hospital, they were actually a resident and so someone else could come and go to bring us things.
- staff only referred to me by my real name. my wrist band had both my deadname and real name on it.
- the first nurse (Peter) misgendered me upon arriving in my hospital room; he corrected himself but it was completely out of left field. I was also misgendered later by the staff bringing and taking my food but that hurt less since they had no clue who I was or why I was there. a nurse that knows I’m there for a vaginoplasty that was just done and has received training on this really shouldn’t make this mistake. Dorian, the trans masc PA, also got misgendered by one of the nurses on my last day in the hospital. this completely shocked me as he’s both a passing trans man and her coworker. this was literally a cis person misgendering a trans person just because they know he’s trans.
- don’t skip pain med doses – fear of opioid addiction has gotten to the point where they’ll use this to immediately cut your available pain meds and make it harder for you to get them when you do need them. the first night, immediately after leaving the post-anesthesia unit, I was in really good spirits. I was so happy that the operation was FINALLY done and I’d finally gotten enough pain meds there in the post-anesthesia unit so I really wasn’t in a ton of pain that night, especially with anesthesia still in my system. so I turned down the next dose of morphine and only asked for 1 5mg oxycodone pill. they immediately cut authorization on the morphine and it was days before I got access to it for breakthrough pain again - only after they screwed up and caused me an inordinate amount of pain between an unmanaged bladder infection and indelicately moving me between hospital beds. just lie about pain levels - a nurse told me that they “didn’t want you to be too comfortable”. a 5/10 (i.e. the level of pain during a fairly intense piercing or tattooing) is acceptable to them but isn’t bearable for days on end. They expect people to describe that kind of pain as being an 8+.
- you will greatly benefit if you can have someone there with you 24/7 at the hospital. the nurses are overworked and their response times can run up to an hour. this is possibly because of covid but it means that basic things like getting water, adjusting the temperature in the room, or feeding you can stretch past the time when you actually need help – your need for basic things can shift drastically and they’ll greatly affect your ability to remain comfortable. Bring a gallon water jug and a large mug with a bendy straw to be fridged and refilled - getting single glasses refilled takes too long and the drugs will dry your mouth out something fierce. you’re on a catheter anyway so may as well drink up since hydration is good for recovery.
- doctors visit annoying early and will just wake you up without warning. nurses also come in at all-hours to give scheduled meds. this means sleep is super-interrupted the whole time, even when you’re comfortable, especially for the support person who isn’t on twelve different drugs that make you sleepy all the time. Try to schedule drug admin concurrently; they’ll resist this but it means you’ll actually get some uninterrupted time to sleep.
- nursing staff weren’t communicating very well with each other. nurses from other departments (such as for xray) weren’t informed about where I had stitches or the fact that I wasn’t able to lay totally flat on my back and were happy to toss me around without sufficient care for bandaged stitches that were incredibly painful to have yanked. always watch the wound vac (sucks blood out of vaginal canal). general nursing staff won’t know about it and can rip it out accidentally. this nearly happened to me - thank god my support person caught it in time. not being able to lay totally flat while bandaged is normal but, for example, the nurses doing your xray don’t know that. the bandages are adherent and cover the whole groin and abdomen. when you try to lay totally flat, they pull on the stitches and push against the swelling, both of which hurt considerably, especially if you’re forced to it.
- docs recommended I ask for drugs (morphine) that nurses wouldn’t give. verify pain med schedule in advance and don’t let authorization for meds slip. just take pain meds when offered them and don’t refuse them.
- I developed a fever from a UTI the day after the surgery. it was low-grade for a day or so then spiralled out of control. they didn’t start tests until my fever went north of 102 degrees and the result was that I had a 104 degree fever at points and we didn’t know what was causing it – ultimately, I was taking the wrong antibiotics. if they’d started testing sooner, they’d have been able to pinpoint the bladder infection earlier, but because they waited until the fever climbed, I was in a world of hurt for about 48 hours. I have no clue why they wouldn’t just run urine cultures as a precaution starting the day after surgery – they’d have caught my infection much sooner and it doesn’t take them much time or energy to do it. doctors tried to disclaim responsibility for the bladder infection by telling me that “if it had been caused in the OR, they wouldn’t have expected it to show up so soon,” but this is clearly bullshit. prior to the operation, I had a long urethra which does a lot of work to prevent UTIs so it’s extremely unlikely I had a UTI to begin with and even more unlikely that I had a UTI without any clue about it. the infection must have happened due to poor adherence to protocol during catheterization but they’re covering their asses. this high fever meant my memory through this whole period is super spotty. at one point I was apparently speaking in tongues.
- they will remove one of the redundant IVs – I had one in each hand coming out of the OR – if pushed. hospital policy requires them to leave one IV in until discharge. this was annoying on day 5 when I was due to be discharged before the next dose of IV meds but they still wouldn’t take out the IV because I wasn’t literally leaving.
- bandages can’t come off a day early; they were really irritating by this point and I wanted them gone pretty badly. in retrospect, the bandages were keeping swelling down so this is probably a good thing since the very first thing that happened after leaving the hospital is that everything became so swollen that it felt like the skin was going to burst. this was extremely painful in it’s own right.
- first dilation session sucked hard. getting most of the way inside only feels weird/mildly uncomfortable. however, the last half inch or so felt like pushing past an exposed nerve, with referred pain all through my abdomen. the PA ignored my attempts to communicate this and then left after we got to depth, tellling me to keep it at depth for 30 minutes. after 15 minutes the pain hadn’t reduced from a 7/10 at all and I began to cry. I pulled the dilator out after 20 minutes, unable to bear keeping it in for any longer. at the first post-op appointment, I found out this is a fairly normal complaint for the LPV approach, presumably because of the sutures used to close off the internal end of the neo-vagina, preventing access to the abdomen, so I don’t know why he pushed past that while I was telling him it really hurt. I was absolutely terrified to dilate for the next couple of days after that. that evening, I only put the dilator in halfway, and continued to avoid anything approaching full depth for a few days. once I started the muscle relaxant, dilation got significantly easier, and I started trying to push for depth again. I did eventually get it back to the point where I felt the exposed nerve sensation again but I’ve never managed to get the dilator to go any deeper, however hard I push. I’m not sure I really care about the lost half inch of depth, tbh. it’s too little of a loss and it would have required forcing myself to do something wildly painful 3x a day.
