One Year After Surgery

Honestly, it's amazing how fast the year has gone by. It's already been a year since I had sex reassignment surgery in September 2018. So, the one year report:

Recovery has gone great. The first weekend after surgery in September 2018 I suffered a complication, an infection of the skin in my abdomen. The cellulitis infection was treated with IV antibiotics and I recovered in full. Pain medication was no longer needed after week three. Bleeding ceased by the end of the month. Minor bleeding from dilation continued into month two. One incident of bleeding occurred in month three, the result of a common and minor complication known as granulation tissue. No further bleeding of any form was experienced by month six. I was able to walk around by week two and driving my car on week three. Discomfort when sitting resolved by month two, which I no longer needed a butt donut to sit on.

Dilation has gone well. I started at once a day for a week, seven days after surgery. Then I began dilating twice and then three times a day. By six months I had reduced the dilation sessions to twice a day. At month ten I was able to reduce it further to once a day. At one year, I am currently able to miss or skip a day if necessary. In another month or two, I should be able to fully begin alternating dilation days to once every other day. I was provided four dilators by the hospital, each one thicker in size. The smallest one was purple. The next size up was blue. Then green, then orange. I am not capable of fitting the green or orange. Unfortunately, the blue dilator's thickness (1.25 inches/3.175cm) is my girth limit.

Dilators: https://imgur.com/ndD8v1V

Sexual function and sensation are incredible. Everything works wonderfully. Orgasms are strong, pleasure sensation can be intense. I have no noticeable numbness or nerve damage. For the first few months there were bits of numbness in some places, but with time, everything recovered. The prostate was left intact, so upon orgasm, I also occasionally leak prostate fluids. The peritoneal graft maintains interior moisture, producing peritoneal fluid to keep the vaginal canal lubricated. At a year, it is not enough natural lubrication for sex or for dilation however, but enough to ensure that water-based lubricant I use does not dry out.

For the first month after surgery I needed to use menstrual pads to help absorb bleeding. From then on I needed panty liners to absorb fluids from the peritoneal graft that would leak out over the course of the day. At a year later, I use one panty liner per day, instead of two initially. The amount of peritoneal fluid leakage has decreased with time.

On Day 365, September 12, 2019, I met with Dr. Ting for my one year follow-up appointment. Once again, journeying into New York City, Dr. Ting asked how everything is doing and inspected my vagina. Everything has been recovering great. I mentioned again the urination issue which causes the stream to spray a bit off to the left and can occasionally make using the bathroom messy. There is a bit of excess skin near the urethra causing this issue. It would require a surgery and it is something I should think about whether I'd want to go through a whole operation to tweak a bit of skin. Not sure it's worth it, but we'll see. I'd have to also weigh the out-of-pocket costs and insurance coverage of a second-stage labiaplasty to adjust the clitoris for realism. I'd rather get it all done in one single procedure but if I'd have to pay myself, it will have to wait, as I have many other out-of-pocket cosmetic priorities. Besides the minor urination issue and a revision as something to consider, all else is well. I am scheduled to see the surgeon again in September 2020.

Month Nine Post-Op

I'll be posting new updates less frequently as there is less news to update on.

Things are going well. I met again with Dr. Ting on month eight and everything is fine. I previously mentioned I was stuck for the time being using the blue dilator because I cannot fit the thicker green dilator inside. It seems I will be sticking with the blue dilator from this point on, unable to go larger. I am still having issues with urination. I last posted about how urine tends to spray a bit, making using the bathroom a little messy. I dangle a folded up piece of toilet paper in front of the stream to catch strays. This is something that will have to be cosmetically revised with a second procedure to fix. Personally, it's more of an inconvenience to me than anything else. Not a problem, but I'll get around to that one day. I've been trying to get myself back in shape, but lower body workouts, particularly things like squats, can feel a little awkward in the crotch. I'm not sure if it's just the new arrangement I have to get used to or if I still need some more time before I engage in exercises that are strenuous on the muscle groups down there. I try not to strain too hard when using weights for leg exercises. Hiking, jogging, running and using machines like ellipticals are good for now. It's finally nearing summer and I'm excited for bikini season. This will be the first time I can confidently wear a swimsuit. No more tucking! No more bulges! No more baggy board shorts! I've finally been able to begin toning down the frequency of dilation. I now do it twice a day. In the morning, I only use the smallest purple dilator, and then at night I use the purple followed by the larger blue dilator. The purple is basically used for warm up stretching. Hopefully in the coming months I'll be able to drop to once a day. This dilating thing can get tedious after a while.

Sexual Function At Six Months Post-Op

I've mentioned in previous posts about post operative sexual activity and function. At only 3 weeks post-op, Dr. Ting recommended I begin stimulating the clitoris, and during that first visit asked if I had an orgasm yet. I wasn't ready to play around with some things yet, even though it was safe to. At 5 months post-op, I was told by Dr. Ting that my vaginal canal had healed to the point that penetrative vaginal sex was good to go. Again, I wasn't so sure and waited before becoming both curious enough and confident enough to try things out.

The Clitoris

The surgery included the construction of the external genitalia, the vulva. That included taking parts of the penis, particularly the glans (or head, tip, etc) to create a clitoris. In a successful surgery, the clitoris should have full pleasure sensation and one should be able to experience a clitoral orgasm. For the sake of preserving nerves from damage, the clitoris is not entirely realistic in appearance, but it does work. At about 5 weeks post-op I decided to test run my clitoris and it works. Clitoral orgasm feels kinda similar to penile orgasm. You get the same sensations but without most of the pulsing feelings guys feel. All those muscles designed to shoot semen out are not there or not working the way they should anymore. For guys, imagine the same intense orgasm feeling but without that shooting/pulsing. That's basically a clitoral orgasm in a post-op transsexual. My clitoris can go a good ten minutes before reaching orgasm with the assistance of a vibrator. Manually rubbing the clitoris with lubed up fingers takes more time, and the friction can cause the clitoris to swell larger, as if attempting to become erect but unable to. The erectile tissues of the penis were removed during the surgery. The orgasms from clitoral stimulation are weaker and shorter than vaginal.

The Vagina

At five months post-op, I was told by the surgeon that I could have sex. I wasn't sure and waited a month. At just over six months post-op, I decided to test things. Dilation can still be tight and sometimes sore. I went to one of those adult porn shops to find a flexible dildo that was about the girth of the blue dilator, which is the dilator I currently use for dilation sessions. The blue dilator is approximately 3cm in diameter. As expected, I had to use the dilators to loosen up a bit first. The vaginal canal can become tightened in between dilation sessions, which are performed 2 to 3 times a day. Afterwards it was time to test out penetrative sex. The dildo was lubed up and slowly inserted. After a few minutes of very gentle and slow thrusting in and out, it felt pretty good. It took time to get used to the new feeling, especially considering how nervous I was about using something that had been surgically constructed. You get a little worried about hurting anything, but it wasn't long before I was okay with going a bit faster. It started out intended as a simple test for function's sake and to make sure there would be no bleeding or other issues, but I got carried away. I will tell you this... penile orgasm, clitoral orgasm, anal/prostate orgasm, it's all nothing. Vaginal orgasm has a power gap over the others. Holy shit. Vagina: intensely pleasurable spasming. Legs: non-functional. Body: quivering. Teeth: chattering. In between the chattering teeth and shivers of good feels was panting "holy fuck" and giggling. I'm not sure what the surgeons did in terms of internal pleasure sensation or what the dildo kept stimulating, but I found my "g-spot" and it was an orgasm I had never felt before. In terms of the design of the vagina and the position of the opening, it will take more time for it to be ready for certain sexual positions. Laying in a missionary position, legs spread, was the best position to start out. As I got used to the feeling, I attempted to sit up more and then went in a doggy position just to see. I'm not sure sex would work the same with a real penis, considering the dildo is very flexible and can fit no matter how the vaginal canal is bent. A hard penis wouldn't fit the same way, so certain sexual positions will likely be a no go, at least for a while. Despite the natural lubrication produced by the peritoneal grafted tissues, it is not enough for sex. I definitely need lube. Simple generic KY jelly works just fine.

Ejaculation

If I am aroused enough, orgasm can cause prostate fluids to be ejaculated. Because of the hormone therapy and the removal of the testicles during surgery, very little fluids actually come out and for the most part it just drools, rather than shoots. The prostate is left intact and functional during the surgery, so it continues to produce prostate fluid. It also allows for prostate stimulation, another source for sexual stimulation and orgasm. The prostate can be accessed through the vaginal canal. The fluids that do drool out are clear and watery.

Sensitivity

Prior to surgery I had suffered from premature ejaculation and hypersensitivity. If I had masturbated, I would have been capable of achieving penile orgasm in 20-30 seconds. Premature ejaculation was always a sex ruiner, because mind over matter could also induce orgasm without touching anything. The sensitivity down there was so extreme that I could somehow end up cumming while simply giving somebody else oral sex. Yes, I was the one sucking someone else off, yet I was the one cumming for no reason. It was annoying as hell how sensitive my penis was. Post-op, this is not a problem. The hypersensitivity is significantly less and serious effort is required to achieve orgasm. No more PE! During clitoral stimulation, the feeling is the same as it was when I had a penis. The head of the penis is now mostly the clitoris. Any guy who attempts to cum through only rubbing the head of his cock will know what it feels like for me. Vaginal sensation is different. I mentioned the mysterious g-spot. That feels damn good. It's located somewhere closer to the vaginal opening, below my pubic bone. It's a very different feel having that stimulated versus when I had my penis. Pushing deeper, I can feel muscle groups and other things being pushed aside as the dildo went in and out. It felt good, kinda like anal sex, but the real pleasure was derived from that g-spot. I'd say that the clitoris is definitely more sensitive to the touch than the interior, even though vaginal orgasms are far more powerful.

Month Six Post-Op

Six months post op. A whole month has passed since I last saw Dr. Ting. He had informed me then that I was okay to have sex. I still have not. I also started leveling up to using the green dilator one month ago, however I noticed problems a few weeks later. By Week 24, three weeks into using the green dilator, I had seen little progress. It is girthier than the blue dilator, which means the vaginal canal has to stretch out. Incrementally, the dilator must go deeper. My experience when I leveled up with the blue dilator from the even thinner purple, was approximately 1 to 2 centimeters deeper per week until I reached full depth in about a month. After three weeks with the green dilator, I had only progressed less than half a centimeter. It won't fit and the vaginal canal will not stretch wider. I aborted using the green dilator and continued to use only the blue until I can see the surgeon again. In the mean time, I plan to try to find soft dildos that are approximately the same girth as the blue dilator and test out sexual penetration at some point soon. Dilation can still be uncomfortable initially, and any sexual penetration would require dilation prior to stretch everything out. During Week 26, I had an interesting experience. I had my first post-op wet dream. I was sleeping and dreaming a pervy dream. I was somewhat lucid and awoke to a mild orgasm. I'm not sure I even remember that last time I had a wet dream... at least several years ago or more. For those that don't know what a wet dream is: it's also referred to as a "night emission". A sexually arousing dream can induce an ejaculatory response in the middle of your sleep. Both men and women can get them and it's more common among adolescents and males. I remember the first time I had one, I was a teenager. Wet dreams can be annoying for dudes considering the mess you have to wake up to and clean up. As a post-op tranny, cum isn't much of a problem even though I still can ejaculate small amounts of prostate fluid if I'm aroused enough.

Month Five Post-Op

As of five months post-op, there is little to update. Things are going well. On Day 143 (Week 20), I began to upgrade my dilation sessions to using the larger green dilator. I am starting by using the blue dilator for the full half hour and then follow with the tip of the green dilator for 5 minutes. Eventually I will continue to go deeper with the green as my vaginal canal stretches and adjusts to the wider diameter. On Day 150 (Week 21), I returned to New York City to meet with Dr. Ting for another post-op follow-up appointment. He inspected my vagina and informed me that the healing has progressed to the point that I can have penetrative vaginal sex. I'm both excited yet scared at the idea of having sex for the first time. I'm not sure I'm ready, by my own standards. Although officially it is safe to have sex, dilation can still be tight and there is lingering soreness. I'm not sure how pleasurable sex would be if dilation is still a bit uncomfortable. I'm considering waiting longer before I attempt anything. But I can't say I'm not tempted.

My set of dilators:
https://i.imgur.com/ndD8v1V.jpg

Month Four Post-Op

During Week 14, on Day 93 post-op, I had a minor complication during my morning dilation. At this point I am still in the transition phase from the smaller purple dilator to the larger blue dilator. After completing my dilation session and removing the blue dilator, all seemed well until I began clean up. I noticed a sizable amount of blood on the tissues I typically use to absorb KY lube that drools out from the vaginal canal when I stand up. Something inside my vaginal canal is bleeding. It was not a serious bleed, but not an amount of bleeding I've experienced since the first couple weeks post-op. The bleeding slowly continued for at least 5 hours. I contacted the surgeon's office and was emailed by the surgeon. It's apparently a very common complication and nothing to worry about. "Granulation tissue" is a common problem in healing wounds and can cause painless bleeding and often takes longer to heal than typical wounds. Following my second dilation of the day, there was significantly less blood. Although it kinda freaked me out that I was bleeding three months after surgery, at least it's normal. I can handle some blood... annoying, but I'm okay with it. The following morning (Day 94), after completing my dilation, there was absolutely no bleeding at all. On Day 96 there was some minor bleeding after my morning dilation. There has been no bleeding since. During Week 15, on Day 101, I began to stop using the purple dilator during my dilations. My vagina has stretched and adapted enough to allow for the larger blue dilator to be used entirely on its own. For the next two months I will use only the blue dilator, and then attempt leveling up again to the even larger green dilator. As of Week 16, I am now able to sit upright normally, even on hard solid surfaces. I also stopped using my Spironolactone entirely and have not seen any resurgence of problems with greasy oily skin, hair or body odor issues. During Month One I had stopped using the testosterone blocker Spironolactone and there was a sudden resurgence of some issues with my face and scalp oils, acne and body odor. For the previous decade, while on the medicine, I had ceased having those problems. I decided to rather than drop the medication cold turkey, I'd reduce the dosages over time and wean myself off. This seems to have worked. I'd recommend post-ops not drop their testosterone blocking medications cold turkey and instead gradually reduce the dosages as testosterone in the body is still lingering some time after surgery. The last of the bills have been reprocessed by my insurance, bringing the total amount billed by the hospital to $263,000. I have so far only paid $106 out of pocket. The numbness noticed during Month Three in areas on the exterior genitalia, the clitoral hood and labias persists now a month later. The clitoris and the ability to orgasm are still fully functional, including the ability to physically ejaculate prostate fluids.

Month Three Post-Op

Three months post-surgery... Things continue to go well. I continue to slowly progress dilating from the purple dilator to the larger blue dilator. Over a period of two weeks my schedule for dilating went from using the purple dilator at full depth for 30 minutes followed by the blue dilator at one-third depth for 10 minutes to the purple at full for 15 minutes followed by the blue at full depth for 15 minutes. I slowly progressed pushing the blue dilator deeper over time to slowly stretch the vaginal canal to avoid tearing anything again. It's gone pretty well and switching from purple to blue has gone faster than expected. By three weeks into this level-up I was able to do the blue for the entire 30 minutes and only use the purple to warm up for several minutes first. Because of initial vaginal tightness, I may need to use the purple dilator to "warm-up" stretch for a few minutes first before inserting the blue dilator, for another couple of weeks. I went to see my endocrinologist for my annual check-up on Day 70 post-op. Once a year I go to see him. He has handled my hormone therapy for transition for several years. I drove upstate to Albany, received blood-work to check my hormone levels and will have my HRT adjusted now that I am post-op. I no longer require the Spironolactone, which was used to block testosterone. I no longer possess testicles, so I no longer produce testosterone in large amounts. The adrenal glands produce much smaller amounts in both men and women, so that is entirely normal. I will also no longer require my Medroxyprogesterone, a progestin which aids in the hormone therapy, particularly in breast and mammary gland development. The Estrogen is being maintained at the same dosage. The doctor also inspected my vagina. They then wrote letters to have my sex designation changed on my birth certificate and changed on Social Security Administration records. My ability to sit upright comfortably has improved. It's about damn time. I can now sit fairly normally. While doing my daily vaginal inspection I noticed a lack of sensation in spots around the vulva (the exterior genitalia: clitoris, clitoral hood, labia, etc). Using a pointy object, I gently dragged it across my skin and could feel the scratching. Doing the same on the clitoral hood, it was numb. I also did the same on both labia majoras, both sides are numb. The clitoris has full sensation however. I am hoping the numbness is a normal part of the recovery process. The original numbness I noticed inside the vagina last month appears to have gone away and I can feel internal sensation again. More bills were processed by my health insurance company recently, bringing the surgery and all related costs to a grand total of $258,000. So far, I've only had to pay a $50 co-pay. There are yet more bills standing by to be processed. Besides this, there is not much else to say. I'm very happy with everything so far.