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.

Dilation Schedule & Strategy

During my research into SRS, I have come across different charts that are provided by different surgeons to their patients on how to dilate. These schedules go week by week telling the patient what to do. Unfortunately when it comes to Mount Sinai hospital, I was not provided any schedule and simply go by what I'm told by the doctors at my follow-up appointments. Leveling up in dilator size  is at this point "as tolerated" and depends entirely on how I feel. Well that didn't help much now that I'm in a transition period between using the smaller purple dilator and the larger blue dilator. I accidentally ripped the vaginal canal trying to insert the blue dilator all the way in. I didn't even know I had torn anything. It was very minor and only noticed when I removed the blue dilator when I was done and saw blood on it. So I think it might be helpful to others seeking surgery to share how I go about dilating.

For those who don't know what dilating is, please go back to older blog posts about dilation. Here's a link to a photo of my vaginal dilators: https://i.imgur.com/ndD8v1V.jpg

Dilating is an all day thing basically. Once you get up to having to do it three or four times a day, it almost feels tedious. A typical dilation session will last 30-50 minutes from preparation to clean up. I've put together a dilation bag which contains all the supplies I'll need for dilating. It keeps things simple having it all together in one place to just grab, lay down and set it all up. Dilation can be messy. The dilator begins to feel a bit more loose in the vagina after about four or five days after beginning the next size up. The initial skin tightness relaxes.

Dilation requires:
-Tissues or toilet paper
-Paper towels
-A bath towel (optional)
-Water-based plain lubricant (KY or WET is recommended)
-Dilator set
-A good sized hand-held mirror
-A flashlight (optional)

A bath towel can help keep your bed sheets protected from any spilled lubes, blood or fluids. Layering up a bunch of paper towels and sitting on them to catch stuff is good too. A flashlight is something I like having to inspect myself at least once day while I'm healing to make sure there are no signs of infection, irritation, cuts or other problems. Being proactive in your recovery can save you a lot of trouble in the future by catching complications early. The mirror helps you see what you're doing during self inspection and during cleanup. Tweezers are also helpful early on to pick out sutures that have dissolved and are falling out.

My Dilation Schedule

Week One:
-No Dilation
-Wound Vac, Foley Catheter & Vaginal Packing are still in

Week Two:
-Purple dilator, full depth (Dot 5)
-Once a day, preferably twice a day
-20 minutes minimum

Week Three:
-Purple dilator, full depth (Dot 4)
-Twice a day (10am, 10pm)
-20 minutes minimum, 30 minutes as tolerated

Week Four:
-Purple dilator, full depth (Dot 4)
-Three times a day (9am, 4pm, 10pm)
-20 minutes minimum, 30 minutes as tolerated

Weeks 5 - 8:
-Purple dilator, full depth (Dot 4)
-Three times a day
-30 minutes

Four Week Long Size-Up Transition Period (Purple To Blue)

Week Nine:
-Three times a day (9am, 4pm, 10pm)
-Purple dilator, full depth for 30 minutes
-Blue dilator, dot 2 to dot 2.5 as tolerated, 10 minutes

Week Ten:
-Three times a day
-Purple dilator, full depth for 20 minutes
-Blue dilator, dot 3 to dot 3.5 as tolerated, 15 minutes

Week Eleven:
-Three times a day
-Purple dilator, full depth for 10 minutes
-Blue dilator, dot 3.5 to full depth as tolerated, 20 minutes

Week Twelve:
-Three times a day
-Purple dilator, full depth for 3-5 minutes (warm-up stretch)
-Blue dilator, full depth, 30 minutes

Blue Dilator

Week Thirteen:
-Three times a day
-Purple dilator, full depth for 3-5 minutes (warm-up stretch)
-Blue dilator, full depth, 30 minutes

Week Fourteen:
-Three times a day
-Purple dilator, full depth for 3-5 minutes (warm-up stretch)
-Blue dilator, full depth, 30 minutes

Weeks 15+:
-Blue dilator, full depth
-Three times a day
-30 minutes

I have updated this as of Week 24. The schedule may change based on my recovery, how I feel and how dilation progresses as a result. I will update this accordingly. This is a very careful, light stress on the vagina type of scheduling. I noticed that already five days into Week Nine's dilation I was at 2.5 to 3 dots and fairly loosened. The first few days in particular the bigger dilator had to be carefully, gently pulled out because of how tight and sticky it was. For at least the first 3 or 4 months post op, it's best to take the safe and gentle route but perhaps later on the dilation progress can speed up.

UPDATE: On Week 20 I began to level up to the next size dilator, the green. After a month, the green dilator has seen little progress as of Week 24. Unlike the blue dilator which reached full depth in less than a month, the green has only progressed mere millimeters. I am unsure if I will be capable of fitting the green dilator and will have to discuss this with the surgeon.

Shooting Down Stupid Memes

I've seen all kinds of myths, fearmongering and general stupidity regarding male to female neo-vaginas, the surgery, the outcome, function, etc. Well, I'll address these memes and disinformation here and update it if I come up with new issues to address or hear some new dumb statements from people who talk out of their rears.


-Pubic hair grows inside the vagina and makes hairballs-

I see the hairball meme all the damn time. It's not true. That is unless the patient went to a sub-par surgeon, never received a hair removal procedure on their genital prior to surgery and the surgeon does not surgically scrape off the follicles in the skin used to create the vaginal canal so hair never grows back. You see, transsexuals undergoing SRS get hair removal, often laser hair removal or electrolysis on the skin on and around the genital area to kill the hair follicles. Hair doesn't grow anymore. This is often compounded by the surgeons themselves during the surgery taking the tissue used to build the vagina and using a scalpel to skin off the hair follicles. This prevents any survivors of the hair removal treatments from ever growing back ever again. It is physically impossible to grow hair inside the vaginal canal if these procedures were done. Transsexuals getting SRS should ask about hair removal with their surgeon, otherwise, yes, you might grow a bush inside your vagina. And that is friggin' gross.

-It's an open wound that bleeds, pusses and gets infected-

Yes and no. It's a surgical site. Your genitalia have just been disassembled and reassembled in a completely new shape. Yeah, it's got cuts, incisions, sutures, bleeding, bruising, swelling, pain, maybe puss, scabs and everything else associated with a healing wound. It even comes with the typical risks of any surgical procedure: infection and even necrosis. For the vast majority of transsexuals who undergo SRS, they do not encounter such complications. The healing process takes approximately three to four weeks. At this point your incisions and sutures should be healed and the stitching dissolving and falling out as it should. There is no more bleeding. There is no puss. There is no infection. If you have excessive bleeding or continuous bleeding passed one month post-op, you should contact your doctor, surgeon or go to the emergency room immediately. If you have signs of infection, you should contact your surgeon or go to the ER immediately. After three to four weeks, it is fully healed skin. The vaginal canal they constructed is also fully healed. It is no longer an "open wound".

-Dilation takes hours a day for the rest of your life to stop the wound from healing-

At first, yes. The vaginal canal the surgeons built is not the same as a real vagina and therefore does not have a lot of the necessary natural features that keep a female's vagina from shrinking or sealing shut. Dilation is necessary on a daily basis for the first year or so after surgery. It can take upwards of three or four times a day, for 30 minutes each time to help maintain the vaginal canal's depth and girth. Over a period of several months, this procedure ramps up from once a day to twice to three or four times and back down to twice and then once a day. Typically by one year post op, most transsexuals will be dilating once or so a week. Dilation becomes necessary once a week for 20 to 30 minutes for the remainder of your life. Is it to stop the wound from healing? No. The internal pressures from your organs and muscles squeeze on the neo-vagina, causing the tissues to smush in. If not dilated, the tissue used to build the vagina will begin to atrophy, basically it gets shorter and tighter. Eventually it would atrophy to the point of no longer being sexually usable or even recoverable via dilation, which would necessitate surgery all over again. Dilation simply keeps the canal open and deep. Over that first year period, the body adjusts to the canal's and the rate of atrophy is significantly reduced. For those with a sex life, dilation may be entirely unnecessary after a year. The act of having sex on a frequent basis doubles as dilation. The rule is simply put: use it or lose it. Addressing pain, no, dilation is not painful forever. The first few weeks of dilation can be hard, especially the first one or two. Pain medication is already necessary as you're healing, so dilation shouldn't be THAT bad, but it is tight, sore and uncomfortable. Dilation should be painless by week three or week four.

-It smells like rotting flesh, feces or other putrid scents-

False. The neo-vagina will smell like nothing, or smell like any other part of the body. It is up to the individual to maintain hygiene standards. Anyone who fails to take showers is going to start to smell. Maintaining good hygiene is important to the healing process anyway. If the vagina does have a strong odor, like in actual women, transsexuals can be prone to infections such as vaginosis, which is notable for the vaginal odor it produces. A normal healthy post-op vagina is largely scentless like any other body part that is clean. There is no rot. There is no smell of feces. If there is rot or necrosis, you should go to the ER immediately. If there is a smell, you might want to go see your doctor. Bacterial Vaginosis is a possibility. Vaginosis infection is particularly higher risk for most post-op transwomen due to the way most post-op vaginas are constructed. Real vaginal canals are a moist excreting membrane. This moisture allows for a particular growth and balance of healthy human bacterial flora to exist. Some of these bacterium are purposed for maintaining vaginal health and reducing the risk of infections. In women with a micro-flora imbalance, they can develop infections such as vaginosis. Transsexual vaginas do not typically have a naturally lubricating moist membrane... not until recently. As a result, transwomen do in fact develop much of the same normal vaginal bacterial micro-flora, however the lack of a proper vaginal environment results in higher risks of infections like vaginosis. The peritoneal graft method of SRS I received provides SRS patients with a naturally moist excreting membrane in the vagina, which may change this. Because the peritoneal method is a recent development, research into how vaginal bacterial micro-flora develop in peritoneal vaginas does not exist. I would assume because the environment has the proper moisture necessary for certain bacterium to grow would allow for a better balance and reduce risks of infections like vaginosis. Sciencey stuff aside, no, post-op vaginas don't smell like rotting death.

-They use colon tissue to make the vagina, so it smells like feces and leaks anal fluids-

The use of colon grafts to create neo-vaginas is an uncommon form of SRS today. Rectosigmoid Vaginoplasty involves to taking of a chunk of the large intestine, also known as the colon, to create a naturally lubricated, moist vaginal canal in transsexuals. The problem with this method is the type of tissue is a mucus membrane. It secretes fluids to help with digestion and moving fecal matter along into the rectum. As the result, these fluids can have a bit of a scent to them and are prone to developing bacterial flora commonly found in the rectum and colon. Because it is an excreting membrane, it constantly produces fluids, which throughout the course of the day, leak. This is the same with the peritoneal graft I received. It too continuously produces peritoneal fluids, although scentless, as self lubrication, resulting in gradual leakage. This necessitates the use of a panty liner to absorb the fluids. The colon graft method of SRS is uncommon in the U.S. and most Western countries. Most surgeons avoid doing these procedures but many do offer the option, usually as a last resort in patients who require vaginal reconstruction after the first surgery suffered severe complications or in cases of patients with micro-penises. Does it smell like poop though? No. Most transsexuals receive a generic penile inversion. The entire vaginal canal is constructed out of the same skin as the penis and part of the scrotum, which is incapable of excreting any fluids.

-Post-op transsexuals cannot orgasm-

I've seen this around a number of times. Oh, yes we can. Really it comes down to the surgeon's skills and potential for complications affecting the nerve endings. Nerve damage can result in numbness or loss of sensation. In the case of the colon graft method mentioned above, the colon has no pleasure sensation. For most transwomen, the surgeons construct the external female genitalia (vulva) and the internal vaginal canal. The clitoris is often fully functional with pleasure sensation and with work, can achieve clitoral orgasm. Part of the penile tissue used in SRS also contains pleasure nerve endings, allowing for penetrative vaginal orgasm. The prostate is also often left in place or moved during the surgery, creating a third spot for sexual pleasure than can induce orgasm with stimulation. Basically we usually have three points of stimulation to induce orgasms. Because I am only two months post-op at the time of writing this, I am limited in my sexual activities. However, I am capable of achieving clitoral orgasm with ease using a vibrator. I've tested the interior for sensation by inserting a dilator and holding my vibrator against it to make the dilator vibrate inside me. My vaginal canal has pleasure sensation and the vibration feels good, but I do not know what I am capable of at this time. Surgeons who do excellent functional work can allow their patients to experience powerful orgasms.

-Post-op transsexuals cannot cum-

Most surgeons leave the prostate intact during the surgery. It's really the only part of the male genitalia left behind and functional. Cum is made up of a number of things. Primarily the sperm cells and some fluids are produced by the testicles and additional fluids from seminal vesicles. While on hormone replacement therapy (HRT), most transwomen's testicles cease functioning which results in infertility. We no longer produce sperm. However the prostate also produces a sizable portion of male ejaculate and this does not stop producing fluids even while on HRT or after an orchiectomy (the surgical removal of the testicles). The prostate produces approximately 0.6mL to 1.5mL of fluids in a healthy male. Post HRT, the production of fluids is decreased, but still present. If you can still cum fluids after long-term HRT use, you will be able to cum fluids after surgery too. Before surgery the amount of cum that came out of me when ejaculating seemed to vary based on how aroused I was at the time. Sometimes a good amount would come out, sometimes very little or almost none. Post-op, I have had only one orgasm so far where I leaked fluids. Because we no longer possess a penis and the muscles and erectile tissue needed to pump and shoot semen, post-op the fluids simply drool out from the urethra instead.

To be expanded...

Dilation: What The Hell Is It?

Few people know much about post-op transsexuals and how it all works, even fewer know about dilation. There is a lot of disinfo out there about it. The surgery involves primarily the construction of a pseudo vaginal canal out of our male genitalia, however it is not a real vagina and therefore does not have some of the important features real vaginas have, particularly what lets them maintain their shape. The vaginal canal that is built is essentially a tunnel of skin or maybe more like a skin cave that goes several inches deep into the body where a vagina would be on a female. However unlike females, the trans vagina has nothing to connect to at the deepest end. In a woman, that would be the cervix, which is the point of entry to the uterus. The average woman's vagina, from the opening to cervix, ranges from 3 to 5 inches and can change size with sexual arousal.

For trannies, most surgeons provide more depth. Some do even better, deeper upwards of 7 or more inches. For me, I have about 5.75" of depth. For the first several months the tissue used to create this tunnel needs to be maintained daily. Like with muscles for example, if you don't use it, you lose it and muscle begins to atrophy away. The vaginal canal will do the same over time. This is combined with the effects of the vaginal canal being squished by the constant pressures of internal organs and muscles that contributes to more rapid tissue atrophy. The first couple months are critical in this process. To maintain the depth and girth of the vaginal canal and stretch it wider and potentially deeper, we use medical devices called dilators.

A dilator is basically a dildo made of medical-grade plastic. It is solid plastic, not floppy or soft. A set of dilators is used over time, each one slightly girthier than the last. We start off with a small dilator, in my case, a purple dilator that is about 1.1 inches (2.75cm) in diameter and 9 inches in total length. The dilator is smeared in lubricant first. Waterbased lube is recommended by the hospital. I use plain waterbased KY jelly. For the first week or two, the hospital provides a prescription lubricant called Metronidazole gel aka MetroGel, which is also a vaginal antibiotic. After the MetroGel runs out, you switch to normal plain lubes. With the dilator lubed up, it is slowly inserted into the vagina until it reaches the end of the tunnel. For me, that's about 5.75 inches. The dilator must remain inside at the full depth and held in place with some slight inward pressure for 20 to 30 minutes. I do 30 minutes. After the time is up, the dilator is slowly removed and you can clean up. I must do this three times a day as of writing this (two months post-op). I was started at twice a day, one week after surgery.

For the first month dilation can be uncomfortable. For the first couple weeks, it's like a chore you just really really do not want to do, but you MUST do it and it is both uncomfortable and slightly painful. I have a decent pain tolerance, so maybe it's not as bad to me, maybe for others it'd be pretty sucky. It is very tight going in at first. After a couple weeks, the vagina is already adapting. The dilation is doing its job loosening it up and stretching it out. Dilation should be pain free after the first month.

Dilation is not as simple as I just made it sound. There's a bit more involved to make it less uncomfortable and to allow for the dilator to slide in more easily. The first week, the doctors recommended laying in bed, on my back, with my legs spread in a "froggy" position. I used pillows to help prop them up a little so they could rest more comfortably. After a month I changed my position as the vagina got looser, making dilation easier. Now, I get into a comfortable laying position on my back, preferably in bed with coffee and Netflix, and sit with my legs up and spread a little... almost like missionary position for sex. I insert the dilator slowly starting at a 90 degree angle to slide in the tip. The dilator is curved inward to a 45 degree angle as it begins to fully enter the vaginal canal. For the first few weeks, this can be tight and somewhat painful as the dilator transitions from 90 degrees to 45 degrees, squeezing around and under the pubic arch (a part of your pelvis), squishing and pinching the swollen urethra and other tissues inbetween against the bone. This was no longer a problem by four weeks post op. Tylenol helps make this less painful. Take it like an hour before dilation. Another issue is learning to relax your muscles. Dilation can make you tense up and all those muscles in your pelvic area are tightening up the vagina. This makes it harder to get the dilator in. However understand that this is not a bad thing later on when you can have sex. Yes, we trannies can tighten our vaginas when having sex, making things feel better for our partners. I had to learn to try and relax those muscles, relax my body, breathe out slow as I insert the dilator to help loosen those muscles and allow it to enter easily. Once the dilator is in, it must remain in for 20 to 30 minutes. It has to be held in with a bit of inward pressure to help things stay stretched. While the dilator is in I have to be sure to control myself if I feel the need to cough or sneeze. That shit sucks. Go ahead and cough and feel your crotch muscles as they spasm. Now a solid dilator is in there when you do it. Ouch. Avoid coughing or sneezing. If you feel a sneeze coming on, try and remove the dilator first.

Link to photo: The dilator set I was provided by the hospital: https://i.imgur.com/ndD8v1V.jpg

Eventually I will have to size up. As I stated, the purple dilator is about 1.1 inches (2.75cm) in diameter. The next size up is the blue dilator at 1.25 inches (3.25cm). Then some months on the green dilator at 1.3 inches (3.5cm) and finally the biggest dilator I was given, the orange at 1.5 inches (3.75cm). By approximately one year post-op, the dilating process will have ramped down from 3 times a day at 30 minutes each time to once a week. What happens if you don't dilate? Well, contrary to internet disinformation and anti-trans memes, it is not meant to keep an open wound from healing closed. The vaginal canal and vulva is fully healed within three to four weeks. It does prevent the skin or tissue used to create the vaginal canal from atrophying. This means that without dilation or neglecting to dilate as scheduled, the vaginal canal will shrink in terms of depth and girth, leaving it shorter and tighter until it is too short and too tight to use sexually and could be so far gone that you cannot regain the loss. This would end up requiring surgery all over again to rebuild the vaginal canal. For about a year the dilation process is necessary to ensure the body adjusts and the vagina won't shrink away. Skipping even a day during the first couple months can result in the next dilation session being tight and uncomfortable. Depth is lost faster than girth and is harder to regain. Initially post-op I had 6 inches of depth, however I dilated once day for the first week instead of twice and dropped to about 5.5 inches. It is important to stick to the dilation schedule. That first week is a bitch, painful, annoying and I really didn't want to do it. But it must be done. Bleeding also only lasts for the first two weeks post-op. The dilator should be coming out clean, except for the lube, by about three weeks.

Does it feel good after the pain is gone? It doesn't really feel like much. I can feel it all the way in, a painless stretching and pulling from the inward pressure as I hold it in. We don't need to move it around except to adjust to get maximum depth. Sometimes if you have gas while dilating you can feel the dilator being pushed as the pressure moves through your intestines and into the rectum. The dilator moves back again after you pass the gas. Kinda funny. If you take a vibrator and hold it tightly against the portion of the dilator that sticks out from the vagina, the dilator will absorb the vibration and begin to vibrate inside. That does feel good. If anything, it's a good diagnostic way to test your nerves and sensation in there while you're still not allowed to have sex.

Currently at two months post-op, dilation is painless and easy to do. I just get comfy in bed and do my thing. The entire process from prep to clean up is maybe 40 minutes. Doing this three times a day now, that's a good two hours of my day just sticking a medical dildo in my vagina, every single day. It is time consuming and for several months, makes certain things harder to do, like school or work. Some surgeons have their patients do this for longer, like 40 minutes and up to four times a day. Things become simple as you near one year post-op and it's only needed once a week. I just can't wait to get this down to at least once a day.

And that is dilation.

Pre & Post-Op Supplies You Will Need

For those considering sex reassignment surgery, I thought I'd make a convenient piece on what is involved and what you'll need to prepare:

Before surgery, you will need some things in preparation. Some of it is provided by the hospital, some you'll have to buy. I would also recommend buying the things you'll need for after surgery before you go too because you will not want to go out to get supplies while you're recovering. First, you WILL need a buddy. Recovery is rough. You will be exhausted, weak and it's hard to get around. Plan to have a friend or family member available to cater to you for at least one week after you get out of the hospital. Mount Sinai demands patients have a helper be available 24/7 for at least three weeks or they might not allow you to get the surgery. Trust me, I wouldn't have been able to take care of myself alone. You will be provided the bowel prep drink by prescription and will have to drink the entire thing the day before surgery. It's not the best tasting thing in the world. I'd recommend refrigerating it before drinking. It helps. You are going to need health insurance. Unless you are a rich mofo, and by rich I mean millionaire, you WILL need health insurance that covers the entire procedure. The peritoneal graft method alone triples the cost of the surgery, bringing the total to over $160,000. This does not include the hospital stay, prescriptions, ambulance rides, nursing visits to your home or in the event of complications, another massive chunk of change because you had to go back to the hospital (in my case, that cellulitis infection was another $25,000+ billed to my insurance). I've blasted passed $200,000 in costs straight to my insurer. Beyond medical costs, the cost of travel to and from the hospital, including followup appointments is not cheap. It's New York City and each visit to Dr. Ting for a followup costs me about $75 to $100 in gas, tolls and parking. Even if your insurance pays your entire bill, I'd recommend saving a few thousand dollars for any other costs that may pop up. Beware of dreaded deductibles, co-insurance and the grand old "non-covered expenses" that can fuck you in a heartbeat and send you into medical bankruptcy. So also make sure you have a source of income to make installment payments should you end up hit with a big out of pocket bill. I was told by the billing people that Mount Sinai offers payment plans. Lastly, you will need two letters of recommendation for surgery, written to WPATH standards. The staff at CTMS will help you if you have trouble with these letters. You require one letter from an MD doctor and a second from a psychiatrist, therapist or psychologist. My letters were written by my endocrinologist and my psychotherapist.

-Buddy/Friend/Family Member/Paid Aide
-Bowel Prep Drink (prescription)
-Savings/Money
-Health Insurance
-Two Letters of Recommendation For SRS (one from MD doctor, one from psychiatrist/therapist)


After surgery and having the vaginal packing, catheter and wound vac removed, you begin dilation. Aftercare is important, especially when it comes to dilation. The important supplies were provided by the hospital. They gave me a set of dilators, MetroGel antibiotic lubricant (metronidazole gel), pain medication, stool softener and antibiotic pills. After a week and a half I no longer needed hardcore pain medication, so I stopped taking my Oxycontin prescription and switched to Tylenol Extra Strength as needed. I'd recommend a big bottle of Tylenol. For a few weeks after, you'll be sore when you stand and walk, especially if it's for longer than 10 minutes. All the swelling makes you feel a lot of sore pressure in the surgery site. It also helps with any soreness during dilation. Pop a couple Tylenol an hour prior. You're going to need something to sleep on and lay on during the day. You'll bleed overnight, and especially during dilation. Get menstrual pads to help absorb blood and fluids. It's not that bad, but when you're sleeping for several hours, stuff drips out over time. By one month post-op, you shouldn't need menstrual pads anymore. If you received the peritoneal graft, you will have to switch to panty liners to help absorb any peritoneal fluids that leak out from the vagina throughout the course of the day and night. During dilation, between the blood and the lube, it'll get messy. Waterproof bed-sheets or absorbent bed pads will prevent you from getting stuff all over your good sheets or through and onto your mattress. Paper towels, tissues and a ton of 3 inch to 4 inch gauze pads are a must for clean up. Buy an antibiotic ointment like bacitracin or Neosporin to treat sore spots or open wounds. Keep them covered with gauze overnight to help them heal. You might want to get more laxatives after your stool softener prescription runs out to help keep your poop softer. For the first few weeks post-op, you don't want solid poops and you're not supposed to strain (aka pushing) when doing a number two. Buy fiber gummies to help your poop too. You can't sit upright for about a month at least, maybe two. You're not supposed to put any pressure on the surgery site and it is still somewhat uncomfortable after several weeks. The hospital provided me a free butt donut to sit on, but you might need to buy one. Donuts are a godsend and make everything so much more comfortable, especially car rides to and from appointments. Eventually you might need tweezers to help pull out the stitches as they dissolve and come loose. When the MetroGel lube runs out, I started using simple K-Y water-based jelly lube. Buy lots of lube. LOTS. Dilating twice a day, everyday, eventually up to three or four times a day, you'll need it. A hand-held mirror is very helpful for being able to see what you're doing. It didn't take long to start figuring out how to dilate by feel, but it's also good to keep close watch of your healing progress and inspect yourself for possible complications or infection. Speaking of infection, buy a thermometer to monitor yourself for fevers, especially during the first couple weeks post-op. You might not feel feverish, but check yourself a few times a day anyway. I'd recommend large ABD pads to use as a crotch cushion for when you have to wear pants. It helps with comfort. For the first two or so weeks, you'll want comfy yoga pants. Jeans are just too tight on the surgery site, even with ABD pads. By three or four weeks, jeans are okay with ABD pads to cushion your crotch. I suppose long skirts would also work for when you must go out in public or to appointments. Skirts and dresses may be better for while you still have the catheter and wound vac installed. Swelling is going to make peeing messy for a while, so beware of spray. I highly recommend a women's camping pee device like GoGirl to help contain the spray and send it out in a controlled stream. Be sure to clean it after every use. With such frequent dilation, you may occasionally need to flush out the vaginal canal. Periodically maintaining the interior should help flush out dried lube left behind, dead skin cells that shed over time and urine or other things that manage to get in there. Early on, I'd recommend a douche device filled with purified or distilled water be used once every couple of weeks at least.

-Dilator Set
-MetroGel (prescription)
-Pain Medication (prescription)
-KY Water-based Jelly
-Paper Towels
-Tissues
-3" to 4" Gauze Pads
-Absorbent Bed Pads or Waterproof Bed-sheet
-Hand-held Mirror
-Bacitracin or Neosporin
-Menstrual Pads
-Panty Liners
-Fiber Gummies or Supplements
-Thermometer
-Butt Donut
-Tweezers
-Extra Strength Tylenol
-Laxative/Stool Softener
-ABD Pads
-Yoga Pants or Long Skirts/Casual Dress
-GoGirl pee funnel or similar device
-Douche device
-Distilled or Purified Water

Month Two Post-Op

DAY 35 (FIVE WEEKS POST-OP)

Life is getting back to normal. There is no more swelling pain anywhere, no more occasional pinches or jolts or stings. I can do chores with ease, walk completely normally with no awkwardness or discomfort and lift things upwards of 30 pounds without a problem. I can squat down if necessary and bending isn't really an issue either. Urination is still spraying, it's likely going to keep being an annoying issue for another few weeks. I still can't sit upright, even on soft surfaces, so for now it's still use a butt donut, lounge, lay or stand. I can shift my sitting position to put all the pressure onto a cheek or sit on top of one of my legs and use it as an improvised butt donut. Healing is going well. The areas that were struggling, left open for the drainage sites, have finally healed over. I also masturbated again. It seems my sex drive is still going strong. This is the third time I've orgasmed from external clitoral stimulation. Each time the orgasms have improved in intensity. They just get better with time. Things are going great. However, the other day I ripped a suture spot beneath my clitoris from wearing tight denim jeans. I assume the tightness pulled on the surgery site when I bent over and something was torn. I bled a bit, but it has already begun to heal. I strongly advise even after over a month to be careful with tight, rough clothing like denim. Pack your crotch with layers of gauze, tissues or something else to cushion and shield the surgery site. It is still healing even at this point and you don't want to rip anything open. Dumbass... Oh well, it is healing already and the bleeding stopped. I still use panty liners and a gauze pad to help absorb peritoneal fluids that leak throughout the day and night. As I've said before, I might be doing this for a very long time, if not the rest of my life. The abdominal hardness from my cellulitis infection is finally gone.

DAY 42 (SIX WEEKS POST-OP)

It's now six weeks after surgery. Not much has changed. Some more sutures have come out around the clitoris and from underneath the clitoral hood. Sitting is slowly improving but I still cannot put direct pressure on the surgery site. Dilation is going very well. I had lost a bit of depth since surgery, down to about five and half inches (5.5") of depth from an original six and quarter inches (6.25"). However I've noticed I am slowly regaining depth and am back up to about five and three quarters inches (5.75"). I'm hoping to regain the original depth entirely. At this point I am able to look down at my crotch, now for the most part healed, and the feeling is incredible. It's gone. My dick, that disgusting tumor, is finally gone. I feel whole, complete, kinda normal for the first time in my life. The outcome isn't perfect, and I'll need cosmetic revisions in the future for the sake of realism, but to not have a penis anymore is something else. I can shower, use the toilet and change my clothes without becoming depressed. I can look in the mirror and not want to cry at seeing my body. Everything so far has been worth the trouble and I don't regret a second of it. Oh and tucking? Fuck yeah, no more tucking. Ever.

DAY 49 (SEVEN WEEKS POST-OP)

This week I learned the importance of not skipping dilation. My dilation schedule is three times a day for 30 minutes each time. I dilate at 9am when I wake up, around mid-day at 4pm and then before bed around 10pm. One day I was busy and skipped my morning dilation. Upon doing my mid-day dilation, it was very tight going in. It is very important not to leave gaps between dilations in excess of 12 hours. Skipping mid-day is okay if I'm really busy and get interrupted. I've done that without issue. Morning and night is a must, no excuses. I had to put in a new order of lube. A 4oz bottle of K-Y jelly will last just over a week of daily dilations. I had ordered a bunch hoping that would last months, but apparently not. I'm gonna need a lot more lube.

Also this week during another dilation session, I noticed I wasn't feeling the dilator in parts of the vagina. I could feel the pressure and stretching along the right side of my vaginal canal but little to no sensation in the left side. I never really paid much attention to it since surgery but have noticed more feeling on the right over the passed several weeks. Concerned I might have numbness or nerve damage from the surgery I got creative to test sensation in the vagina. I'm still not allowed to engage in penetrative sexual activities and don't wanna poke around in there with my fingers, so I took my vibrator and held it tightly against the portion of the dilator sticking out of my vagina. The dilator began to vibrate and I could feel it inside. I have no feeling along a large portion of the left vaginal wall. The rest of my vagina, the right side, the deepest end and the first inch or so in from the entrance felt the vibration. It actually felt pretty good, but I need to behave and not mess around in there. Anyway, I will have to bring up this left side numbness to the surgeon.

DAY 56 (EIGHT WEEKS POST-OP)

Two months after surgery. Not much has changed. Healing is pretty much done. All that's left are scars along the inguinal incisions that will eventually fade to a natural skin tone in a couple years. The clit has full sensation and orgasms get better and more powerful with time. Dilation is pretty simple. The peritoneal graft is doing its job producing natural lubrication. I still use the panty liners to absorb fluid leakage throughout the day and over the night. I'm able to comfortably sleep on my sides again, finally! I hate sleeping straight on my back. Urination is still slightly messy but I think it's improving. I still can't sit directly upright. Putting pressure on the surgery site is still uncomfortable. I think this will remain an issue for another month, but sitting in any number of other positions to help keep direct pressure off my vagina is much easier now. I see Dr. Ting in a few days.

DAY 59 (THIRD TING FOLLOW-UP)

Today I saw Dr. Ting in New York City. These follow-up appointments are quick. He inspected the vagina and was impressed with rate of recovery. My healing is going excellent. There is still swelling in areas around the urethra. The messy peeing will still be a bit of an issue as that swelling has to come down. As of today, I'm allowed to have anal sex again. I'll be allowed to exercise, lift weights and the like in another month. I also can take submerged baths and swim in a month. For now, I've not been allowed to submerge in water, only taking showers. I cannot ride a bicycle, motorcycle or horseback (not that I ever have), basically nothing in between my legs until further notice. I can't have any penetrative vaginal sex for at least three more months. My next appointment with Dr. Ting is in February 2019 and he will decide then if it is okay. Also today I begin dilating with the next size up. I will start my dilating sessions by dividing the 30 minutes between two sizes. I'll do 15 minutes of the dilation with the current purple dilator and then use the larger blue dilator for the remaining 15 minutes. Eventually, I'll be able to do the blue dilator for the full 30 minutes. The blue dilator is approximately half a centimeter wider in diameter than the purple. My first time going up to the next size, it wasn't all that tight. The deepest end though is a bit tighter. The dilators taper off at the tip to be thinner than most of the rest of the shaft, so the dilating doesn't make the far end as widened as the rest of the vaginal canal. The blue dilator's tip is much thicker than the purple, so the blue does not fit as deep as the purple can go. I found it is not a good idea to try to push it as deep as the purple. Upon removing the blue dilator after 15 minutes, there was some blood on it. I must have ripped something a little bit. For now, the purple dilator will be used first to loosen up and focus on depth training, while the blue will be used secondarily to increase girth. Eventually the far end of the vaginal canal will widen enough to go deeper. This will take time. It's for the best not to piss off a healing surgical site by jamming things places it doesn't fit.

Month One Post-Op

DAY 14 (TWO WEEKS POST-OP & FIRST TING FOLLOW-UP)

By two weeks I was able to walk around on my own, though slowly. I could go up and down the stairs and shower on my own as well. I had my first followup appointment back down in New York City that week and met with one of Dr. Ting's surgical team members. He inspected the surgery site to see the healing process and checked inside the vagina. Everybody was quite impressed with the rate of my recovery, especially considering the infection I also just had. I had concerns about why the clitoris was black, however he stated it was just a scab. The doctor asked me if I had an orgasm yet. The question had confused me, because I was like, "What?! I'm only two weeks post-op, I'm not touching shit." He recommended I begin stimulating the clitoris to help calm the sensitivity, getting it used to feeling. The neo-clitoris is definitely very very sensitive, but I'm not comfortable with the idea of messing with anything yet. By about the end of the second week, I was able to drive my car again, but short distances. I was able to get around the house better, up and down stairs, cook my own food. Though, much of my time was still spent in bed. I wasn't supposed to strain myself or over-exert myself. No exercise. No lifting anything heavier than five pounds. Bleeding during dilation was minimal and dilation was nearly painless. It was more uncomfortable going in, as the angle of inserting is odd, requiring it to slide under and around the pelvic bone. This can be quite uncomfortable, but once fully inserted, the dilating is fairly painless. I'd rate it a 0 to 2. In between going to the bathroom and getting food, I laid in bed and played video games or watched TV and movies on Netflix and Hulu. I've begun notice an issue with urination that I hoped would improve with time. I do no pee in a straight stream, but instead the urine sprays all over. I currently fold up a wad of toilet paper to hold in front to block the spray from getting everywhere. I'm not sure if this is the result of swelling, scabs or something else, but I hope it improves.

DAY 21 (THREE WEEKS POST-OP)

During the third week, I was fairly close to being back to normal. I could get around the house easily and even drive my car to do basic errands like picking up prescriptions or fast food. Dilation was becoming pretty quick, painless and no more blood. Twice a day for 30 minutes each. The MetroGel ran out and I switched to using KY jelly for dilation. During my first followup appointment, I was told to should start to stimulate the clitoris to help the nerves get used to sensation. The area was very sensitive, almost too much. By the beginning of the third week, the scabs were shedding off. The scabs on and around the clit had come off too. Urination spray continues to be a problem. On day 21, I felt comfortable enough with my healing progress to try stimulating the neo-clitoris as recommended. There were still sutures in place, I could feel them. I wasn't sure if I should go that far, but I decided to try to go for an orgasm. Essentially, the neo-clitoris is constructed out of part of what was the glans of the penis, the head, tip, whatever. I had never really been able to ejaculate through stimulating only the head of my penis, so trying this was a challenge. After an hour of masturbating only externally on the clitoris, I orgasmed. New sensation... it didn't feel the same as my old ejaculation. It was like cumming but without the pulsing/pumping the penis normally does, a muscular pulsing necessary to squirt out semen from the testicles. None of that was there anymore. No more testicles, no more tubes, no more penis, no more erectile tissue. It was weird and new but still good. Then I noticed the best part: normally after cumming, I'd get this sudden sensation in my body of exhaustion, as if everything just wants to shut off. It's a chemical released into the male body after ejaculating called prolactin. It makes you sleepy. No sleepy though. No tiredness. No shut off. I hated that. I previously suffered from hypersensitivity and premature ejaculation, so whenever I had sex, even if there was no stimulation of my penis, it would just blast off and ruin sex for me anyway. Not anymore. I orgasmed and felt just fine, as if I could have just kept going. But that was enough, I'm still healing and shouldn't mess around too much. I was still very happy to achieve a clitoral orgasm. I had heard from many people over the years myths that post-op transsexuals cannot orgasm. Bullllshiiit. For the next 3 to 6 months, I'm not allowed to have vaginal sex, so that will have to wait, but at least I know I can get off via the clitoris until then.

DAY 22 (INFECTION FOLLOW-UP APPOINTMENT)

On Day 22 post-op, I had to return to New York City for a followup appointment with the infectious disease doctor to checkup on my recovery from the cellulitis infection. I was not confident in my ability to drive for long distances, but that day I had no choice but to drive myself after the person who was going to drive me ended up being unavailable. At only three weeks post-op, I was able to drive four hours round-trip into and out of the city, by myself. My cellulitis infection was defeated. One of the symptoms of the infection was a hard, tense lower abdomen. To the touch when pushing down, it felt as if I was tensing my abdominal muscles. They said it will take more time for my lower abdomen to recover and loosen up, but the infection is gone. The hot compresses help with this and I continued to use them. I returned home without incident. I honestly had no idea how well my recovery from surgery would go. During my efforts to research SRS and hear stories from other transwomen who underwent the procedure, I had mixed experiences about what recovery would be like. One told me I'd be barely able to walk around for a month. Others said they were up and about in two weeks. Either Dr. Ting is an SRS master or I'm just naturally awesome at recovering from a major surgery. Lone roadtrips at three weeks is impressive I'd think. I dilated when I got home. No blood. No pain. Slipped in, 30 minutes later slipped out. Awesomeness. The drainage site they left unsutured had begun to finally show signs of healing. It will take time for the wounds there to seal closed, and I'll probably have a bit larger scarring as a result. I'm not happy about it and just hoped for the best.

DAY 25 (PERITONEAL GRAFT UPDATE)

Today I had two new experiences. In the morning I woke up and used the bathroom. I had been using gauze smeared in bacitracin overnight to help protect the drainage site wounds struggling to heal on the lower left labia. I had noticed that the gauze over-time would become moist with a fluid of some sort. When I peeled off the gauze to pee, a small amount of clear fluid plopped out of my vagina into the toilet. The peritoneal tissue is now producing peritoneal fluids... it's producing natural lubrication. Good to know the graft is actually working. However, I'm concerned I may require continued use of pads or something else to help absorb the fluids throughout the day and night to prevent my underwear from getting covered in it instead. At this point I am no longer bleeding at all, even after dilation. Because I am no longer bleeding and my only concern is some peritoneal fluid leakage, I've switched to using panty liners rather than full size pads. Way more comfy. My sutures have begun to dissolve and fall out as well. I carefully removed some strays that were sticking out around the exterior of the vaginal opening and from the underside of the clitoris and near the urethra. I hope the rest in those spots can be removed soon. The prickly tied-off ends occasionally poke sensitive parts.

28 DAYS LATER (FOUR WEEKS POST-OP)(ONE MONTH)

Four weeks after surgery, life feels mostly back to normal. Sutures continue to come out as they dissolve. Still no more bleeding. The drainage site wounds are finally healing, some spots are finally healed or sealed over. Swelling and soreness are almost completely gone. There is some sore sensitivity in both labias if pushed on. Urination is still a problem however. When I use the bathroom to pee, it still sprays all over and I have to use a plastic scoop thing I found in my kitchen to try to block the spray and send it down into the toilet instead of everywhere. The scabs have all shedded off. Dilation is going well. There is still a bit of discomfort if I try to sit up, placing pressure onto the surgery site, so I still need to either lounge or use something to sit on to keep pressure off. I'm walking entirely normally and walking is a lot better without larger menstrual pads. The panty liners have been working out just fine since I switched to them. The abdominal hardness from my cellulitis infection has softened almost back to normal, though I still feel some tightness in the area if I stretch.

DAY 29 (SECOND TING FOLLOW-UP)

I returned to New York City for another follow-up appointment with Dr. Ting. As of now, I am to start dilating three times a day for 20 to 30 minutes each, instead of twice a day. I was also told I am allowed to lift up to 20 pounds of weight, instead of no more than five pounds. The urination spray problem is common and normal, caused by swelling around the urethra. Within another month, I should be peeing normally instead of spraying a mess. I was told I am still not allowed to engage in any bottom sex, that includes receiving anal, for at least another month. I was never a fan of it anyway though. I'm also allowed to drink alcohol again. Healing is apparently going very well. They scheduled me to return for a third follow-up appointment a month from now (Day 60). Tomorrow is one month post-op. I'm very happy with how things are going. I tried masturbating again, clitoris stimulation only, but this time using a vibrator. I was able to reach orgasm within ten minutes rather than an hour like doing it the first time with just fingers. The orgasm was more intense this time and fluid leaked out. My prostate still works it seems.

The Surgery, Complications & Recovery

Day of the surgery, we woke up at 4:00am and left the house around 4:30am to drive to the Mount Sinai New York Eye & Ear Infirmary (NYEE) where the surgery was to be performed. Yeah, I was a bit confused too that I was having a sex change at an "Eye & Ear Infirmary". I had originally scheduled an afternoon appointment, however because I was getting the peritoneal graft method, they only schedule morning appointments because a second surgeon was only available in the mornings. This surgeon, Dr. Iskandar, specializes in the laparoscopic peritoneal graft procedure. I arrived at NYEE around 6:30am and was admitted and sent up to the P.A.C.U. where I was given medical gowns and bags to put my clothes in. I waited in the P.A.C.U. for about an hour. My surgery was scheduled for 7:30am. Different members of the surgical team popped into my waiting curtain area to see how I was doing and asked me some questions. I expected I would be terrified or at least anxious but the whole time I was actually pretty calm and happy. Eventually Dr. Iskandar came in to introduce himself. He would be the one taking the peritoneal graft. Dr. Ting soon popped in to see how I was. Then the time came and I walked with Dr. Ting into the OR. At this point things got real. I had never seen a real OR before. There was about half a dozen other people in the room, all part of the surgical team and they began introducing themselves. I was kinda overwhelmed but still calm. I laid down on the operating table. The anesthesiologist came and told me he was going to give me a shot which would make me woozy as they prepared the IVs. Within a couple minutes of the shot I began to feel almost like being drunk, but not drunk. The room kind of spun. Suddenly I was out cold.

Surgery began and lasted approximately four hours. The peritoneal graft involves a second surgeon to assist Dr. Ting. They entered the abdomen with a laparoscope to cut a graft from the peritoneal lining. This lining is a sack that basically holds all your organs together like a bag of fruit. It is a pinkish, quickly healing, self lubricating mucosal tissue. The graft is used to build the vaginal wall during the vaginoplasty, allowing for the neo-vagina to have a degree of self lubrication, a natural pinkish appearance and can allow for more depth, especially in cases of patients who have small male genitalia. In my case, my penis was only three and a half inches when fully erect. With the graft, I had a total of six inches of depth post-surgery. Dr. Iskandar performed the graft, while Dr. Ting performed the penile inversion vaginoplasty and labiaplasty.

I woke up back in the P.A.C.U. The surgery was complete. I didn't feel any pain. Eventually I was wheeled in my bed up to the recovery floor where I was to stay in the hospital for a total of four days (including the surgery day). I had a foley catheter in my urethra to urinate into a bag. They also installed a Medela wound vac. This is a device used to help improve the recovery process while draining fluids and blood. It maintains consistent negative air pressure on the surgery site. The drainage tubes connected to a small Medela Wound Vac pump device which gathered the drained fluids.

DAY 1, 2, 3 (HOSPITAL POST-OP)

During the time in the hospital I slept a lot. Napping, lots of napping. The TV sucked. They only had like eight channels, so I watched the news mostly. Hospital food is... well, it's hospital food. It wasn't great. A few of the meals were actually good, but for the first couple days I didn't have too much of an appetite as it was. Combine that with nasty food and I basically ate pudding, yogurt or drank water or apple juice. The nursing staff were wonderful. Everybody was super friendly and helpful. Buzz for help and somebody is in the room within 30 seconds. Sleep wasn't so good though, so I napped a lot more. I usually sleep on my sides, but you can't do that. I was stuck laying on my back and hospital pillows are just terrible. The foley catheter gave me a lot of trouble too. It depends on gravity to drain the urine and if it's not laying correctly, it doesn't drain and I start filling my bladder and have to bother the nurses to readjust the tube. On the second night, the wound vac had an air leak. So the alarm buzzed all fucking night. The nurses weren't able to fix it and had to wait for doctors to come in the morning. After a good 10 hours of relentless leak alarm beeping, a doctor came to fix the air leak. I didn't have anymore leaks afterwards. Pain was managed well. At worst, the pain was a 6 out of 10, 10 being excruciating torment. Most of the irritation was from the catheter and the occasional clogging that prevented it from draining urine. I hated the catheter. They tried to have me getting out of the hospital bed each day to walk a bit. I was started back on my Estrogen two days after surgery.

I was discharged on Friday, three days after surgery and went home with the catheter and the wound vac still in. I was prescribed antibiotic pills, Oxycontin and a stool softener to help the poo pass easier. The pain medication however constipated me, so there was no pooping. The ride home was not really fun... Manhattan potholes and traffic is harsh post-op. I slept the rest of the drive home. I spent most of my time in bed. The next day I began having fevers and started vomiting. They assigned home nursing visits to check up on me. By Sunday, the fevers hit 102 and I was throwing up pretty much anything I ate or drank. The visiting nurses became concerned, as was I. They got in contact with the doctors after a few failed attempts myself and we were told I might have to come back to the hospital.

DAY 5 (CELLULITIS INFECTION)

Around 10pm Sunday night (Day 5 post-op), with a 102 fever and still vomiting, I was driven to the Mount Sinai Beth Israel ER by a family member. I stayed in the ER for about 3 or so hours. An IV was put in to help with my dehydration from vomiting and was then given x-rays and a cat-scan. I had to drink a contrast drink for the cat-scan, but then I threw it up. Projectile vomiting. That's the first time I ever did that in my life. An infectious disease doctor was called in after I was admitted to Beth Israel and moved up into a room. They determined I had an infection in my lower abdomen called cellulitis, and I was put on a regimen of IV antibiotics. The next morning some of the surgical team doctors came to check in on me. They decided to remove the foley catheter and the wound vac. I was already starting to feel better. The removal was extremely painful and I screamed. The pain only lasted several seconds, but that was totally a 9 or 10 scale pain. They then removed the vaginal packing and I was to start dilating that day. They did it for me the first time and it was very uncomfortable. It was very tight, but the entire dilator went in to the last dot. A full six inches of depth, about average for real women, who average around five and a half to six inches of vaginal depth, vulva to cervix. Dilation is required for the rest of my life. This process involves the insertion of what is basically a medical-grade dildo. It is slowly inserted into the full depth of the vagina and held in place for 20-30 minutes. This helps maintain the shape, depth and girth of the neo-vagina. Over time, I will have to use larger sizes to increase the girth. For now, it was once a day, then twice a day. Eventually up to four times a day. By a year post-op, I will have to dilate once a week for the rest of my life. I was told I need to try to urinate within several hours or they'll have to put the foley catheter back in. I made three attempts to pee. The final time I only got a few drips out. They put the catheter back in, which was very painful as well. A solid 8 or 9 on the pain scale. I screamed again. I think I was just very irritated and swollen down there.

DAY 7 (ONE WEEK POST-OP)

That night I was transferred back to the New York Eye & Ear facility a couple blocks away by ambulance. The medics were kinda cool and funny. I was admitted back into the same recovery room I first stayed in after surgery and remained back in the hospital for four more days. I was given a constant flow of IV antibiotics. This second stay was rough. I didn't sleep all that well. Nurses would have to come in in the middle of the night to take bloodwork and give shots or change the IVs. But I was feeling a lot better. Hospital food was still kinda gross, but at least breakfast was always good. I got waffles and bacon. I started having to dilate on my own, which is hard with a catheter still inserted. The doctor had to assist me in trying to get the dilator in myself because of the catheter. I managed to get it myself from that point on. It just made dilation tighter and complicated. I dilated once a day for 20 minutes each time. I started getting kinda antsy and miserable being in the hospital. I was discharged after four days. The catheter was removed and I was able to pee on my own just fine. Thankfully, with the swelling down, the second time taking out the catheter was mostly painless. I was released that night and went home.

At about only a week and a half post-op, I no longer needed hardcore pain medication. I took Tylenol everyday and it was enough to keep the pain in the 0 to 3 range. I began pooping again. You're not allowed to strain while using the bathroom, so I just let it flow on its own. Getting around got easier. I had to keep using heat compression pads on my abdomen to help the cellulitis recovery. I was also prescribed more antibiotic pills for home. Dilation got easier and each time less blood. I was prescribed a medical gel for the dilation as both a lubricant and a vaginal antibiotic. I had to use this gel, Metronidazole or MetroGel, every time I dilated until I was all out of the gel. I started using menstrual pads to help absorb bleeding from the surgery site. They left a drainage wound open, which continued to bleed a bit. It would slowly heal on its own. Eventually it stopped bleeding. Dilation ramped up to twice a day for 20-30 minutes each time. The vaginal canal got looser, however some depth was lost. I was down to approximately five and a half inches. I lost half an inch of depth. Still average for women.

Preparing For Surgery

I had Sex Reassignment Surgery from male to female in September of 2018. My surgeon was Dr. Jess Ting of Mount Sinai hospital in New York City. I have been transitioning for eleven years. I started when I was 19 and have been on HRT for 9 years. It has been a long time coming to finally accomplish this major aspect of becoming who I should be. After a while of trying to research SRS, I read about Dr. Ting. I was impressed by what patient testimonials I was able to find around the internet and was particularly curious about his new method of using peritoneal tissue grafts in the procedure. On September 11, 2018 I had standard penile inversion sex reassignment with peritoneal graft method of vaginoplasty. I am documenting my surgical recovery with both this blog and photos on Imgur so others seeking surgery can find detailed information they need about Dr. Ting, Mount Sinai hospital and the peritoneal graft method of surgery.

WARNING: NSFW: Images of genitalia, medical gore and blood.
Link to Imgur Photos: https://imgur.com/a/tJHkd1g

I first went for my intake appointments at Mount Sinai hospital's new Center for Transgender Medicine and Surgery in New York City in August of 2017. I had to meet with three people who would interview me. First was a social worker. She asked me questions and we filled out some paperwork, including designating a family member as a healthcare proxy in the event I needed someone to make decisions on my behalf, like if I end up in a coma or something. Second, I met a psychiatrist who also asked me many of the same questions about myself, my transition, what support I have and the like. He also assisted in getting my letters of recommendation for surgery together. Third, I had to meet with a nurse practitioner, again asking questions, confirming I'm aware of risks and how things work and I had to provide bloodwork. In total, my appointments took a couple of hours. My appointment to meet with and have a consult with Dr. Ting was scheduled. Before I went to my appointments at CTMS, I had to have two letters of recommendation for surgery written by my endocrinologist and another by a psychotherapist. There is a specific format they must be written in. The WPATH standard outline for letters of recommendation is a good guide to provide your doctors or therapists if they do not know what to write. If the letters aren't right, the social worker or psychiatrist you meet with will help get them corrected.

I met with Dr. Ting at his office at Mount Sinai's main hospital next to Central Park in Manhattan in December of 2017. We discussed the surgery, possible complications, risks and expectations. He showed me photos of other patients' results and I was confident in his abilities. We discussed the two options for surgery, one being the standard penile inversion vaginoplasty, the other was his newer method involving a peritoneal graft. I decided I would go with the peritoneal graft method. He inspected my genitalia and explained a bit what they would be doing in the surgery. He was friendly yet kinda serious and direct.

I met with the billing and other office staff after meeting with Dr. Ting to schedule the surgery date. I was told my insurance would cover 100% of the expenses. It did. I never got one bill. The only reason I got SRS was because my insurance paid for it, otherwise I would never have been able to afford it. I originally would have been scheduled for June 2018, but I did not want to spend my summer recovering from surgery. I was scheduled for September 11, 2018 instead.

Months went by and eventually I was scheduled for a series of hair removal appointments to destroy the pubic hair on my genitals before surgery. This is important for SRS patients, especially if the surgeon does not surgically remove the hair follicles during the surgery too. You do not want pubic hair growing inside of your vagina. Gross. I went to four laser hair removal appointments at Mount Sinai's Union Square facility. They used a really cool hair removal machine, the Lightsheer Infinity. I had previously had laser hair removal on my face and was terrified when they told me there would be no anesthetic. Laser hair removal is typically painful, especially in sensitive areas. But this machine was different than the previous Candela laser machine I had used on my face. In just four sessions, I had a solid 80% hair loss with no pain at all. I actually had to ask if the machine was even working. There was basically no feeling at all, just the pressure of them pushing the laser device onto my skin each time they zapped. Towards the taint region between my anus and scrotum there were very slight pinching sensations, but still painless. I was originally told I'd be receiving electrolysis, but they switched to the laser machine by the time my appointments were scheduled. Dr. Ting also surgically removes hair follicles during surgery. Any surviving hair follicles were scraped off with a scalpel.

A week prior to the surgery I had the pre-surgery testing appointment. I went back to the Union Square facility and met with doctors to give some more bloodwork and review everything that is about to happen. They test you for STDs, drug use, tobacco use and the like. I was told to stop taking my estrogen and progesterone pills a week prior to surgery. This is to help prevent blood clots, particularly in the legs as I would be bed ridden for over a week. They also told me to stop taking my anti-androgen (a testosterone blocker) the day before surgery. I was also prescribed the bowel prep drink that I had to consume the day before surgery.

On September 10th, the day before surgery I had to consume a gallon of GaviLyte, a bowel preparation laxative drink. I had heard from a lot of people that the bowel prep drink is disgusting. Mine came with a lemon flavor packet. The drink was weird tasting, but bearable. I totally recommend refrigerating it before drinking. Warm GaviLyte is kinda gross. The cold definitely helps. Every ten minutes I had to down a glass of it, approximately 8 ounces (1 cup) each time until I finished it all. Within 40 minutes I was pooping. Fortunately, there was no discomfort or pain with the pooping. It starts coming out as pure liquid within a couple hours, like diarrhea but without the pain, burning and cramping. The day before surgery I was only allowed to have breakfast. I decided to eat nothing. I had coffee in the morning and nothing else the whole day except the GaviLyte and water. I went to bed early because my surgery was early in the morning and I had to drive into New York City with a family member.