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.