Next Stop Surgery

I have to admit that I am losing interest in writing this blog and thus posts are likely to be quite infrequent from now on; I doubt they will be particularly missed in this disposable society that we live in. I had a lovely holiday in Austria at the end of August but now, at the end of October, it seems a bit pointless writing about it… even if, should I write about it on a grey, miserable day, I might enjoy the reminiscence. But I set this blog up to write about life as I transition and live life as my true, female self, and I suppose I feel a tiny obligation to continue writing about pertinent matters if only so that it will help others on the same path.

At the start of October I had four health appointments. One was with Endrocrinology to check my progress with hormones and to do a blood test to check oestrogen levels, during which I was told that in 2-3 weeks I’d get a letter confirming those levels – unsurprisingly, three weeks have passed and I have heard nothing. Another was for a non-transition health issue which remains and worries me after an appointment with my doctor today – more tests and a scan on the horizon. The third appointment was for my three-monthly blocker injection… which does not seem to have been totally successful this time… causing some distressing moments. The final, and most significant, appointment was a milestone on my transition path which was an assessment for surgery.

In the UK, or Northern Ireland anyway, one is considered for surgery at some point after having been on hormones for over 12 months and as this target passed for me in July then I was therefore due for surgical assessment at some point. In the past, patients have been sent over to Brighton, where the surgery takes place, for this assessment, but due to what would seem to be a sensible cost saving measure, perhaps due to the increasing number of transsexual people passing through the healthcare system, Dr Thomas from Brighton and two of his assistants were invited over to the Belfast GIC for an ‘assessment open day’. The near two-hour appointment was split into two parts. The first session was conducted by a very pleasant lady who talked to three girls including myself through the surgery path from admittance to care and procedures once at home again a week after surgery, including pre-surgery preparations. The second session, following a form-filling exercise, was with Dr Thomas himself who asked a few questions about my path and my health and medical history, answered my questions on surgery and explained risks, and conducted an examination to confirm if I would need electrolysis to the male appendage that I am still lumbered with; although this session was informative, it all felt increasingly rushed to me just like a lot of sessions at the doctor and in the end it was as if he couldn’t kick me out quick enough.

Now, as some/many of you may know, there are at least two options as regards surgery… well, three actually, because one can decide to have nothing done at all… although unless there is some particular health reason or circumstance to not have anything done at all I personally find it bizarre to be a woman but remain with the deformity of a male organ. Anyway, casting that option swiftly aside, the option chosen by many is the full works, with the male genitalia dispensed with and parts of it used to fashion a realistic female anatomy including a full vagina and also a clitoris – sorry, can’t use the male anatomy words vividly, I hate them too much, but you can Google details on the surgery procedure if you want to. However, there is a third option, which is a cosmetic option consisting of the full-works option minus the vaginoplasty, such that cosmetically everything looks just as good but there is no functioning vagina. Now I have to say that so many people seem to assume that every transsexual would have the full-works option, and indeed someone said to me last year “don’t even think about not having a vagina”… but how does anyone know what is right for me except for me?!? Another opinion I have heard is that they “wouldn’t feel complete as a woman without a vagina”… and it is fine for them to have that opinion for them… yet I feel complete already, everyday I live as woman, do everything in a typically female fashion, and get along fine with practically never any bother from anyone, even if I do hate having the male appendage that becomes visible when I am inside a toilet cubicle… and so to remove it will make me feel physically right. Going back to the appointment, it seemed to me that the people from Brighton also assume by default (unless advised perhaps of any medical issue) that everyone is going for the full works option, and never at any point was any mention of the other option made, apart from when I brought it up in private… because, you see, I have pretty much always been in two minds since I started this path as to which of the two surgeries are most appropriate for me. There are pros and cons with both options of course – for example, to not have a vagina obviously rules out penetrative sexual activity and consequently rules out a relationship with a proportion of male partners who would want that (although, let’s be honest and realistic, I’m already ruled out from having a relationship with the majority of available partners because of my transsexual gender history), but on the flip side to have a vaginoplasty means a variety of increased risks with surgery, having to dilate for the rest of one’s life (or have intercourse with a partner on a fairly regular basis – not a problem for some if they have a partner I guess) to keep the vagina open with a very time-consuming dilation routine in the initial few months, having to have (what I presume to be painful) electrolysis on the male appendage prior to surgery, having a prolonged recovery period, and so on. Another factor is one’s current attitude to the male genitalia – some people can put up with the bits without too much bother although do want to get rid of them while I am to the other extreme and loath them, have almost developed a phobia of them such that I can’t even imagine having intercourse with a guy (although like the idea of close companionship and kisses/hugs), and can’t watch a couple making love on the screen (for other reasons I won’t go into)… and there are others whose opinion is in between. Therefore, I went back into the lady conducting the first session on my own and went through the whole thing again on the premise that if I went for the cosmetic option then what would the revised schedule be… and I explained my current preference more for the cosmetic routine and she understood my view… even if she had not considered age to be a factor as she thought I was about 35! 🙂

Having considered the pros and cons… I am still considering them… and I will continue to do so for a while, especially as I am soon likely to experience some interaction with one or two potential male partners and when I eventually tell them of my history, if they don’t run a mile, I will broach the subject of intercourse (although have already done so with one) and consider reactions. But at the moment, having had the assessment, I have verged even more towards the cosmetic option taking account of my age, my work lifestyle which involves a huge amount of commuting time, that I live in an isolated location with little local support should anything go wrong, consequent risk aversion, my hatred of male genitalia (if only due to being stuck with it for such an awful long time), and my dislike of sex. I will go think some more… my opinion may change… or may not…

11 thoughts on “Next Stop Surgery

  1. Well, i, for one will miss them. You are very detailed in the way that you write, which is both rare and incredibly useful. Your day by day diary following going full time was fascinated and I looked forward to getting the email update that you’d added to it. I don’t think for a moment your voice is disposable, but I do understand that need to stop doing it. I hope that if you stop, you’ll continue to record your journey somewhere. I suspect when you look back on it, you’ll find it interesting / helpful. I told someone the other day that my blog was 4 years old and then looked and realised it was 6 and was horrified and how long I’d been navel gazing on this journey and that action is required. I talk nonsense, but I realise now that even nonsense can be useful! Given that yours is actually helpful, it seems a shame…

  2. Hi Andrea,

    Obviously you must choose the surgery option that you feel is right for you so I am not trying to change your mind, but do you want me to outline my thoughts on why I chose full vaginoplasty and how I managed to balance work and dilation?

    • Thanks, it’s nice of u to ask, go ahead and outline because it may help someone else even if they end up of no use to me. Personally I can’t stand the thought of having to dilate using something that even reminds me of the male appendage and also reminding me essentially of intercourse…. and using to keep on doing it for the rest of my life.
      Another factor I forgot to mention, I’m scared of choosing the wrong partner and ending up being used as a sex machine because he knows there’s no risk of me becoming pendant. Extreme I know.

    • I chose full vaginoplasty rather than the “cosmetic” variation. I never really considered the cosmetic variation but it was put to me that if dilation was too onerous then I could simply stop and the vaginal canal would slowly close and leave me with the same outcome as having gone cosmetic in the first place. This way I could put off any choice.

      If I had chosen cosmetic then if I ever changed my mind my only option would be privately funded sigmoid colon vaginoplasty. Expensive and risky.

      “… I can’t stand the thought of having to dilate using something that even reminds me of the male appendage …”

      All I can say to that is that dilators bear no great resemblance to male genitalia.

      So how onerous is dilation? Well, it all depends on your surgeon and they all have very differing schedules. Many of my friends used Mr Thomas and dilation took up a lot of their day. After six months they were on two hours a day – usually once in the morning and once in the evening. For myself, at six months I was on 15 minutes twice a week because my surgeon (Mr Fenton in Leeds) uses a different technique. The most I ever dilated was 15 minutes 3 times a day for a couple of weeks. I also did not dilate for the first 6 weeks after surgery because Mr F does not like ramming plastic objects into fresh surgical wounds. Most other surgeons start you on day 5. These days I dilate once a week for 15 – 30 minutes.

      Genital hair removal is a nuisance but if you are dark haired down below you can do the initial clearances with laser and then follow up with weekly sessions of electro. That is what I did, 4 laser sessions and a dozen electro and then a wait to check for regrowth. It worked and I am hair free internally (which is nice 🙂 🙂 ) This did add 9 months to my wait so that was frustrating but I wanted to be sure it would be OK. In terms of pain, the laser was no worse than facial laser and electro was made tolerable by a tube of EMLA cream being liberally applied 30 minutes beforehand.

      The downside of Mr Fenton’s technique is that the clitoris is not sufficiently hooded and if I could have a revision I would have my hood redone. I think that Mr Thomas’s result looks more natural but no one is checking other than me so I am not too fussed. A number of my friends have had Mr Thomas do their cosmetic option and they seem very happy with the outcome. A lady who I was in Leeds with had her cosmetic and I know that she is happy with her outcome too. All the UK surgeons offer it as an option.

      One other thing I would add is do not travel home too soon. I know a few who did a 6 hour journey 7 days after surgery and they got huge swelling and infections from irritating the wound from sitting down on it for so long. They would have been better advised to hire a cheap hotel for a week and just stay there. In the early stages the swelling goes down a LOT in the first few weeks. For me it was easy as I only live an hour from Leeds and I just reclined the car chair and when I got home I went straight to bed and stayed there for another week.

      If you have any questions then just post them below

      • Thanks for the detailed reply, lots of good information, and good to hear about people having both options and being happy.
        The hotel stay idea (which would be in or around Brighton for me) is an interesting idea, though I’m not sure how much an impersonal temporary abode without all home comforts would be post-op for someone who might feel down due to pain, where everything is not to-hand…..

      • There is not a lot of pain post-op. It is uncomfortable but after the first day pain is minimal and they only give you paracetamol and ibuprofen. Sitting down, on the other hand, that really, really hurts.

        Men sit on their perineum, their genitals are forward of that. Women sit on their genitals because they are underneath. You would be sitting directly on your surgery and possibly with a catheter in place. These days, many patients are discharged with a catheter in place as a blocked uretha used to be a common post-op complication so allow for that in your travel plans.

  3. Hi Andrea

    I have loved following your blog. I guess many of us start blogging to use it as a way of externalising our thoughts. And on that basis I can well understand why you feel inclined to stop or at least become an infrequent blogger. I do think that blogs also serve as a guide to others coming behind on this path, so if you do stop posting please consider leaving it in place for a while.

    I wish you every success with surgery. In the beginning I didn’t feel the need, but your blog amongst others is inclining me toward maybe the cosmetic option, though I don’t (yet) share your distaste for that with which I was born.

    Thank you for blogging.

  4. A thoroughly interesting read, as are all your posts Andrea – I do hope you continue blogging.

    This post is particularly enlightening – I’ve learned new things from what you’ve written and the subsequent comments. Food for thought indeed, I can only begin to imagine how difficult it must be to weigh up all the options.

    All I can add is take your time and don’t rush (or be rushed by the medics) into a decision. Trust that a moment of clarity will come when you’ll just know inside what the right decision is. Heart wins over head every time, IMHO.

  5. I think that you will know what feels right for you, re whether having a vagina or not. For someone to tell you what is proper or not to feel like a woman is not for that person to decide. This is YOUR choice, not theirs. Also, regarding whether you will continue blogging or not, I hope you will as we do like hearing from you. xx

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