Bottom Surgery

On February 6th 2019 I underwent a “vaginoplasty without vaginal cavity.” In other words, the surgeon turned my penis and scrotum into a vulva.

I wanted to talk about that process, and how it went. Before I do, I just want to say how thankful I am to Jay, who stayed with me and took care of me in the days before surgery and at the hospital. He held me when I was scared, and was there to help me through. I am likewise so grateful to Tim, Gillian and Iain, my dad and step-mom, and Joy. I am also indebted to all those who messaged me online during this period.

The road to surgery

Bottom surgery has been on my mind for a while. I know that I blogged about wanting it in 2013.

When I saw my doctor in June or July of 2014, she asked me if I wanted to start the process. I declined as I needed time to think about it further.

Over the next three years, I resolved it was for me. It would free me from spiro and its unpleasant side effects. I would be more comfortable wearing form fitting bottom wear. I would be safer in change rooms. I wouldn’t miss the sex – it had always been a chore and painful for me. My sperm was frozen. Plus I had had a post-puberty penis for twenty years and now I could experience something different. I wasn’t as resolute as I expected, but would I truly ever be? It was a jump into the unknown but as with hormone replacement therapy I was comfortable with all outcomes.

In October 2017, I saw my doctor to get the ball rolling for surgery. I had printed out a template letter for her to use with the Ministry of Health. She wrote her own instead, and gave me a referral to a second doctor. Under the new way of doing things, I needed one doctor and another registered health professional to write letters proving I was trans enough.

In November 2017, while Joy and I were seeing a play, I got a call from Jay. The surgery information had come in from the surgeon’s office. I was in tears. I had been approved! The second doctor must have just signed off and this was it! I called the surgeon’s office. They had no file on me. They couldn’t tell me why they had sent this information, and what it meant. I was deflated.

Come January 2018, I hadn’t heard anything from the second doctor. I saw my GP, and she gave me another referral. The first referral finally called me to schedule an appointment. Then the second. I cancelled with the second explaining them what had happened. They were understanding.

In February 2018, I saw the second doctor. She was the local community health clinic something like once a month to see trans patients. We talked for an hour, and by the end she approved me.

In April 2018 the surgeon’s office contacted me to request missing documents. This meant the Ministry of Health approved funding for my surgery. The second doctor had submitted the letter to the Ministry, but perhaps the surgeon’s office hadn’t received a copy.

I went to my GP to get a copy of the second referral letter that the other doctor had written and submitted everything to the surgeon’s office in May 2018. The office informed me that they would process my file at some indeterminate point in the future. They wouldn’t give me a rough idea of whether that would take weeks or months.

During the summer of 2018 I didn’t hear from the surgeon’s office and worried I had fallen through the cracks. I resolved to call them every three months for updates.

In October 2018, I got a call from the surgeon’s office. They had a tentative date for in February. They would send me information three months before, so in November.

November 2018 came and went and I hadn’t heard anything from the surgeon’s office. Meanwhile I knew from friends that I needed to stop taking hormones a month before surgery. I had received no instructions. That same month, I lost my job. I would be having surgery right after starting at a new workplace, complicating things.

In the first days of December 2018, I emailed out asking about being off hormones. Two weeks later, I got a reply saying yes, and that it should be in the information sent to me. Only, they hadn’t sent me any such information. I called and emailed to get that information, but no one answered phones or returned my messages. Meanwhile I found a job. My manager there was understanding about surgery.

In January 2019, I started calling every day until I got someone. I got the surgeon’s wife, who worked in the office. She was surprised I wasn’t given the information. Finally, they emailed it. In the package, there was the request that I have blood tests done and sent in for December 15th, 2018. It normally would take a month just to see my doctor. I called the surgeon’s office. They said I had to get the blood tests done for two weeks before the surgery date or the procedure would be cancelled. I called my doctor’s office explaining the situation. I was able to get the blood test done the next day. A week later the surgeon’s office let me know they had received the results.

In late January, the surgeon’s office sent me an email with the time to show up at the hospital. 11 am on February 6th. I wrote letters to my besties Jay and Joy to read in the event that I passed away during surgery. I also left instructions and spent time with people close to me.

On February 4th 2019, Jay and I took the train out. We would get off a stop early, at the request of the taxi driver that was pre-paid by the surgeon’s office.

Surgery

It seemed like surgery was so far away. Then it was immediately upon me. There didn’t seem to be an in-between. It hit me when I arrived at the train station. This was it.

I was scared. I was scared of going to sleep during the surgery and not waking up. I suppressed that fear as best I could, but in doing so I removed the capacity to feel happiness or excitement at the procedure.

I felt a bit in the dark. I showed up at the hotel on February 4 2019 with Jay. The hotel had reservations for me paid for by the surgeon’s office. I went to the room and found two enema kits and instructions from the surgeon’s office.

The enemas were bottles with a long lubricated tip. One on February 5 at 4 pm, the other four hours later. Right during Trump’s state of the union address. I resolved the enema was preferable to Trump.

I was worried. Up until this point, I hadn’t talked to any medical professional at the surgeon’s office. Communication wasn’t really respondent with the administrative staff. What if I missed something? What if they needed to cancel on me that day? I felt so in the dark. Being sent generic PDFs as the sole source of technical information wasn’t super reassuring.

I thought I wouldn’t be able to sleep the night before surgery but I did. The next morning we showed up at the surgeon’s office for 11 am on February 6. We arrived early and filled out paperwork about not photographing other guests without their consent, the risks of the procedure, etc. A cute trans guy showed up with two friends.

At around 11 am they came for me. I was brought to an office the size of a closet, where the nurse went over the information I had sent in: allergies, weight, etc. She checked if I had shaved my genitals well. She gave me pills to take, and then she brought me and Jay to my hospital room.

I put on the hospital gown and robe. We waited. The surgeon came by. He was amenable. He asked if I or Jay had any questions. He then said there was a concern of whether there was enough material for my junk to work with. He inspected it, said there was more than enough. He then told us it would be an hour to an hour and a half wait.

At around 12:30 pm the nurse came by. She brought me to a separate admissions room alone. We switched to talking in French; the English was for Jay’s benefit. I waited in the admissions room. The cute trans guy showed up. We talked. He was here for top surgery and would be discharged that day. He was really nice and from Montreal. We both had a lot of nervous laughter as we talked. He was scared too.

The anesthesiologist came in. We switched to talking in French. He said he would give me an epidural. There would not be general anesthesia. I would be conscious but under heavy sedation. He asked if I had any questions, then left.

A nurse came by shortly later. She brought me to the operation room. The anesthesiologist told her I spoke good French and we could talk in that language. Everyone switched. We laughed; she said and here she was trying to pronounce my name in English. In the operating room was a table for me, with extensions and straps for the arms. It reminded me of what they put people in the US who had lethal injection.

A nurse asked me to sit up. He gave me a pillow to hold on to. Something that felt like a bag of cold gel was applied to my back. I was tense; he was there with me telling me to relax and rubbing my shoulders. His presence really helped. Then they put a cream. Then I felt the prick of a needle, comparable to what I had with my intramuscular injections. Then I felt something funny inside my spine. The epidural was done. It wasn’t painful. Just mildly uncomfortable.

The surgeon came in. My legs were raised up, like at a gynecologists office. They put these wraps on my legs that would compress them every twenty seconds for ten seconds. A blue sheet was placed to cover my view. The surgeon started working, I could feel him applying something to my thighs and junk. I could feel him doing something to my genitals.

I woke up in the recovery room. To one side was a third person who had been in the admissions room with the cute trans guy. He was moaning and under a lot of pain. To the other was someone who had breast augmentation. I waited there an hour on a bed, immobile. It was longer than anticipated due to a shift change. I was fully alert. My pain was maybe 1 out of 10. I couldn’t move my legs.

They wheeled me over to the hospital room. Jay was there. We chatted. My pain got to 2 or 3 out of 10. There was another person in the room with me. She was a trans woman from BC. She told me about her life.

Joy arrived. Jay was here too and we took selfies. Having my two best friends here was such a moment of happiness for me. I love them so much. She left then two friends from church, Gillian and Iain, came. We had a lovely talk and they took Jay out to dinner. Joy came back and stayed with me until visiting hours ended at 8:30 pm. We had a good chat that included talking about the Buddhist interpretation of Christianity. I got given pills to help sleep. Pain went down to 1/10. I had full control of my legs now.

At 10 pm they came to change my dressing and get me to walk. They got me up, I took two excruciating side steps, and was back in bed. The pain increased to 4/10. At midnight they woke me up to take my pulse. Pain was back down to 1/10.

I couldn’t sleep easily after that so I took my phone and wrote a draft for this article. It was a good move because this day would be really blurry come a few days later. I did fall asleep at 2 am, but was woken up again two hours later. My hospital mate was in a lot of pain. At 5 am the staff came in to change the dressing, replace the IV, and give me a breakfast menu. I checked off white bread, peanut butter, and herbal tea.

Day after surgery

The breakfast was the first food I had had since the burrito the night before surgery.

A nurse then came by and took me for a walk. I was bracing for it to hurt like yesterday but it didn’t. I was able to take a loop around the unit. It’s only in getting back in my bed that I felt pain.

We went back to bed. I talked to my bunk mate. Jay, my dad and step-mom came to visit.

They fed me lunch. It was a really good full meal, not at all what I expected for a hospital. A nurse came by to change my dressing, and later to do two more laps walking around the unit. Then a nurse removed my IV. I didn’t feel the needle come out.

I napped the afternoon, interrupted by nurses. It was quiet time. I listened to a Spotify playlist of Steven Universe influenced musical selections.

I was fed supper, and did more laps. My roommate was with me, and it felt like being in a race between two turtles. They changed my dressing.

I slept well that night.

Second day post-op

The nurse came in at 6 to change my dressing. The bleeding had stopped. She replaced the dressings with lighter versions.

I was served breakfast. A nurse came in and replaced the catheter bag with a valve. I was now able to go to the washroom to pee, by opening up that valve. I was expected to do so every two hours.

A nurse then helped me to dress up and pack my stuff. Then later, a nurse took it and the two of us walked to the rehab center next door.

I was given my own room. It had a sink, and quite a pretty view.

Once there another nurse introduced herself, and gave me instructions to read. She removed the tubing for the blood grenade that went into my groin. Pulling it felt like being touched after a bad sunburn. She then applied ice. I had the room to myself. I was tasked with walking around four times a day. Every two hours I also needed to move the ice around four spots for ten minutes each.

My dad and step-mom came, along with Jay.

After they left I had lunch. This was done at a large communal table. The manual they gave me showed the different meal times they had. This was the first time meeting other patients. There was maybe ten of us. As best as I could tell they were all feminine trans women. There wasn’t enough space so I was off in the hallway to the side.

The others, except for my hospital mate and another, seemed to ignore me and my hello’s. At this point getting in and out of bed was starting to get relatively painless.

Boredom started to set in. I learned that to replace the ice on my groin, I needed to empty the pack out and fill it from the ice machine next to the dining room. I could move with much greater ease than the day before.

Gillian and Iain came over to visit a final time. They were amazing, as usual. A nurse came in with some information, as I hadn’t been properly inducted. I learned that I needed to call the orderly to get dressings to replace mine with, and that I would do it. I learned that it was important for me to drink two or three pitchers of water a day to prevent infection. That I should wear slippers even in my room to reduce risks.

Jay came over. I ate dinner. I wasn’t very hungry and ate half a sandwich. I noticed the one trans guy in a sea of feminine trans women. It was neat listening to people converse about their experiences of trans-ness, though I didn’t really want to participate. It looked like half the people were over forty-five, and the rest being young adults.

My guts were uncomfortable now. I hadn’t defacated since the day before surgery. I took two more pills to soften my stool. The nurses wouldn’t start administering laxatives until the next day.

I didn’t have to wait too long. While video chatting with my sister, I felt it. And again. I went to the washroom, and it came out. I didn’t force. It was diarrhea like, which was a relief.

I replaced my rehab-issued underwear, and took a shower in the sink of my room. I wouldn’t be permitted a real shower for another three days. I cleaned my arms and chest with soap, and brushed my teeth. I swapped out my PJs; I had stained my top with blood. It was the first time I had felt clean since arriving.

No nurse interrupted my sleep that night, but I did wake up three times to drain my catheter in the toilet.

Third day post-op

The nurse checked my dressings. I had just changed them. She checked my pressure. Another nurse came in and took my laundry. I tried sitting for the first time after she left. It hurt too much to stay there.

I had breakfast and got to know the others better. One was from my home-town. Another from Arizona and was chatting with her followers back home. I was able to sort of sit for thirty seconds. We got talking about how public transit in Ottawa sucks.

The rest of my day seemed to be pretty on my own. I just needed to periodically empty my catheter, check on my dressings, make an effort to drink water, put ice packs on me, replenish said ice packs, attend communal meals, have nurses check my dressings, and entertain myself. I enjoyed the view out my window. My mood improves so much in the presence of a sunny day.

In the evening, I had a bit of a scare. My pad was soaked in blood. I replaced it, and an hour later it was soaked again and this time my dressings too. I replaced them, and saw a nurse. She inspected it minutes later – and my new dressings were already getting bloody.

She explained that because the inflammation was going down beside the catheter tube, and the catheter tube creating an opening into the bladder, that pee was coming out around the tube. Only because my dressing sutured on my skin was bloody, the pee was mixing and becoming blood red. It was normal she said, and she gave me diaper sized pads to use. I had read about the blood mixing with pee thing in the PDFs the surgeon’s office had sent, but I didn’t know this is what this was until the nurse identified it as such. It just looked so much like regular blood.

I also asked the nurse about the dates in my rehab paperwork. My confirmation document said was being kicked out of rehab on the 12th at 7 am. But my rehab paperwork said the catheter was coming out the 12th. Was that correct? She checked. It should come out the 11th instead. She would inform the night staff to inform the day staff.

Fourth day post-op

I had breakfast with the other patients. In a room adjoining the dining area the sutured dressings were being removed for the patients who had their surgery the same day as me, and catheters for those who had it the day before.

I approached the nurse at the end. I wouldn’t be having my sutures removed today. The sutures and catheter would be removed tomorrow. If there was issues they would leave the catheter in for an extra week, and I’d go home with a prescription to have it removed. Another nurse later explained that the surgeon sometimes delayed removing dressings like this when there was little skin to work with, or the cavity was shallow. I replaced all my dressings and used a wash cloth to wash myself in my room and then I washed my hair in the sink. I missed having showers.

I couldn’t wait to go back home, but at the same time, I felt like I was going to be leaving two days too soon. The routine was the same as the day before.

I used time while icing my junk to read, and to process things in a notebook. The sun imbued a positive and constructive outlook. I wrote about shame and relationships past and present, simultaneously identifying with clarity what needed to be let go and finding the bright path ahead.

I walked to the common area and talked to a woman there. In some ways, being institutionalized first in a bed and then something the size of a large detached home for a week, monitored regularly, fed on a schedule, with a bunch of strangers felt simultaneously like being caged and really nice. It was soothing to be taken care of in this way; it’s not something that happens in adulthood. There a spirit of bond making comparable to a first day at school or uni, with strangers together in a space facing a shared burden. I would soak what I could in, and then leave it behind as I joyfully regained my full independence.

I looked at the guest books with writings from patients dating back to 2008. It was a collection like no other, containing sometimes funny, sometimes insightful, sometimes banal messages taken from a specific moment in these hundreds of lives. Each patient took up a page.

Tim came to visit me that evening. He noted he could see in my eyes how content I was. We chatted, and after he left, I watched an Agatha Christie murder mystery on television.

Fifth day post-op

I had my last communal breakfast. I would miss this part.

Afterwards I went into the examination room which was connected to the dining room. There a nurse removed my sutured dressings and catheter. Nether removal hurt, but it did feel weird, like I was being tickled, and uncomfortable. It was over before I knew it though. She gave me a container, a piece of paper and a pencil. I would write down everything I drank today, and I was to drink a lot. Then I would pee in the container and let her know, to make sure my bladder emptied completely.

I had my first shower. This included washing my newfound genitalia, with the instruction not to have the shower head water it directly. I put on my PJs and fresh cotton underwear to get back into my room.

Once there, I found my underwear bloodied. The nurse came in and told me I was to not use coloured underwear as the dye could cause complications. I should instead use the underwear they provided with pads. She fetched some ice and showed me a new method to ice my junk.

A bit later I looked at my genitals. They looked way less engorged than they had hours earlier. The ice was working really well. I had expected this to look like ground meat, but even at its worst, I was really pleased with the result.

Six glasses of water later, I had to pee. I went to the toilet with the pan they provided, and placed it beneath the toilet seat as instructed. I had my first catheter free pee in five days, which was very exciting to me. I sanitized everything and took the pan to the nurse to inspect. All good. Then she took me to the examination room to do an ultrasound of my bladder. I had let out 500mL of urine but still had 200 mL of urine in me.

I returned to my room to ice. Had lunch. Two of the ladies were heading off to grab some beers. First at the dep and then the hipster bar.

In the afternoon, the nurse called my room. It was time for my first bath. The bath was to be filled up to my belly button. Then I’d go in, rub the unscented bar of soap between my hands, gently wash my genitalia, and then sit in the bath for ten minutes. At the end I’d empty the tub, and point the shower head to my stomach to rinse my genitals. I read Alan Cumming’s Not My Son in the tub. After I was to dry my junk by exposing them to the air in my room; no patting down.

The surgeon came in to check up on me. This was the first time I had seen him since the hospital. Again he was very amenable. He checked on my vulva, said the discoloration was normal, said I understood hygiene and that it would be important not to force for stool. He gave me his blessing, recommended I book a follow-up in a month, and left.

Later a nurse came in, and asked to check on my genitals. She too was pleased, and said it was pretty simple without a cavity. Because I hadn’t peed everything out in the morning, she would do two other ultrasounds on my bladder. I would inform them the next time I urinated.

When that time came the nurse took a measurement of my bladder. The first two readings indicated half as much left-over pee as the morning. The third reading indicated a touch more. This risked the catheter going back in, which I really really did not want.

I had my last dinner. I found out one of the girls had left earlier that day. It felt like we had spent much more time together than we had. I packed my stuff.

Tim came over and dropped off some absorbent briefs I could use the next day. We chatted again, and the nurse came by to give departing information. I’d be given antibiotics to take 4 times a day. I should take Tylenol twice a day. If I had questions I could email/phone them. The swelling would continue for months; so I should continue to ice my junk and take Ibuprofen as needed. Discharge was normal, so I should continue wearing pads.

I had my second bath of the day. I could see the sutures float freely from my skin in the warm water; they were invisible otherwise.

In the evening I went for a pee and informed the nurse. She scanned my bladder. 164 mL. No need for a catheter. I was relieved. I applied ice and went to bed. A nurse came by to give me the evening’s pills. I set my alarm for 6.

Heading home

I didn’t sleep that well. I had gone to pee a few times, and was too excited to fall asleep. I woke up at 6:30, Tim showed up fifteen minutes later.

I got some ice, got dressed with Tim’s help, and iced my junk for a while. I told Tim part of me wished I could be here an extra day. Part of me just wanted to get the fuck home. A nurse gave me my last set of pills.

The driver came by. The trip to the train station was painful. Sitting on its own had been okay, until we hit potholes. Once at the station I popped a tramadol, my first during the entire time. I just didn’t see how I could make it home without it.

Waiting at home and work would be two months of baths or siltz baths twice a day, applying plenty of ice, and limited movement. But I could see the end.

Tim got the staff to get me a wheelchair to board the train. I couldn’t get up the stairs on my own. We got on, and I looked out the window at the scenery as we headed back home.