This was written in 1998 and is presented without revisions for historical purposes. — Andrea James
Introduction
This is one of the most well-documented topics for women in our community, especially among those who feel that primary and secondary sex characteristics are the essence of being a woman.
Most of the information in this section applies to any surgical candidate, but some applies specifically to Toby Meltzer’s patients. I had vaginoplasty with Dr. Meltzer in Portland, Oregon on June 16, 1998. I was 31 and in excellent health. I had no complications to speak of and found the whole procedure quite uneventful, although somewhat symbolic.
I have some very strong opinions on prioritizing vaginoplasty in your transition:
- I think vaginoplasty is one of the last things to worry about, and shouldn’t really even be dealt with until you are full-time. I feel vaginoplasty has almost nothing to do with your ability to function in society. The only place it will be important is in a tiny handful of intimate situations (whether sexual or not). So, in other words, it’s important, but it has nothing to do with your ability to keep a job or to walk down the street without being harassed.
- Facial hair removal, voice and face should be your first priorities (after coming to terms with your feelings). See my discussion of setting up your transition timetable for more on this.
- My site has information on most major vaginoplasty surgeons’ recommendations for genital electrolysis prior to surgery. This is a very important thing to consider, as genital electrolysis can make a major difference in the quality of your surgical outcome.
My surgical account
Note: certain costs, policies, and procedures have changed since my surgery. Check with Dr. Meltzer’s office for the most up-to-date patient information.
After a delightful weekend in Seattle visiting a friend, I drove to Portland with my mom on June 15th. She happened to be out that way for a business meeting the day of my surgery, so it seemed fated.
Monday, June 15
Morning:
I recommend a big breakfast and light lunch the day before surgery. Begin drinking lots of water at noon. No milk, cream or sugar all day. My friend from Seattle drove me to my mom’s hotel, where we all ate. My friend gave me a wonderful gift– the invalid ring she’d used, with a cloth cover on which she’d embroidered “Congratulations! It’s a girl!” After a long hug, I jumped in the car and headed to Portland.
Afternoon:
Presurgical consultations are performed at Meltzer’s office, usually in mid-afternoon. It’s a chance to ask last-minute questions, go over the schedule, and have a final physical exam. They take some presurgical photos, have you sign consent forms, and take care of any financial matters. You are given your prescriptions to be filled and the bowel prep. I recommend filling your prescriptions before dinner.Turns out Meltzer’s staff was on the way back from Seattle to Portland at the same time I was riding down– they had presented at a conference that weekend. In the waiting room, I believe I saw a celebrity (actually, my mom pointed him out), but I didn’t ask the staff, figuring they probably wouldn’t tell me even if it was.
Evening:
The instructions say to continue drinking a lot of water, to have a clear liquid dinner, and to begin taking the bottle of magnesium citrate around 5:30. This actually is quite palatable to drink– like a 7-up or club soda, but a touch “chalky.” It draws water into the intestines and flushes anything out after about half an hour or so. You let this work for a couple of hours, then take Bisacodyl tablets, which seem to stop the effects. By then you will have purged your system pretty thoroughly.As soon as you get your bowel prep, start chilling it on ice in your room. Even though it’s pretty tasty, it’s probably much better cold. I watched “As Good As It Gets,” although I missed several scenes during some impressive purging sessions. I didn’t bother “flipping the minnow” a last time, since my mom was in the other room, and I had an irrational fear I’d so something to compromise the surgery, like raise a blister or something in a final attempt. I slept just fine.
Tuesday, June 16
Take a shower. I strongly recommend putting a lot of conditioner or detangler in your hair and leaving it in. This will help reduce tangles many get after lying in bed for days.
Check in to Eastmoreland hospital at 6:00 am. It’s a small hospital, and it looks like an elementary school or an insurance office as you drive up. You fill out more papers and are taken to a prep room. Visitors are allowed to accompany you. A nurse fills out some papers and asks for a urine sample. At your consultation the day before, you were given a suppository which should be inserted when you are taken to the prep room. Amazingly, you will be able to purge some more in the morning. They check any valuables, draw some blood, and start an IV.
The anesthesiologist comes in. Mine was Dr. Delgahardt (?), a nice guy. Meltzer stopped by and we chatted briefly. I had forgotten to fill my prescriptions, thinking I could do it when I got to the hospital this morning. I was assured this would be taken care of for me.
I spoke to a couple of friends on the phone, said goodbye to my mom (who happened to be in Portland on business and would be gone after my recovery), and was wheeled in to have the anesthesia started.
If you want photos taken during surgery, be sure to bring your camera to the operating room. With all my worry about the prescriptions, I got totally thrown and forgot about the camera. This was my biggest mistake, and I’m still kicking myself for it. In the prep room, we talked about some commercials of mine that were running and about how piercing your tongue often results in chipped teeth. I was loopy from the sedation quite quickly. I don’t remember going under or being in recovery.
As hard as I’d tried, I couldn’t remember to say, “So, how’d the appendectomy go?”
I remember bits and pieces of being taken to my room. My voice was messed up. I had flowers. I spoke with some nurses, with Meltzer and the anesthesiologist. A friend called, and we talked briefly, but I can’t recall about what.
The surgical area was covered and had an ice pack on top of a big obstetrical maxi pad. Nurses changed both frequently. I had on mesh underwear which held two J-P drains. These are lemon-sized and are used to draw excess fluid from the surgical site. The nurses would periodically drain them and measure the content. I was also catheterized, which was connected to a drainage bag next to the bed. Nurses would empty and monitor this as well. I had pneumatic sequential-compression stockings on my legs. I thought it felt awesome when they squeezed, but some people complain they’re terribly itchy. Every now and then they would check my pulse, blood pressure, and temperature, plus give me a pitcher of water. I drank a lot. I used the spirometer. I don’t remember noticing the breast augmentation. I drifted in and out all evening.
There were only two times the nursing staff didn’t impress me. The first evening, the nurse told me I was drinking too much water and to cut it out. She said I was putting out too much urine and that I would screw up my electrolytes. The nurse who replaced her asked my why I wasn’t drinking water, and when I told her, she said I should keep drinking plenty of fluids, since my urine was too dark. Hmm.
Wednesday, June 17
Another day basically in and out. My mom returned from her meeting, but I remember little. They began bringing clear liquid meals, but I wasn’t very hungry. They had a patient-controlled anesthesia (PCA) button, which I hit whenever I remembered, even though I was in no pain. It beeped when it worked, and it only beeped about every 10 to 15 minutes.
I usually hate to be hot, but I kept the heat cranked almost all week in my room. It felt really, really good to do so for some reason. The flowers started rolling in from all my wonderful friends, enough to fill the entire windowsill. Toby had given me a koala as my stuffed animal, which was very cool, since one of my favorite stuffed toys when I was little was a koala.
I met Fran Kern, who probably came in the day before without my remembering. Fran works for Toby as a Personal Patient Assistant. She’s very motherly, very kind, and has great advice. Listen to what she says. She introduced me to a couple of other patients, and she talked a long time with me. Throughout my visit, I had daily visits with friends and with other patients, which helped make the time go by quickly. Thanks to all of you– S., R., J., G., D., T., R., S., S. (lots of S.s!).
I’d been lying so still that I felt like I had an 800-pound butt. The nurse came in and rolled me to one side a bit, then wedged some pillows under me. This felt really good, so I recommend doing this as soon as you start feeling a bit sore. I didn’t want to do it long, since I’d been instructed to lie flat on my back because of the breast implants.
Thursday, June 18
My I.V. was taken out and I was “released,” which just meant the nursing staff was no longer going to make regular stops in my room. I was moved to oral painkillers, which I took even though I wasn’t in pain. I was helped out of bed by a nurse, and they cleaned my room and changed the bed. I took my first shower– the Eastmoreland showers take several minutes to warm up. It felt good to get up and shower, although the smell of my shampoo made me nauseous. I threw up in the shower a little. I’ve been nauseated and constipated after each time I’ve had general anesthesia.
While preparing for the shower, I got to look at myself. The implants were VERY high and hard, and there were clear plastic adhesive sheets circling the nipple. A small suture stuck out of either end, and there was dried blood along the incision around the underside of the nipple. The implants were almost touching my collarbones, but they began the three-month process of moving down during the next week. They were pretty sore, especially if I sat up or rolled on my side, but they didn’t restrict my movement much.
I was pretty tired by the time I got back into bed. Although they said I no longer needed the ice pack, since its effects lasted only the first couple of days, I left it on anyway. It couldn’t hurt, I thought. Met some more Meltzer patients, talked to a few friends, ate, and slept.
I learned a couple of things about catheter management. First, I was lucky, since leakage around the catheter happened to a couple of other patients. I found that when I stood up, I’d often have a mini-flood head down the tube. I found it was somewhat painful if this flood did not drain into the bag properly. This happened if the bag was too high or if the tube was not positioned right. If the urine backed up the tube all the way to the bladder, it felt like it slammed into the end of my urethra. I’d say this was the most uncomfortable part of the entire procedure for me. I also discovered that if you bear down, you can empty your bladder before taking a nap. This made sleeping more comfortable. I had also been passing gas without problems since a day or so after surgery. Others have reported difficult and pain associated with gas. I suspect walking and rolling back and forth in bed can help with this.
That evening, I had lame nurse encounter #2. I went out to refill my ice pitcher. When I hobbled up to the nurses’ station. I asked the nurse behind the desk, “Excuse me, could you tell me where I could get more ice?” She was cross-stitching or needlepointing on a pillow. Without looking up, she sighed impatiently and said “In the kitchen, ” as if I’d just asked the stupidest question. I said, “Where’s that?” She tossed her little craft project aside and said sarcastically, “I’ll get it.” When she went into the kitchen (which was right behind me, though I didn’t know), I waited outside. There was a sign that said Staff Access Only, so I figured I was supposed to be asking her anyway. While she was in there, a maintenance guy went in and asked how she was doing. She said disgustedly, “I can’t get shit done tonight” as she walked out with my ice and handed it to me without making eye contact ever. I said thank you pleasantly, since I didn’t feel like getting in a big argument with some testy nurse.
Besides that chick and electrolyte lady (both deservedly on graveyard shift), the nurses were simply outstanding. I was especially impressed with the day staff, and the housekeeper Rose was exceptionally nice.
Friday, June 19
Today I took a shower followed by a walk. Meals were switched to regular ones. There’s something fun in the morning about filling out your menu selection form. That’s how dull it is. Days began to fall into a pattern of rest, eat, shower, walk. Each day Meltzer visits. I enjoyed the peace of lying there in silence. Very relaxing, though I can see how some might go stir-crazy. The TV in Portland is possibly the worst I’ve ever seen. Apparently Oregonians are very interested in local news, with 4.5 to 6 hours of morning, noon, dinner, and evening news on each network station. My tastes in TV run from the worst (Fox, trash talk shows, reality TV shows) to the best (Charlie Rose, Nova, Frontline). Thank gawd they had PBS, since I couldn’t get Fox and was jonesin’ bad for some Simpsons action.
Saturday, June 20
More of the same.
My bruising was probably at its worst today. Almost none on the inner thighs– just a light yellow tinge. Dark blotchy bruising from the vagina toward the hipbones. Light purple-yellow bruise on my sternum and at the lower side of my left ribcage. None of it hurt, and it completely subsided in less than three weeks.
Sunday, June 21
More of the same. I believe this was the longest day of the year, not just in terms of daylight, but also in terms of being bored. I was ready to get the dilation going, and I was tired of sitting on the drain and catheter tubes. They didn’t hurt, but they were annoying. I spent the day watching the weekend gardeners on the community gardens outside my window, and admiring the mini-garden of brilliant, fragrant bouquets inside my window.
Apparently, this was one of the busiest weekends in Portland. They had a huge Rose Festival, the Gay Pride Parade, and a major IndyCar race at the Portland Speedway. The thousands of bisexual Oregonian redneck horticulturists must have been tired on Monday.
Monday, June 22
Meltzer’s nurse Lindsey came at 8:30 and took out my sutures. She’s very sweet and impeccably professional, although she’ll be taking maternity leave soon. Lindsey is well into her third trimester, so Shannon will be back doing patient care stuff in Lindsey’s absence.
I still hadn’t looked at my crotch– I wasn’t that interested or curious. I figured I’d see it soon enough. Meltzer sews everything shut after surgery anyway, to help reduce swelling and to protect the site. Removing the sutures didn’t hurt, although I’d taken some Demerol prior to Lindsey’s arrival. Next, she removed the drains. This hurt a bit, since they snake up and around the pubic bone– much longer than I’d expected. I felt much better after getting these out. One had rubbed a tiny raw spot on my left labia.
With the sutures out, everything opens up a bit. next, Lindsey takes out the packing. As others have described so well, it’s like a magician’s hanky trick. She kept pulling and pulling, which caused a feeling like a spool of kite string was unwinding inside of me. It didn’t hurt, but is a most unusual feeling. It had no smell to speak of and wasn’t gross-looking. It just looked like a big long piece of moist cloth.
Once the packing was removed, Lindsey instructed me about the use of dilators. She handed me a bag containing a set of three Lucite stents, a tube of Surgilube, a tube of Neosporin, a small douche kit, a hand-held mirror, and a travel-size bottle of Liquid Dial soap. Lindsey put about a teaspoon of lube on the smallest stent and inserted it. It went in pretty easily, so much so that she said I could try the medium if I wanted. I did, and found it was a tiny bit uncomfortable at first, but not too bad once in. It felt neither good nor bad, although I was amazed how far up it was able to go. She said I had about 6.25 inches [15-16 cm] depth, since I could get the stent in past all the dots (which went at half-inch increments to 6″).
Dilating is an interesting feeling. As you heal, different sensations begin to emerge. You can feel the stent against your urethra and your prostate, especially on the way out. You can also feel it moving organs around as it goes in. As things continue healing, you can feel sensation in your clitoris area when you insert the stent. Additionally, a lot of the penile nerves encircle the clitoral area, so there’s sensations all over the mons pubis. The labia were a bit painful for me to touch at first, but they feel different than I’d expected. They feel kind of like you’re touching your scrotal tissue, but the nerves go in different directions. I’m sure it takes a while for your brain to re-map everything.
Next she showed me some breast exercises. The implants are very high and hard when first put in, and you need to help move them into the pocket. You use your left arm to press your right breast downward five times and vice versa. Then you push them together from the sides five times. This is slightly uncomfortable, since the chest muscles are sore. Lindsey and I were both surprised to find I was lactating. Later Meltzer said he’d also noticed that during surgery and had not seen that before except in genetic women.
I was very pleased with the outcome so far!
Now the days seemed to get rather busy:
- 8:00 am Breakfast
- 8:30 dilate
- 9:30 douche and shower
- 10:30 have room cleaned
- 12:00 Lunch
- 3:00 dilate
- 3:30 douche and shower
- 5:00 dinner
- 9:00 Dilate
- 9:30 douche and shower
- 12:00 dilate
Plus, take pills and empty catheter bag, etc. I took a lot of short naps and didn’t get up much. Others were walking all over the place, but my body was telling me to lie still.
Fran came in for almost an hour that night. We talked a lot (I suspect I liked her even more than most), and she gave me some very good practical tips, some of which made my top tips list. One of my favorites was she handed me a rubber glove from the dispenser on the wall and told me to put some lube on one finger and feel around. It helped take away some of the mystery and the fear I had of touching things. It gave me a very good sense of where everything was, and it was really very cool to feel! I had a big scab covering the clitoris, and this took over a month to fall off. I wasn’t about to pick at it!
Fran also recommended going without underwear whenever possible for the first few weeks. Since I was at home, I did just that, and when I slept, I’d also let the fresh air circulate. I slept on a towel in case of problems, but there was nothing to speak of.
Tuesday, June 23
Lindsey came at 8:30 and capped my catheter, removing the bag and instructing me to uncap it every two hours or so. This was to train my bladder for when the catheter was removed the next day. This made it much easier to walk around. The bladder training seemed to be just fine.
Also, I decided today was the day to deal with another concern. I had not had a bowel movement since before my surgery. I had gotten constipated after my other surgeries as well. Some people have one within a few days, but Toby said others don’t have one until the packing is removed. When I didn’t have one the day before from taking some Phillips geltabs, I decided to get serious. I asked the nurse for some prune juice and some milk of magnesia. I retched as I tried to drink the stuff, but it did the trick in about an hour. I felt much-much-much better after that. Subsequently, I had no problems in that department.
Rest of day was like above.
Wednesday, June 24
Catheter out. I took some pain medicine before this, but it wasn’t too painful. I immediately felt much, much better. I had no problems with urination after that, although it’s not as satisfying a feeling as it was previously. Maybe that will change. The stream went perfectly the first time, but after that, I was spraying like everyone else.
Rest of day was like above.
I went out to dinner that evening with someone traveling with a Meltzer patient, and a woman who just had voice surgery and could not talk. I did fine despite taking a 4-block walk and sitting on a wooden chair through dinner. However, I started to feel very weak as we stood waiting for a cab. I went back in and sat down because I was starting to shake a bit. I found standing much worse than sitting on the surgical site. Others said the opposite was true for them.
When I returned I found the Always maxi pad had some blood on it way up in front. I later learned that was leakage from where the drains had been. After that, I made sure to put the pads more up front.
Thursday, June 25
Lindsey took the abdominal sutures out. This didn’t hurt at all. These two thick sutures just above the pubic bone hold tissue out of the way as the vagina heals. The sutures are as thick has heavy fishing line. It felt good to get them out. Everything else would heal or dissolve from this point out.
Later in the day, Meltzer came by for a final exam. I made him take a few photos of me and wished him a happy, well-deserved vacation. I thanked him for everything he does for our community, as I did Lindsey.
You should start packing early the day before. You may want to rest every now and then. I asked the housekeeper for a big box, which I used to ship some stuff to myself. I shipped the bear Toby gave me, several vases, some dirty clothes I wouldn’t need at home, and whatever else I didn’t want to lug on a plane. It cost about $20, but it meant I didn’t have to check any luggage or carry a lot of bulky and heavy stuff around. I strongly recommend doing this. You can ship it from Eastmoreland’s mail room, but I had Tara ship it for me.
My flight was full, but I recommend inquiring with the airline before leaving about getting an empty seat or seats next to you so you can lie down if necessary. I didn’t need to, but the option might be nice.
I combined the flowers that still looked good into a bouquet which I gave to Fran. She’d just come out of her facelift surgery and was sleeping. I didn’t want to disturb her so I snuck in with my three bouquets and a card. She looked like a Cabbage Patch Kid– swollen head with tiny eyes sunk deep in the swelling. Poor thing. I wanted to comfort her as she’d done me, but I knew it was more important for her to rest.
Friday, June 26
Travel home. Tara picked me up at 5:15 am. Perhaps it was because of taking an antibiotic without eating, but I began feeling very nauseous after getting in her car. We stopped and I bought some saltine crackers and milk. I felt OK for a minute after having some, but as we pulled out of the gas station, I started throwing up. I sat there with the door open, and threw up for a minute or so. I felt great afterwards, incredibly relieved. I forgot there’s a good part of throwing up! The rest of the ride and the flight were nausea-free, although the first thing I did was locate a barf bag after I sat down.
This wasn’t as bad as I’d feared, except the in-flight movie, which was far worse than I’d feared. Luckily, I slept through most of Blues Brothers 2000. Had I watched it, I might have needed that barf bag after all.
I had a friend meet me at the airport and drive me home. I felt good enough to treat her and my housesitter to lunch after dropping off my luggage.It was great to come home to a clean house. My housesitter had bought me some flowers and treats, and I had a big care package from another dear friend. My cats seemed to have some abandonment issues they wanted to tell me about (loudly), but I think I smoothed things over by spending 24 hours a day with them for the next two weeks.
Saturday, June 27
I settled into a pattern over the next two weeks. See my list of tips for things I learned during this time.
I had paid medical leave, so I rested, wrote up all the stuff for this vaginoplasty section, and dealt with all the post-op maintenance stuff. Friends would come by and watch movies or have dinner with me. One even brought me an air conditioner to borrow! I would talk with friends, write, watch TV, catch up on reading, and basically lie around and relax. I could have been more active, but my body told me to take it easy, especially since it was pretty hot out.
I began getting occasional “electric shocks” in the surgical area as nerves regenerated. This happened every now and then, and some were enough to make me jump. I took them as a sign that things were healing well. I seem to have no numb spots around the surgical site, although one nipple and my abdomen from belly button to pubic bone have a numbness that feels similar to the temporary numbness I had after my facial surgery.
Tuesday, June 30
For my two-week anniversary, I had two goals: using the giant stent and having an orgasm. Both took some effort, but both were accomplished. I had named the stents Cindy, Jan, and Marcia. Like her namesake, Marcia was the biggest and scariest of the three sisters. With a four-inch circumference, it looks pretty daunting at first, but I was able to do it fine after starting with Jan. The key to dilating is to relax as much as possible and to apply steady firm pressure. It was uncomfortable at first, but after a couple of minutes I got used to it. I found it was difficult to remove, requiring a back-and-forth twisting motion.
In case you haven’t figured it out, I’m a touch obsessive and goal-oriented. I was very interested in the peace of mind I’d get from knowing orgasms were possible, so I got out the old Hitachi Magic Wand (I wasn’t about to do any sort of insertion-type toy). I pressed it on my pubic bone above the clitoris and found a heavenly little spot on the right side that (after some coaxing) gave me a good, respectable, strong orgasm. Whew! Now I could rest easier. I’ve had a few more since then, which if based on surgical costs works out to about $3,000 to $4,000 per orgasm to date. I’m looking to reduce my per-unit cost to about a buck apiece over the course of my lifetime! 😉
My only complications to speak of during my at-home recovery were a mild case of hemorrhoids (cleared up with some suppositories), a mild rash at my uppermost inner thigh (either ingrowns from being shaved there of a mild yeast infection), and a tender spot caused by a pulled suture at the very bottom of the vaginal opening (something I’d been warned might happen– treated with extra applications of bacitracin). I would have tiny amounts of blood (never more than a few drops) from around the urethra and where the drains came out, but I had fully expected much more.
Friday July 10
The two weeks of at-home recovery went VERY quickly. I wish I’d had another two weeks just to get more done. I made some major progress on this site, and work was going to slow me down again. I felt I was basically ready to return to work after 4 weeks, but we shall see.