GRS Surgery

GRS Post Op Day 63 – Nine Weeks

So, I’m nine weeks post-op as of today. As expected month 2 really kicked my ass. Getting better week by week, but definitely up and down.

The good news is that pain has been gradually improving. In fact, I’ve often been late taking my pain meds for the last week because my body hasn’t been making it clear that it was time to take them. So starting to experiment with ramping down the amount.

Unfortunately those plans have been foiled the last couple days by a probable urethral opening tear. (Thanks constipation…) Which is really painful, and all the more so because I’ve having to wear menstrual pads for the discharge, which makes it pretty much impossible for the tender area not to be rubbed and bleeding constantly. At night, even a single bed sheet put an uncomfortable amount of pressure there. Doesn’t help that dilating puts pressure on the urethra can cause irritation, plus the dilator stretching the skin around the urethra wasn’t pleasant at all. But gotta dilate lest my neo-vagina close up. So just tried to do my best to grit my teeth and think of England.

There’s also been two bouts with vaginal order, which occurs when I don’t get the lube (used for dilations) completely rinsed out and it ferments. Which can occur rapidly and smells really nasty. Thankfully, I’d reached the point where I could switching from the irrigation syringe to an actual vaginal douche bottle, which resolved things. (With either it’s just rinsing with clear water.)

Still fairly wiped out, since at a minimum I’ve had to wake up every three hours to take pain meds, and there have been plenty of nights where I’ve also woken frequently due to pain. Hard to nap during the day because they’re doing construction next door.

I knew it was going to be hard recovery, but I definitely underestimated how hard it would be. But I’ll get through it. Until then, I’m just embracing the suck.

GRS Post-Op Day 56 – First Time In The Stirrups

It’s another womanhood achievement unlocked — first time in the stirrups. 😉

Granted in Thailand I had to assume the positionevery morning during the daily post-op visits by the nurses, as well as during the twice weekly check-ups at the clinic. But today was the first time stirrups were officially involved.

I was actually in to see my hormone doctor, since now that I’m 1) sans testes and 2) done with the initial round of breast growth, it’s time to adjust my estrogen prescription to take me down a “maintenance” dose, which I’ll need to take for the rest of my life. (Otherwise, I wouldn’t have any hormones in my body at all, and long-term that can cause some health problems.)

But since my hormone doctor has decades of experience treating trans women, it turns out that he’s also done post-op care for them — including with other patients of Dr. Suporn, who uses a technique that’s very different than the one used in the States. (In fact, Dr. Suporn generally doesn’t want you to have other doctors examine your new vulva/vagina unless it’s an emergency, since they won’t understand what he’s done, and they might cause damage if they try to “fix” something that’s actually not a problem. It’s happened.)

However, since my doctor is familiar with Dr. Suporn’s work, I took him up on his offer to check things out if I wanted. I figured it would be useful to get his opinion on how I’m healing. So up went to the feet, and out came the speculum.

The good news is it’s going well overall. There’s a small area of the 400-500 stitches inside me that has granulated tissue, which can be painful, but nothing that he’s concerned about. He also confirmed that I’ve got urethral opening irritation, apparently it’s pretty red. But while it’s ouchy and annoying, it’s not serious. Hopefully some of the things I’ve been doing in the past week will help calm it down.

GRS Post-Op Day 48 – Bloody Annoying

Had my first real urethral bleeding earlier today. It’s not serious and most of Dr. Suporn’s patients have it at some point during their recovery. Rather it’s annoying, a bit messy, and definitely ouchy.

In this case, it seems like straining on the toilet — opiate pain killers cause constipation — caused local blood pressure to increase and popped a blood vessel. Thankfully it happened at home, so I could just lay down, apply pressure with the clinic-supplied medical cotton balls and after about 10 minutes it stopped.

Although things were hampered by not knowing exactly where my urethral opening is — things are still so delicate that I’m still not allowed to spread my inner labia for another six weeks. (There’s a risk of tearing or even detaching the inner labia until everything’s healed.) Which means I haven’t had an up close and personal look down there yet. So it was a bit of trial and error, applying the cotton balls and seeing how much blood was on them until I found the bloodiest spot.

Thankfully things seem back to normal tonight.

GRS Post-Op Day 46 – Urethra Frankly

TMI, post-op ouchiness….

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One of the persistent problems I’ve been having is urethral opening irritation, most likely from wearing menstrual pads for 39 days straight. The last couple days I’ve also had light urethral bleeding, which is a normal part of the recovery, and nothing to be worried about.

But the pain has been a deterrent to doing much, since moving around causes chafing, which in turn causes more irritation and more pain. Tried epsom salt baths but while those were soothing, they also caused swelling — which is the last thing I need at this point.

Thankfully, on Saturday I talked about this with a women’s coffee group I belong to, and they suggested trying reusable pads, since they’re made of fabric, which is a lot kinder on the nether regions.

I tried it, and it’s made a huge difference in comfort — although things are still irritated enough that I wake up a lot during the night unless I take a sleeping pill, which I’m trying to only do once or twice a week at most (to avoid long-term sleep problems).

The main disadvantages of the reusable pads are that they’re a bit bulkier, although they don’t feel as bulky as a regular pad of the same thickness, and also that I have to wash them constantly. Got two three-packs, so I’ve got one set to wear, while the other set is being washed.

Hopefully, the irritation will subside soon because I’m getting really tired of it.

GRS Post-Op Day 42 – Homo Erectus

One of the things Dr. Suporn does is to map analogous tissue between the male/female genitals. So he reuses erectile tissue from the penis when creating the outer labia, so that the labia can become engorged with blood when aroused, just as the factory-installed version does.

Unfortunately, during recovery I’m getting temporary swelling in the clit and labia, which creates an uncomfortable feeling of pressure and stiffness. It can be so intense that it’s really discomfortable if I’m driving (seems to put more pressure on things down there, probably because my car has bucket seats).

At first I noticed it during the night, and thought it might be a holdover neuro/biological thing, since people assigned male at birth have involuntary erections during REM-state sleep. (Not sure if people assigned female at birth have a similar involuntary arousal of their vulvas.) But then it’s started happening at random times during the day.

Thankfully, I’ve been able to talk with other patients (there’s a secret Facebook group for us), and found out this is fairly normal during recovery, with your body testing what’s going on down there and how things work now, and it goes away over a number of months.

In the meantime, like a lot of other things, I’m just having to embrace the suck.

GRS Post-Op Day 41 – Juicy Details

Wow, I just went through a pack of 44 menstrual pads in less than two weeks.

Obviously, I don’t have a period, but there is a post-op “flow” that typically lasts for the first three months. It’s a yellow-ish slurry of plasma (from the internal stitches), lube and skin cells that are being sloughed off from the internal skin graft that forms the neo-vagina. Plus the occasional urethral bleeding, which is normal during recovery.

Unfortunately, pads do irritate the vulva, clit and urethral opening while the nerves are waking up, which makes things more uncomfortable.

I’ll be really happy when I reach month 4 post-op, when things are supposed to get easier.

GRS Post-Op Day 36 – Eat, Sleep, Dilate

Pushed too hard last week… Late yesterday afternoon I realized that I was too tired to go into work (to pick up a package that was accidentally shipped there) and needed to take a nap instead — and slept for three hours. Would’ve slept more, but I didn’t want to wake up in the middle of the night and further screw up my sleep schedule.
 
As it is, I’m waking up in pain during the night, since the painkiller doesn’t last overnight and I need to take another pill every 3-4 a.m. So I definitely haven’t been getting enough sleep.

It’s been hard to rest during the day because there’s two houses under construction behind my home, six days a week. But thankfully, they actually took the day off for reason unknown. So making the most of it today and tomorrow.

Consequently, today has been an exercise in eat, sleep, dilate.
 
Especially because the scar contracture is kicking in, making it harder to dilate — and when that happens the solution is actually to dilate more to loosen things up. So trying to dilate 4x/day, plus longer each time, while I’ve got time off. Adds up to a good 5+ hours each day.
 

GRS Post-Op Day 35 – To The Pain, Part 2

Thankfully, my nurse practitioner had no problems renewing the pain medications I’d gotten from Dr. Suporn. I figured it would be OK, but I wasn’t sure, given the crackdown on prescription opiates.*

I’d brought “my Thai boyfriends” to show her if needed (i.e. “I’m having to put these really large things inside me to push against scar tissue formation”), but she said the description on my dilation routine was enough to make her cross her legs involuntarily.

Not a moment too soon, because the nerve re-awakening has begun in earnest. Not fun.

Didn’t help that yesterday I went to an after-work happy hour for a co-worker who’s leaving (before I return to work), and the bar stools were very hard and small, so my pillow wasn’t that much help. During the hour or so that I was there, I ended up having to stand several times — although I suppose that’s not entirely bad, since if people were paying attention, it was clear why I need more time off. Hopefully, I’ll be better able to sit for longer periods of time by the time I return to work.

*Albeit Tramadol is the weakest of the opiate pain meds, and it also helped that she commented that I’ve shown in the past that I’ve been conservative about my use of any medications. We spent a bit of time talking about dosing, and at my suggestion, she intentionally wrote me prescription for lowest dosage per pill, so that I’ve got more flexibility in using the minimum needed to keep me out of pain.

BTW, for those who are about the suggest CBD, I’ve already got CBD pills from Highland Pharms (legal in all 50 states because they’re hemp based) that I’ve used in the past for pinch nerve pain, so I’m experimenting with those as well. Unfortunately, they are a bit pricy, whereas Tramadol is covered by insurance (and has more predictable dosing).

GRS Post-Op Day 34 – Burning Sensations

Good news: I definitely have genital sensation.

Bad news: I know this because as the nerves are reawakening, and it’s hurting like hell. My clit in particular feels like it’s on fire whenever the pain meds wear off.

Unfortunately, this is a normal part of the healing process. With Dr. Suporn’s technique* months 2 and 3 post-op are the most difficult, since that’s when nerves that were temporarily deadened by post-surgery trauma start “waking up,” and when the internal scar contraction really starts kicking in — hence the need to dilate 3x/day (or more) to prevent scar contracture from causing you to lose depth.

Admittedly, it’s not helped that due to some scheduling mishaps I’ve been sitting far too many hours during the last two days, which puts pressure on the genital area. (Although it was useful in confirming that there’s no way I could return to work just yet, since I’ve got a desk job where I sit most of the day.)

Just gotta embrace the suck.

*Don’t know about the recovery from the more commonly used “penile inversion” technique.

GRS Post-Op Day 30 – Along Came a Spider

TMI, dilation stuff….
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TMW you’re rinsing yourself out after dilating and think you see a spider in the shower — and then realize it’s just a wad of stitches that came out.

And before anyone worries, this is a normal part of the healing process, since the labia stitches are designed to work their way out as the incision heals.

In fact, it was a Good Thing, since it involved some stitches that had been poking out and were really uncomfortable.