10 weeks post-op and the first week back at work was pretty rough, but I made it through it. Well mostly — I had to leave early Friday afternoon to go home and nap because I realized I’d been staring at my computer screen for the past half-hour and not gotten anything done. Fortunately my co-worker on the project has been understanding, and I’ve got a job where as long I get the work done in time, I can be fairly flexible with my hours.
So this weekend is pretty much devoted to catching up on work and catching up on sleep. Much as I really want to go to a major even in San Francisco (after having missed it last year), it’s simply pushing too hard to do so. Trying to dilate three times a day (which takes about 90 minutes each time) has been a huge challenge time-wise and mentally, even with leaving work early. I’ve had to fight through a bad case of the “just don’t wanna’s” and did miss the third dilation more than once. In three weeks, I can go down to twice a day, and I can’t for wait that.
The good news is that the pain is slowly going down, and I was (mostly) able to dial back my pain meds a notch. Which means I now only have to wake up once during the night to take them, which in turn will help me get better sleep, although the short-term trade-off is I’m waking up a bit more due to pain as the meds wear off.
The non-stop post-op discharge also seems like it’s starting dry up, and it’ll be a welcome relief when (eventually) I won’t have to wear pads 24/7. Especially since I’m still getting urethral irritation and bleeding, and even reusable pads, which are softer, tend to worsen that.
Acupuncture to the pubic mound and vulva also has made a noticeable difference in reducing swelling in both places. I’m really lucky that a few years ago I saw an acupuncturist for my pinched nerve pain, and she 1) also has a specialty in pelvic floor acupuncture, and 2) has worked with other trans women post-op. The trade-off is the drive up to San Francisco to see her tends to worsen the swelling, but she’s offered to educate my local acupuncturist about what to do, so that I won’t have to travel.
I’m also at the point where I’m officially allowed to have “sexy thoughts” and engage in “gentle self-exploration” of the outer vulva (the inner labia is still too delicate), which I did for the first time last night. It was a mixed bag. The good news is that I definitely have sensation and it was pleasurable. The bad news is getting aroused is still a bit painful — as mentioned, my vulva is still swollen and so when blood flows to the erectile tissue that was reused to create my labia, the pressure is too much and makes things hurty.
Trying to be patient….
So I’m headed back to work tomorrow. Not really ready, either physically or emotionally, but Mama’s gotta eat.
It’s especially going to be a slog the next four weeks because I still have to dilate three times daily, and each session takes 75-90 minutes. Thankfully, I can work from home and my office schedule is usually fairly flexible, so I can leave early to take care of the second dilation and then catch up on work in the evening. But it means I won’t have much of a life, at least until I can reduce to dilating twice a day (for another three months), which is a bit more doable.
The upside is at least I’ll be around people again. It’s been disappointing how few people reached out to see how I was doing.
I’ll make it through, I’ve got a Master’s Degree from Figure It The Fuck Out University. I’m the strong friend. Come 2019, hopefully I’ll be feeling good enough again to start making some major changes in my life (as if I haven’t already been through enough of them the last three years). One chapter of my life closes, another one begins. But yeah, I wish this past chapter had been a little different.
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.
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.
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.
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.
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.
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).