Neo-Vagina Monologue 10
The Downside of SRS
Recently on a discussion board for post-op transsexuals, a couple of the girls complained that nobody warned them about the less desirable side-effects of sex reassignment surgery (SRS). I suppose they must not have paid attention to the lengthy release forms we all sign as a precondition for our surgery! Seriously, the release forms do warn about all the possible medical complications, but there are plenty of other ways SRS changes our lives. For those of you who may be contemplating SRS, or post-ops who want to see if their experience matches up with what I have gone through and heard about, let me lay out some of the possible and probable downside effects of this procedure.
1.Cosmetic appearance. Let me begin with the good news. You don't need to worry about the Hedwig effect ("The Angry Inch"). If you go to one of the leading surgeons, chances are that you will be quite pleased with the cosmetic appearance of you new vulva. Oh, there are some horror stories out there, and Dr. Schrang has a number of them in his famous slide show, but to my knowledge the top surgeons are producing excellent results on a regular basis these days. And pretty much any result is better than that thing that used to hang there, isn't it? (If you don't answer "Yes" to that one, maybe you should think harder about your desire for SRS.)
Sadly, this good news does not apply to Female-to-Male SRS. As transmen are actutely aware, that technology is not nearly as good as what us gals "enjoy". Guys, my heart goes out to you.
2.Risk of surgical complications. I don't think I need to belabor the point that SRS is a major, invasive surgical procedure. Like any such procedure, it carries a risk that something will go wrong, such as infection, hemmorage, fistula, etc. Fortunately the risk of serious difficulties is small these days, provided you go to an experienced, reputable surgeon AND you follow your various doctors' and surgeons' orders and advice, both pre- and post- surgery. On the other hand, be aware that the chance of a minor complication or two is highly likely, but usually easily remedied. For instance I had excessive bleeding that required a second trip to the OR three days after my initial surgery. (This was at least medium on the scale of minor complications.)
3.Pain. The next thing you should realize is that
SRS hurts! Some girls suffer more or less pain for longer or shorter periods, but in any case SRS is no walk in the park. Morphine is indeed a wonder drug, but its own side-effects become miserable after a day or two. Anyway the pain is not so much directly from the surgical site, as it is that your whole body is debilitated for a period of time. Some girls are up and shopping in three days, but I myself would have been hard-pressed to return to work after 6 weeks.
4.Catheter. Did you know that you will be tubed-up to a urine bag for at least a few days? I had my catheter in for 10 days, including several days after I left the hospital. I actually got to like it, not having to worry about when to pee. But there is something of an "Ewwww!" factor to get past, in having a urine bag as a constant companion and fashion accessory. By the way, it did not hurt at all when the catheter was removed.
5.Follow-up surgeries. Even if you, like me, have a so-called "one-step" procedure, where the labia majora and labia minora are created at the same time as the intial penectomy/vaginoplasty, it is not unusual to need a little bit of follow-up surgery. In my case, we did this to create the clitoral hood and remove some excess mucosal tissue. This was not a big deal, just an office visit under local anesthesia. Other girls have told me of one to several procedures to re-position the urethra. And of course some surgeons prefer to do the labiaplasty as a separate procedure about 6 months after the initial operation. Prior to my surgery it seemed important to me have a one-step procedure; but at this point, anything that doesn't require full anesthesia is little bother to me.
6.Additional costs. Your follow-up surgeries and general follow-up care (office visits for check-ups) may add to your SRS expenses. In my case, my surgeon Dr. Annette Cholon's initial fee included any follow-up surgery as well as the office visits, so that worked out nicely for me. I will need to cover any additional costs that may be incurred by unplanned follow-up surgeries such as hospital and operating room charges and anesthesiologists. I incurred some such charges for that second surgery that I had three days after my initial SRS. Fortunately, and much to my surprise, my Blue Cross insurance helped out on these bills. So there's a suggestion: try billing your insurance even if they've got a policy against covering SRS-related charges. Also, if you are on a tight budget, don't forget the costs of supplies such as lube (for dilating, see below), antibacterial soap, Maxi-pads and panty liners, Monostat, your donut pillow, etc.
7.Peeing. Oh yeah. They're removing several inches of your urethra as well as some or all of your urethral sphincter muscle. It's going to affect the way you pee. When my catheter was removed, it took me a couple of weeks to develop control of my urination with my new plumbing. By "control" I mean that I was wetting myself before I could get to the toilet. I needed to learn to become alert to the very first tingling that meant it was time to go, and then to get to a bowl "stat". Over the next few months I became able to "hold it" better and better, so it wasn't necessary to move quite so quickly. But I still need to take care of business faster than when I had that extra length of urethra. Some girls have a worse problem with incontinence, and for some incontinence and seepage is a permanent problem. And that means Maxi-pads every day. So much for that smooth silhouette you expected in your bikini bottom! (These problems are not unusual for any women, especially after childbirth and with age. Now you know why bikinis are for young girls.)
8.Spraying. And that's not all on the topic of peeing. There's also the issue of impersonating a garden sprinkler! Your water is not likely to exit in the well-mannered stream that you are used to, at least initially. There is going to be a lot of swelling in your various insulted parts, and that will squeeze down your urethra so it sprays pretty wildly. Also it may point in the general direction of down your left thigh, or toward your right shoe, or into your face, anywhere but down in the bowl where you want it. Both of these problems are likely to correct themselves somewhat over the first few weeks and months. After about 3 months I was fortunate to be peeing a compact stream down into the bowl. But it is not unusual to have minor corrective surgeries to fix these types of problems, and some girls have permanent complaints in this embarrassing area. (By the way, the sound of my peeing is now a constant stream like the genetic girls, but not as powerful. I wonder if that will come with time. If you don't know what I'm talking about, I guess you are not using the ladies restrooms yet.)
9.Dilation. If you don't know about dilation, you'd better find out. You can start here. A point I would emphasize is that dilation hurts a bit for the first few weeks, and whenever you step up to the next size dilator. It was only recently, at four months post, that I realized it wasn't hurting much anymore. I am sorry to say that I am getting absolutely no erotic pleasure out of it, although some girls say they do. The other point is that I find it to be much more burdensome than I expected, in terms of time and commitment. For the first few weeks you will be dilating at least 4 times a day, 30 minutes each, plus set-up and clean-up time, so it pretty much dominates your life. At four months post I am still dilating twice a day, 40 minutes to an hour each session. Generally I do this while watching television, but that may not be so easy if you have a family and the TV is in the family room.
10.Infection. Urinary tract infections (in your urethra) are very serious and painful. They must be treated immediately. These are best avoided by being very careful about keeping the area and equipment such as dilators clean and sterile. I have been fortunate to have been spared this problem, at least so far. Then there are yeast infections, which can occur inside the vaginal canal and also externally in the folds of the labia. Be sure to examine you vulva carefully with a hand mirror often, to catch yeast infections as soon as they crop up. I got my first yeast infection a couple of months post-op. "How womanly!" I smiled. 8 weeks later I was grimacing, "Why can't I get rid of this god damn infection??!!!" You should expect to get yeast infections. You will need to work out just the right recipe of washing and drying and douching to keep them at bay. One girl I know wears a tampon all the time to keep it dry. She swears it was the only way for her to prevent yeast infections (though I am not recommending it.) My yeast infection wasn't particularly itchy or painful, just annoying. And you are not allowed to have sex while you've got it..
11.Sensation, orgasm, libido. I pity the poor girl who undergoes SRS mainly because of the erotic appeal, because she may wind up with none at all! Responses here vary all over the map, but you should be prepared for the possible worst case of being inorgasmic, having little vaginal sensation, and completely losing your sex drive. In fact, this is pretty much the state I find myself in just now, but I am confident that it will get better as I heal.
12.Getting laid. Suppose you are lucky enough to have a fantastically erotic vagina, earth-shaking orgasms, and the sex drive of a tigress. (Or even if not, you like me may nevertheless be inclined to experiment.) You've still got a problem: nobody wants to date you. I didn't want to believe it, but I've become convinced. So-called normal heterosexual men squeak "EEEK!" and run when they find out that I used to have a penis. "Admirers" want their girls to have penises. I don't know about women, they never did and still don't pay any attention to me. There are exceptions, I know — at least, I need to believe that! I simply want to warn you that finding someone to date, someone to love, can be a real challenge for the post-transsexual woman.
13.Healing time. We tend to fixate on the magic 6 week window: 6 weeks after the procedure, if all went pretty well, your surgeon will release you for all activities, including SEX. Hooray! But the game is not over at that point. The swelling will continue to go down for 6 months, just like for a nose job. After about 3 months, your vulva will be close to its final appearance (barring any subsequent follow-up surgeries). If your surgery is planned as a 2-stage with a separate labiaplasty, that will probably happen at about 6 months. It can take 6 months to a year for your insulted nerves to get fully set and firing in their new configuration. So think of SRS as a one year activity, not 5 hours!
14.Long-term health care. Don't forget that you now have a mix of male and
female anatomy. You need to pay attention to the health care needs of both. You are
still at risk of prostate cancer, at least until the hormones have caused it to
shrink up to a negligible size. I personally know of one trans woman who needed prostate
surgery some years after her SRS. So make sure you are screened for it, until your
doctor feels it is no longer necessary. Self-exams and mammograms for breast cancer
are recommended, even though I haven't heard of any cases of trans women contracting
breast cancer. Even though you don't have a cervix, some gynecologists recommend pap
smears, which are primarily intended to detect cervix cancer.
15.Profound feelings. Even with my cynical streak, I have to admit that SRS has affected me more profoundly than my nose job or other changes. I never accepted the idea that SRS was necessary to "complete me as a woman"; but now I feel that at least I've completed my body-modification project. (In fact, I don't think I'm going to bother with breast implants, despite my tiny AA's. I'm done.) I feel like I'm now on top of the heap of the transgender hierarchy, despite my best efforts to respect all our paths as equals. (Part of that feeling comes from the new deference that cross-dressers and pre-ops seem to give me.) I have trouble understanding how a girl can consider herself to be transsexual, but not be doing her damnedest to get her SRS — even though intellectually I grant the legitimacy of other choices. I find myself thinking and saying, "I'm not transgendered, I'm post-transsexual", in spite of my belief in inclusiveness. I find myself drifting away from my former friends, even as I resolve not to be one of "those" post-ops. I feel a greater right to take my place in women's spaces. I feel a relief that I'm not hiding anything any more, especially not that particularly masculine little thingie. Sex partners (okay, there have been a few) seem to treat me with more respect, more like I'm a delicate little flower. People ask me what it feels like to have a vagina; it doesn't feel like anything, it just feels right. Having a penis felt wrong. I'm very happy I had my SRS.
On the other hand, however you might feel about your new equipment specifically, don't be surprised if you generally feel quite different about your entire life and way of living. It's not unusual for girls to quit their jobs and change careers. One girl described a feeling of cloudiness: " I just don't seem able to focus and get projects done with the same (admitted) obsession with time and deadlines that I had previously. My mind wanders into aimless reveries when I try to read, particularly if the reading material is technical and boring." Another girl had this reaction: " I feel like I've fallen apart completely. I need to make some radical changes in my life. None of the old ways work for me anymore. It's an awful experience." A wise long-time post-op explained it this way: "I suppose it's like the reaction after a sporting event, college exams or with any other event that you prepared and worked so hard toward. Give yourself a little time to 'download' and it will come back to you as it did with me and with most others I have talked with."
I have spoken or e-mailed with two or three dozen girls who have had SRS. All of them are happy with their decisions. We have of course heard stories of people who came to regret their SRS, but we tend to believe they probably weren't truly transsexual to start with. So if you are sure of who and what you are, and what you want to be, I encourage you not to be afraid to to fulfill your destiny with SRS, if that is what you choose for your path. Hopefully this article has helped prepare you for a realistic assessment of the project you will be undertaking.
Lannie Rose
6/2003
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