8 Months Post-GCS

Content warning: graphic descriptions of vaginoplasty recovery, surgical care, biological processes, emotional distress, and sex.

Eight months??? Has it already been eight months since I had surgery?

For some reason I have it fixed in my brain I had surgery in April 2019, even though it was March. It might be because those first few weeks were so dislocating and painful, I’ve tried to block them out.

Since my last update in May, things have been going better. Much better.

Weeks 8 to about 14 saw a progressive reduction in pain until the only time I felt pain was during dilation, which came from a tender spot in the vaginal canal. I still had and still have some swelling and numbness, mostly in deeper, internal tissues around the vaginal opening. My clitoris still looks raw and can be painful to touch, and I discovered a loose flap of skin under the clitoral hood that will need to be removed at some point.

I’d go to the doctor but I still haven’t sorted out my insurance issues, so I’m way overdue on a followup appointment and I’m hoping to get it sorted out next week. The United States’ health insurance system sucks.

Weeks 14 on saw a very gradual reduction in swelling and numbness. The overall appearance is good, though super-tight clothes give me the mother off all camel toes. At this point I can’t quite tell if that’s a permanent outcome because it’s just how the fat distribution is in my body, or if further reduction in swelling will help smooth things out. My incision lines are fading and I like to believe that at a quick glance they’re hard to see.

Then there’s dilation. Dilation has become even more boring and annoying and I’m anxiously awaiting when I can drop to once a day at my one-year surgical anniversary mark. I’ll admit to skipping a session or even a day here and there when I’m too tired or my kids have made the timing impossible.

I stressed about this at first, but my thinking has shifted to treat it more like the oral estrogen I take: if I miss a day or am late, nothing irreversible is going to happen right away. I also re-framed it in my brain to be physical therapy, and that’s helped me push through when I have some pain or am feeling lazy.

My set of dilators are blue (S), green (M), and orange (L), and after a few attempts of trying to size up to the green one in the early months, I gave up until the blue one wasn’t causing me any pain. Moving up to the green one was painful at first, mostly around the top of the vaginal opening. The whole point is to stretch the tissues and, yeowch, were they stretching!

It took about a month until the green one didn’t hurt anymore. Per the discharge instructions, I started with fourteen minutes with blue, then a minute of green. I added a minute a day to green until I was at five minutes and hung there for a couple of weeks as I worked through the pain. After that, I discovered there wasn’t a change in pain in adding more time, so I jumped to one minute blue and fourteen green.

After another month or so of that, I tried adding orange for a minute. Double yeowch! It was too much, and after trying for a few days, I gave up. Once the green one wasn’t causing me much pain, I tried the orange one again, followed the same sort of ramp-up, and now I’m at one minute blue, one minute green, and thirteen minutes orange. It still hurts a bit with the orange one. I hope the pain goes away at some point.

Let’s talk about sex. Trans woman sex to be precise.

I always had an ambivalent attitude towards my penis. I’ve also always liked sex and had a lot of fun with my penis over the years. Around the time I was trying to come to grips with being trans in my twenties, a mental shift started to happen. I still liked sex, but while having sex I started to imagine myself having a vagina. As the years went on, it reached a point where it was almost impossible to orgasm without those mental gymnastics.

After starting estrogen, I started to experience the typical sexual side effects of decreased libido and attaining or maintaining an erection. My sexual response and desire also changed from a “must and always will orgasm” mode to a “eh, if it happens great but no worries if it doesn’t, and goddamn if it doesn’t take a lot of work to get there so I’m not committing to coming” mode. Intercourse became difficult to impossible due to challenges around getting and maintaining an erection, and when it did happen, I found it physically painful.

One of the few expectations I put to my surgeon pre-surgery was to be orgasmic post-surgery. She assured me it was very likely but that it might take some experimentation and a lot of time to get there. She was not kidding.

For the first few months post-surgery, I was in too much pain to even think about sexytimes. Once the pain receded I still had numbness. But a few months back my brain whispered, “Hey, Heather. Orgasms. Remember those?” and I realized it had been a long time, so I set out to find some.

The few toys I already owned didn’t do a damn thing for me in that department, so I bought a very expensive, very highly reviewed vibrator with clitoral stimulation. And readers, I used it several times with no luck. I tried after dilation, I tried in the morning, the evening, the afternoon, all to no avail. After one session that lasted two and a half hours, (not a typo and thank science for inductive battery charging,) and I got about 70% of the way there before finally giving up, I chucked it in the drawer and started mental work on accepting I might never come again.

Then I met a woman on Tinder this summer who asked me, “What do you like?” and I had no clue how to answer due to continuing numbness and the aforementioned inability to masturbate to orgasm. Despite valiant efforts on her part with her hands, mouth, and a strap-on to discover what I like, there was still no joy in Vaginaville.

I let her try my fancy vibrator and she nearly fell off my bed with ecstasy in under five minutes. So much for me thinking the vibrator was oversold. That woman ended up ghosting me and I went back to my silent and now angry grudge with the vibrator while meditating on being anorgasmic for life.

About a month ago I reduced my dosage of anti-depressants because I realized I hadn’t cried in months and that bothered me, and lo and behold, my libido perked up. And I was able to cry again.

So I took my fancy vibrator out to give it another spin and…still no joy. Worse, it made my clitoris hurt. To add insult on top of injury, the state it left me in reminded me of my male puberty before I had my first orgasm: having tons of tension and knowing an orgasm would relieve it, but being absolutely clueless on how to make it happen and the ways I’d tried didn’t work at all.

And then my brain teleported me back in time to those frustrations and the memory of how I, uh, blew through that barrier. Reader, if you’re under a certain age, do you have any idea how hard it was to research girls’ masturbation techniques in the early 1980s? It was really fucking hard. I don’t recall how or where I found the information, but I eventually did.

The literature was thin and it boiled down to rhythmic rubbing against a surface. Whatever I read, it stuck deep in my brain because I remember with clarity it mentioned horseback and bicycle riding. I didn’t have access to a horse, and I rode my bike every day and I couldn’t recall even getting a boner, let alone an orgasm while I was pedaling. But the third method it mentioned, rubbing the pelvis against a mattress or pillow while face down, worked.

Add, “You might be trans if you masturbate like a girl,” to the, “you might be trans if…” list.

Unsurprisingly, there is little medical literature around female pelvic and clitoral nerves, particularly with how they connect to orgasm. It would be a fascinating study to compare  pelvic nerves between trans and cis people.

I hate horses now and I’m not much of a biker anymore, but I still own a mattress and pillows. I’m happy to report that I’ve taken my relationship with them to a new, more intimate level and they make me come about 80% of the time, and this has brought me great mental relief.

There is a wide variance in post-surgical experiences depending on things like the surgeon, surgical technique, general health of the patient, complications, etc. The above are my experiences only, and should not be considered typical or expected for vaginoplasty.

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Support Trans Youth – Help Jaiden Get Puberty Blockers

Can you help Jaiden get puberty blockers by donating to her GoFundMe?

Jaiden is the child of a family friend and she came out as trans a few months ago. Jaiden’s lucky, because her mom has embraced her new daughter and has been working to secure puberty blockers so Jaiden can decide when she’s older if she wants to start hormone therapy. We should all have been so lucky!

The hitch is that the family’s insurance has denied the initial claim and appeal for puberty blockers because their coverage does not provide for transgender care. If Jaiden’s mom can get coverage somehow, she has pledged to donate any remaining funds to another trans youth in need through Seattle Children’s Hospital Gender Clinic.

If you’ve read my blog and it’s helped you in any way, I’d be forever grateful if could kick in a few dollars to the fund and share the link (http://gf.me/u/ugk3wr) around. I know money’s often tight for trans people, so if all you can do is share the link with your network, it would mean the world to me and Jaiden.

Thank you!



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Week 4-7 Post-GCS

So, where am I at after almost eight weeks post-GCS?

Sitting down still fucking hurts. Standing around for too long fucking hurts. Stubbing my toe when walking fucking hurts and sometimes just walking fucking hurts. Jogging or running is still out of the fucking question.

What’s driving all the non-sexual fucking?

My pelvic floor and glutes are still swollen, which means that when I sit it feels like a fucking water balloon is being shoved up into my vagina, putting strain on the internal sutures. When I stand around, it feels like I have a water balloon sagging out of my crotch, pulling on my internal sutures. When I stub my toe all that extra water jolts my internal sutures. When walking, all those engorged tissues squeeze my clitoral and urethral area, where there are more internal sutures to get tugged on.

The pain isn’t terrible and sometimes I don’t even notice it, until I do, and then I notice it’s been there for almost eight fucking weeks. Most of the time I ignore it. When I know I’m going to be out for a while, I take 400, 600, or 800mg of ibuprofen, depending on how long I’ll be out. A few nights here and there I’ve popped a Vicodin when it crosses the invisible threshold of, ‘I’m fucking sick of this and want to go to sleep without noticing the pain.’

On the upside, I am being more active, getting in a walk of two to four miles a day. I’m able to lift more weight without feeling like I’m going to pop a stitch. The long incision line is almost all closed up except for two tiny spots. Centimeter by centimeter, sensation is returning to my vulva. Dilation isn’t all painful.

Speaking of dilation, it’s now shifted into the tedious chore column. I’m anxious for when I can reduce daily dilations to two instead of the current three. I’m proud I’ve only dropped my dilator on the floor once so far.

I have an almost constant slow discharge from my vagina, which appears to be a mixture of yellowish fluid from the internal incisions tinged with the faintest trace of blood. Pads and liners seem to irritate my skin so I’m going through at least two pairs of cotton granny panties a day.

My surgeon’s office followed up with a call on week six and I called them back on week seven. The good news is that there really wasn’t much for me to report back and they cleared me to up my activity levels. Regarding my numbness, they said not to worry until it’s been a year. The swelling should mostly subside by month six and there isn’t anything that can be done to reduce it; I just have to wait it out. They’ll call back at twelve weeks.

My libido turned back up, nosing around the new equipment. It tried to pump more blood into an already swollen and constrained area and it hurt. Damn libido.

I saw my doctor again last Friday, and she said everything looks great and to come back in a month. Her front office told me they don’t take my insurance so that’ll have to get figured out before I go back.

So, everything’s normal, I have no major complications, and per my doctor, I’m healing faster than she usually sees.

Yay my vagina!

©Heather Coldstream

I’m on Twitter @cistotrans

Please consider supporting my writing by sharing it with others with attribution and linking back or buying one of my poetry collections from the Kindle store. Thank you!

2016: Poems from a Year of Change

Uncertain: Poems About Gender Transition

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Two Weeks of Hell

Content warning: graphic descriptions of surgical recovery, surgical care, biological processes, emotional distress

There is a wide variance in post-surgical experiences depending on things like the surgeon, surgical technique, general health of the patient, complications, etc. The below is my experience only, and should not be considered typical or expected.

The second and third weeks of recovery were a clambake of pain, itching, and depression. A choral symphony of misery hung in the air.

It was a miasma woven by moans and tears, electrified by static generated from expectations of the past, present, and future rubbing against each other. Bolts of physical and psychic pain coursed through my body as it sought to knit together flesh and spirit.

Painkillers dulled my senses, leaving me logy in a twilight of despair. I wanted this? Numb and sometimes bleeding flesh demanded and required my attention when all I wanted to do was hide from it. Thrice daily I was forced to confront this now bloated body’s painful needs by examining and care-taking its landscape of scarred tissue by dilating and applying antibiotic ointment to my incisions.

The itching, first manifested and localized to where surgical tape gripped me in the thighs with a red rash, grew to encompass my anterior torso in angry, red spots where I had been wiped down with antiseptic prior to surgery. Then the itching spread to my entire body as a flush. For days unending it was my primary torment. I popped Benadryl by the handful to try and knock it back but to no avail.

I noticed the itching increased after taking a Percocet for pain, so I gave up the opiate for ibuprofen supplemented with CBD-infused honey in chamomile tea. The itching receded enough to notch it down from mind-numbing wretchedness to misery, but it did not go away.

Skin flaked from my face like it had been burnt and my arms and lower legs were so dry it looked like I’d been rolled in powdered sugar. As much as I tried not to, I scratched. I scratched my scalp, my armpits, my back, anywhere where I couldn’t resist it’s insistent calling. Angry, red welts rose from my nails as I scratched and left me with as much lasting satisfaction as eating cotton candy for dinner.

I was a fucking mess. Then I got worse.

Dancing on every itchy tingle, skipping amongst the painful throbs and jolts, and mocking my island of numb, the brain weasels moved in. In my isolation, they told me I’d made a horrible mistake, that this disfigurement was permanent, and that all I had to look forward to was pain and suffering.

They pointed out discolored and swollen flesh, whispering in my ear it was going necrotic. They told me my rotting crotch would fall out when I sneezed hard, dropping with a painful, bloody sploosh into my underwear. They laughed at my itching and told me the rash was a bacterial skin infection, and that it had migrated to the inside of my vagina and was incubating a permanent colony for future attacks.

The weasels told me I didn’t have a clitoris and even if I did, it’d never work, and I’d never have an orgasm again. Besides, who’d want to have sex with someone who had a disfigured crotch, anyway?

They laughed at me and told me my hopes for surgery were delusional. While trying to block the discomfort and fall asleep they fished even darker thoughts from the recesses of my addled and rattled brain, sowing seeds of doom and gloom. Depression fell upon me like an over-weighted blanket, making it hard to breathe or move.

Were the brain weasels right? Would this never end? Was my disfigurement and numbness to be permanent?

In desperation, I asked the trans women of Twitter about their experiences. In private and public messages from those that have gone before, (thank you to everyone who replied, I am forever in your debt,) I was reassured things would get better in the coming weeks. Knowing the bad place was temporary helped me to keep the weasels at bay and focus on the future, but things were still touch and go for a couple of days and I shed many tears.

A post-surgical depressive freak-out sometime around the second week was startlingly common among the women I corresponded with as was a longer depressive streak. Post-surgical depression is a thing, and there are studies about it for cancer and heart patients, but of course none for trans patients.

I struggled with post-surgical chronic pain and the reduction in physical capability and stamina. I felt like an old woman who couldn’t move without pain and whose spirit and flesh had succumbed to the ravages of age, unable to do things I had previously been able to do with ease.

My doctor’s office had convinced me to schedule a checkup a week after I arrived home and I’m so glad they did. After consulting with my doctor, she suggested the itching was a reaction to both the oral antibiotics I had been prescribed and the topical over-the-counter antibiotic ointment I was slathering on my incision lines.

She instructed me to stop the topical and prescribed some industrial-strength antihistamines, which knocked me out so I could sleep. I’d already completed the oral antibiotic course. For good measure, I stopping using the chlorhexidine soap I was using to wash my dilators and shifted to liquid non-antibacterial soap. It took a week for the itching to subside to background noise and another for the welts I gave myself from scratching to fade.

The weeks detailed above were probably the worst physical experience of my life in duration and discomfort.

I’m a bit over six weeks post-op as a write this, and the depression is still here, but I can feel it starting to lift as I regain strength and stamina. I still have pain, but it’s manageable. Most of my incisions have healed, but I still have sutures working their way out. As others have told me, it will take weeks to months before I feel normal and for the swelling to go down.

As always, I look to the future.

©Heather Coldstream

I’m on Twitter @cistotrans

Please consider supporting my writing by sharing it with others with attribution and linking back or buying one of my poetry collections from the Kindle store. Thank you!

2016: Poems from a Year of Change

Uncertain: Poems About Gender Transition

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Genital Confirmation Surgery (GCS) Part 2, March 2019

A beautiful flower

Content warning: graphic descriptions of surgical recovery, surgical care, biological processes, emotional distress, swearing

There is a wide variance in post-surgical experiences depending on things like the surgeon, surgical technique, general health of the patient, complications, etc. The below is my experience only, and should not be considered typical or expected. Written between four and weeks post-op, it’s a close-up look at the first week of my recovery.

If Part 1 of my March 2018 genital confirmation surgery (GCS)* was the gauzy, emotional journey where the heroine awakens in satisfaction of a milestone reached, this Part 2 is the blood, sweat, and tears knife fight that is still happening afterwards.

There’s no other way to put it; the pain of surgical recovery has been bad and the post-surgery depression has unraveled me some.

The first couple of days were pain, and drugs, and more pain, and more drugs to make me ignore the pain. Then more pain. And discomfort. Lots of discomfort. The discomfort of feeling my crotch compressed into a taped-on bandage I wore like a diaper. The discomfort of feeling stuffed by packing filling my new vagina. The discomfort of lying on my back and not being able to move around much because every time I moved it hurt.

Every four hours a nurse or aide would come in and check my vitals. Then they’d empty the Jackson-Pratt surgical drain of its strawberry-gray puree-looking fluid and my catheter bag. I found this attention comforting in the daytime but annoying at night when trying to sleep. I didn’t sleep much.

The second day on rounds, my doctor and a nurse peeled off the bandages with such vigor I was afraid the skin on my ass was going to come off with it. My doctor was pleased I had little bruising and not much swelling. Then they stepped back and evaluated at my crotch while I lay in the bed with my legs spread.

My doctor christened my new equipment a ‘designer vaginer’ and declared it some of her better work. I made a mental note I’d had a vagina for less than forty-eight hours, it had just been objectified, and I guessed I had better get used to people objectifying my pussy.

For all the feeling coming through as pain and discomfort, most of my crotch was, (and parts of it still are,) numb. Not the slept on it funny numb, but dead meat Novocain numb. And swollen. Swollen like a roadkill raccoon lying in the summer sun, juicy in its contents. As a bonus, I had a skin reaction to the surgical adhesive on the bandages and the insides of my legs bore painful, angry pustule-threatening red stripes that over the following week would spread their fury over my mons pubis and down my thighs.

One high point was my catheter. Yellow surgical tubing jutted out of my meatus like I was the source of fluid for a chemistry titration experiment. Relieved from having to go to the bathroom to pee, I drank even more water than normal and the nurses came to be amazed at the efficiency of my kidneys and dismayed when realizing they’d have to make an extra trip to the toilet when emptying the collection bag. They said to drink plenty of water and I did, so they asked for that extra work.

Three times a day, a nurse applied triple antibiotic ointment to my sutures and cleaned the catheter tube. My visible sutures run on the outside of each labial fold and a third runs in a long arc from leg to leg through the perineum by following the fold of the skin where my legs joins my torso. My perineal suture was bruised in a blackberry color, and for a while it looked like a twisted cross between a sewn-shut Jack Skellington and Joker smile.

As they ramped down my pain meds, I realized the tight feeling in my crotch wasn’t just from the bandage. What I had thought was just compression was instead a persistent feeling that someone had yanked my penis back in a severe tuck and pulled my pubis down along with it before stapling it all to my perineum. Getting out of bed to sit in a chair brought no relief, as it hurt just as much if not more to sit on my sutures.

The packing made it feel like I needed to poop. Speaking of pooping, I was terrified of it. I was afraid that I’d strain on a hard turd, sutures would pop or tear, and I’d be a bloody, shitty mess. It was an irrational dung-pile of fear that grew and grew in the back of my mind each day until five days post-surgery I pooped with the consistency of soft-serve chocolate ice cream because hospital food.

On the third day they discharged me, (to the shitty nurse’s aide who wanted me to walk downstairs instead of riding in a wheelchair like my nurse told you to take me in, you are not going to like the letter I’m going to send to your CEO but the awesome nurses are going to love it and you will never again be able to shirk your duties so fuck you and your, ‘Is purple your natural hair color?’ question,) and my friend drove me back to spend the night at the local hotel.

Most of what I remember about that first day out of the hospital is the relief from constant interruptions, the delicious Chinese food, and sleeping through the night. The next day it was back up to Monterey where my friend lives for the rest of my California convalescence. It’s an almost a two-hour drive, but this one took about five days when measured in the time dilation of pain.

The first days back in a residential setting found me popping my Percocets, laying around with an ice bag on my crotch, and cataloging how a catheter bag is like a cat:

  • It’s always tangling around your legs
  • It needs almost constant attention
  • Its output requires regular disposal
  • Its position is paramount over yours when sitting or lying down
  • Its your friend
  • It will fuck you up if you ignore it too much

This list was composed as I walked a half mile to the drugstore for supplies while carrying my catheter bag in a tote bag. The bag’s top almost perfectly aligned with the hem of my skirt and given how uninterested people are at looking at a middle-aged woman, I’m not sure anyone noticed the tube snaking from underneath my skirt into the bag.

For some reason, I had this expectation I’d be more mobile those first few days. The reality was that amongst the packing, catheter, and pain, a slow waddle was about the best I could do and it was tiring as fuck. Speaking of pain, it was hard to disentangle discomfort from pain, but does it really matter?

One week post-op I went back to the surgeon’s office to have the catheter and packing removed, and learned how to dilate.

Of the three things, catheter removal gave me the most anxiety. I had imagined feeling it slowly slide out of my urethra with a burning sensation. In reality, it slid out in under a second and I barely had time to realize it was out before the nurse was dropping it into the garbage can.

Packing removal from my vagina took longer and near the end of this magic scarf trick, she was yanking and it hurt some.

I was then handed a mirror and given a tour and anatomy lesson of my new downstairs configuration. The mons pubis, labia majora and minora, clitoral hood and clitoris, urethra, vagina, and perineum were all named and pointed out.

After that and in a very serious tone, I was warned to wipe front to back, so, and I quote verbatim, ‘No poop germs get in the pee hole.’ Since that dread warning, I have endeavored not to cross-contaminate fecal bacteria into my vaginal or urethral biomes through improper ablutions so I never have to present at my doctor’s office with poop germs in my pee hole.

Last up was dilation training. In absolutely, completely different circumstances having another woman lube up a dildo-like object and put it inside of my vagina sounds delightful. In this instance, it was not delightful. On the upside, it wasn’t terrible.

With practiced and efficient ease, the nurse washed and lubed the dilator, explaining the finer points of lubrication distribution as she worked. My dilators have dots on them to indicate depth and she pointed out the one appropriate to my new anatomy. She explained the importance of insertion angle; roughly equal to my bent leg; so as to avoid the pubic bone, and then it was in.

Some might make this out to be a seminal moment. In my case, it was more of a, ‘Is it in?’ moment. (Remember, dead meat Novocain numb.) It was, and the nurse continued to push it in until it bottomed. I did feel it inside of me before it ran out of runway. She then pointed out the marker dot and the fact it needed to be further in. She gave it a bit of a shove, ‘It should feel like you’re constipated some,’ (it did,) and then it was where it was supposed to be.

She had me view the dot in relation to the vaginal opening and explained I was to hold it like that for fifteen minutes per session. She had me practice inserting it and getting it to depth while she explained that when I sized up dilators, (there are three sizes in my set,) total time at depth across them should be fifteen minutes.

Since the packing had only just been removed I didn’t need to dilate until later that night. My dilation schedule is three times a day for three months, then two times a day for the next nine months, then once a day thereafter. With an exhortation to avoid stretching or yoga for twelve weeks, I was then sent home without my packing.

It’s implied, but to make it explicit, I was up on an exam table with legs spread and crotch fully exposed for those procedures. When living as a guy, there wasn’t much attention paid to the down below. I had the annual physical ‘turn your head and cough’ hernia check and maybe a quick testicular palpitation for cancer, both of which were often completed in under a minute. To have someone I’d just met staring at and working in my crotch for upwards of ten to fifteen minutes required a mental shift to accept.

The ride back to Monterey was uncomfortable. I think I popped a Percocet on the way. It was nice not to have to worry about the catheter tube anymore and there was a relief at not feeling full from the packing. The flip side of this was I was no longer under doctor’s care and pretty much on my own unless a complication arose.

That night I completed my first dilation and it was scary and a bit painful and probably took me over an hour while I figured out what the hell I was doing. I was pretty stoned on pain meds so it’s fuzzy. As I contorted myself to dilate, I struggled to square the instructions of not doing yoga while holding a pose under tension for fifteen minutes.

To be continued…

* Over the years, the surgery was known as SRS (sexual reassignment surgery), then it switched to GRS (genital reconstruction surgery) or GCS, which are sometimes used interchangeably. Usage seems to depend on age, (older people tend to use SRS,) or personal preference.

©Heather Coldstream

I’m on Twitter @cistotrans

Please consider supporting my writing by sharing it with others with attribution and linking back or buying one of my poetry collections from the Kindle store. Thank you!

2016: Poems from a Year of Change

Uncertain: Poems About Gender Transition

Posted in gender transition, health, healthcare, LGBT, personal history, transgender, transition | Tagged , , , , , , | 7 Comments

Genital Confirmation Surgery (GCS), March 2019

Beach waves at Monterey, CA

Monterey, CA

I meet with my surgeon the afternoon before surgery. My appointment has been re-scheduled twice; once because traffic is preventing me from arriving for an earlier appointment and then later because the doctor is running late.

This is the second time I’ve met with her and it’s an opportunity to ask any last-minute questions.

Do I have any?

No. We covered everything the time before.

She asks me a question: what are your expectations?

This question gives me pause. I realize I’ve never really thought much about expectations.

I know the whole reason I’m sitting here is because my expectation is that she will re-configure my genitals to conform to what my brain tells me should be there. Beyond that…

‘I don’t know. I don’t really have any,’ I blurt.

She seems surprised by this and starts mentioning a few things that include depth and appearance. I don’t want to look like a complete idiot so I spill out a couple.

‘No infection. Orgasmic.’

‘What about appearance?’

‘That’s out of my control so I don’t worry about it.’

We chat a bit more and she seems satisfied with my answers. My surgery time has been moved from 07:30 to 11:00 since there was a power outage at the hospital today and she had to bump her afternoon surgery. News of a power outage gives me a moment of pause but I’m cheered that I don’t have to be at the hospital at 05:30.

She hands me the bowel prep kit and gives me an overview of how to use it, directions to the local Walgreen’s to pick up some other prescriptions, and then I’m sent off with a, ‘See you tomorrow!’

My friend, who lives in Monterey and who I’ll be staying with, has been patiently waiting and we walk to the pharmacy down the street to pick up the prescriptions and some last-minute supplies. My mind is overfull, and it’s all I can do to focus on where we’re supposed to go.

Waiting in line at the pharmacy, an older woman sitting in a chair waiting for her prescription comments on my backpack by asking me if I’m going hiking. I mumble no. Talking to other people is hard right now.

I wonder how many other trans women have stood in this line waiting to pick up their medications. Hundreds? At least. Thousands? Easily. I see myself as another in a long line stretching back in time and others queued up behind me for the future.

I’m really here. I’m really doing this tomorrow. Right?

The pharmacist says my meds aren’t ready. Maybe fifteen minutes. My friend and I make our purchases and I’m looking at the map app and see there’s an Apple Store nearby. I need the trackpad on my Air fixed so we hike down the street and it’s only after I’ve gotten into the queue that I realize I forgot to pick up my prescriptions.

How the hell could I forget? I guess I’m overwhelmed. I have things on my mind. The years it took to get here weigh on me like slabs of polished granite, squeezing the life ouf of me and compressing me to jelly.

Breathe, Heather, breathe. You’re almost out from underneath them.

My friend holds my place in line and I trot back up the street to the pharmacy. There’s no line and the cashier rings me up and passes them to another counter where I have to get counseling from a pharmacist. I didn’t ask what all the prescriptions were and I pick them up and start to read. Oral antibiotics. Painkillers. Antibiotic ointment.

The pharmacist sees me and comes over. Do I have questions? I don’t and I’m off again. It doesn’t occur to me until I’m back on the way to the Apple Store that for all the trans people that have gone through that pharmacy, I never saw the knowing smile or smirk I sometimes see or heard the gentle condescension I sometimes hear.

Apple doesn’t have my part in the store but Palo Alto does if I want to go there? Or come back in a couple of days? It’s getting late so I thank the nice man for his time and my friend and I head back to the hotel.

There are two doses in the bowel prep kit and I’m supposed to have them about five hours apart and nothing at all to drink after midnight. I was supposed to only have clear fluids all this day but I screwed up and had eggs for breakfast so I’ve been pounding Gatorade to flush everything out.

It’s close to 20:00 so I get mixing and drinking. It tastes awful. A mixture of three different salts, the manufacturer decided to overdose on sweet flavoring to mask the salts. It tastes like salted and distilled Mountain Dew. My first batch goes down reluctantly in about 40 minutes. I decide I’ll start the next batch at 23:00 and I spend the intervening time sorting and packing for the hospital.

I pack a couple of pairs of pajamas, some shirts, underwear, a light sweatshirt, clothes for the morning, and my toiletries and phone. With hindsight, I ridiculously over packed. Besides my toiletries, all I really needed was the clothes I walked in with and the sweatshirt.

23:00 rolls around and I mix up my second batch of bowel prep. I can feel things rumbling from the earlier dose but nothing has happened yet. The taste, if anything, is worse now. The salted and distilled Mountain Dew now tastes like it’s been pumped through unicorn veins and boiled with glucose in spun sugar bowls.

23:45 rolls around, I’ve barely drunk a quarter of the dose, and the osmotic pressure in my bowels reaches a critical point and tells my nervous system to enter high alert: it’s time to go.

And go I do, beginning what turns into an almost all-night liquid sedimentary layer excavation of past meals.

00:10 comes and I’m trying to take small sips and then rinsing with water or orange Gatorade. It’s not working. There’s still easily two-thirds of the dose to go so I dilute it with what remains of the water I’m also supposed to drink. It’s still nasty.

By 00:20, I’ve choked down another quarter of the diluted version, run to the bathroom twice, and watched the color of my effluvium trend clear. I need to finish this. I top it off again, this time with the Gatorade, and this turns out to be the wrong thing to do.

Whatever sweetener in is Gatorade is close to, but not quite, what’s in the bowel prep, and now I’ve just poured high fructose corn syrup into the already devilish brew of sweet.

I valiantly try to complete doctor’s orders but at 00:40 I give up and pour my cocktail of Smurf juice down the drain, swish my mouth out with water, and pound another 16oz of water before dashing to the bathroom again.

I’ve set my alarm for 07:30 to give us both enough time to get ready and get to the hospital by 09:30. Again, my ambition outstripped reality.

Reader, I was up at least every half hour to void myself and it was awful. The cycle was thus: clean myself up from the latest purge, waddle back to bed, sit on edge of bed, do a body check-in, convince myself it was okay to lie down, lie down, feel the urge, struggle to get up and waddle to the throne without dousing myself, and begin the cycle anew, seemingly ad infinitum.

Some people, (mostly cis,) think gender confirmation surgery (GCS)* is the glamorous denouement of the gender journey, where the plucky heroine has surmounted all obstacles to attain serenity and appears dewy-eyed in the recovery room, while her scrappy but tough found family of friends cry tears of joy for her while holding balloons that say, ‘It’s a girl!’

Some people also think Trainspotting glorifies heroin use.

Somewhere around 05:00 I was able to start catching snatches of fleeting sleep, so by the time the alarm went off two hours later, I was a shell-shocked, empty vessel of sleep-deprived nerves with a tender bum. (20/20 tip: use baby wipes at the start, not after it feels like your anus is trending towards becoming a Ring of Fire.)

The brain weasels moved in while I was shaving my crotch in the shower and asked all sorts of questions and offered their unsolicited insights.

To wit:

‘Do you really want to go through with all of this? Are you sure? This is permanent and recovery is long. Sure you can’t just deal with your equipment? Lots of other people do. You might be able to get a partial refund or donate your slot to someone who can’t afford it. Is this worth it? Is this really what you want? You’re afraid. You can bail out right before they put you out, you know.’

Etcetera, etcetera.

Fucking brain weasels.

My transition required me to take agency to transition and not let those that opposed it or tried to deflect or slow me down take it away from me, and that includes brain weasels. So, I pack my bag and we leave for the hospital.

On the way, I realize that most of yesterday I felt a deep sense of calm and happiness. I take this thought balloon and tie it to my wrist.

I check in for surgery. There is little paperwork, it goes quickly, and then I’m off to surgical check-in. The nurse there is sweet and she shares a name with my mom. The last time I was in a hospital was when my mom died and I am overcome and I weep for a bit.

What do I feel? Everything.

It has been a long journey to get to this moment. It feels hard now, but the real hard work is past.

I go to the bathroom. I disrobe and put on a gown that’s impossible to tie without help and I’m grateful again for my friend who is here to help and comfort me.

An intravenous port is installed. I scrub my teeth and gargle a minty antiseptic, and it reminds me again how much I hate mint because of the time I gorged on too many leaves from my mother’s garden and became sick.

My blood pressure is a bit higher than normal, but I’m dehydrated and anxious, so it’s not a worry. There’s some paperwork to sign and then I’m swabbing my nose with an iodine solution and wiping my body down with antiseptic wipes.

I mentally Marie Kondo my penis and thank it for such good use over the years, but it’s time for it to go.

It’s almost 11:30.

The anesthesiologist comes in to introduce herself. I’ve never met her before and she’s about to have my life in her hands. I get a competent vibe from her and her bedside manner is attentive. She explains what she’s going to do and the only new news to me is that I’ll be intubated during the procedure. I hadn’t remembered reading or hearing about that before.

She leaves.

Things are getting more real by the second.

My doctor pops in and asks if I’m ready.


She vanishes and then I’m being wheeled down hallways on a gurney to the operating room (OR). This area is clean and I am comforted. I’ve never liked hospitals. The irony is that I’ve worked in two and been through so many emergency rooms as patient or advocate I’ve lost count. I idly wonder if all that time I spent in them was to subconsciously prepare me for this moment–the moment I dreamt about when I was five.

We enter, and I’m surprised. It looks very high-tech and different than the surgical suites I was in for the cesareans of my children. It’s a big room, easily thirty by twenty feet across.

Besides the operating table, there are a bank of four flat-screen monitors on the wall. Two display vital signs, one is a clock, and one is of a live video feed of the table. There are four surgical nurses arranging instruments on different trays and tables.

They have me hop down from the gurney and ask me what surgery I’m expecting today. Flummoxed, I have to read it off the clipboard, ‘Genital reconstruction surgery.’

I’m introduced to the team and promptly forget all their names because my mind is blank because everything going in is whooshing right back out. I thank them for caring for me as I climb onto the operating table, and they seem appreciative.

I am laying on my back and I’m asked to shift up a bit into a depression on the table around my butt. Properly situated, my arms are spread out wide, a belt is placed across my hips, and it is time.

I stare at the huge surgical lights looming above me. There are three, and each is about three feet across. There are translucent, irregular dimples scattered across the slightly parabolic surface that look like large blobs of slushy water frozen on. To distract myself, I consider why they’re like that and tell myself it’s so the light spreads irregularly through them to reduce shadows.

The anesthesiologist comes in and asks if I’m ready.

I’m terrified and want to say no. How the hell did I end up in an operating room to have my genitals turned inside out?

The question is absurd and asked by fear.

I didn’t arrange my life and make the choices I did to bail out at the last second from fear. That would be absurd.


‘Okay, let’s get going.’

My doctor enters and leans over me.


I want to say no. I want to flee from the room and live a life where I don’t have to worry about my body or my gender.


She asks the room what time it is. Someone answers, ’11:53.’

‘Are you sure?’

I can see the clock on one of the screens. It says 11:56.

‘Uh, 11:56. She came in at 11:53.’

‘Let’s get going.’

Someone moves just out of my vision behind me to the left. I think it’s the anesthesiologist.

I awaken briefly in the alternate universe of the recovery room, relieved I’m still alive. My doctor or someone tells me everything went well. I close my eyes, and open them in my private room. My friend is there, smiling. It’s afternoon and my crotch hurts and is swaddled in bandages. I can tell I have packing in me.

It is done. I did it. I made what I used to think would never happen, happen. I am proud of myself.

For the moment, I am content.

Continued in Genital Confirmation Surgery (GCS) Part 2, March 2019


* Over the years, the surgery was known as SRS (sexual reassignment surgery) for a long time, then it switched to GRS (genital reconstruction surgery) or GCS, which are sometimes used interchangeably. Usage seems to depend on age, (older people tend to use SRS,) or personal preference.

©Heather Coldstream

I’m on Twitter @cistotrans

Please consider supporting my writing by sharing it with others with attribution and linking back or buying one of my poetry collections from the Kindle store. Thank you!

2016: Poems from a Year of Change

Uncertain: Poems About Gender Transition

Posted in gender transition, health, healthcare, LGBT, personal history, transgender, transition | Tagged , , , , , , | 16 Comments


Moonlight over the Salish Sea in Seattle

It rained last night, but now it is mostly clear, and the moon walks with me to the bus stop in the pre-dawn, dancing between still-dripping Douglas fir boughs to drop moonbeams between shadowy places. Stars add their twinklings to the celestial show. All of them are my remote companions on their own journeys towards eventual transformations small and large. I meditate on the seemingly universal and eternal nature of change.

Nothing changes, then everything changes, then nothing changes again. I’m in a big everything changes cycle now.

My work, my relationship to myself, the shape of my body, my relationships to others—they’re all changing around. Underneath it all, the catalytic substrate I worked so hard to build will remain after all those changes. Then nothing will change for a while as I rest.

I’ll use that time to consider tearing it down or modifying it for the next round of change. But that’s the future.

The now is moonlight, starlight, dripping boughs, and the beginning of the last leg of a journey I started ages ago.

©Heather Coldstream

Please consider supporting my writing by sharing it with others with attribution and linking back or buying one of my poetry collections from the Kindle store. Thank you!

2016: Poems from a Year of Change

Uncertain: Poems About Gender Transition

Posted in gender transition, LGBT, personal history, transgender | Tagged , , | Leave a comment