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

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2016: Poems from a Year of Change

Uncertain: Poems About Gender Transition

About cistotrans

A Seattle-area trans woman seeking a happy spot to stay at along the path of transition.
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7 Responses to Genital Confirmation Surgery (GCS) Part 2, March 2019

  1. Thank you so much for sharing. I love your humour despite the pain. I was scheduled for June 7 but they postponed a week as the doctor wasn’t available. Um, isn’t he the important one? I do feel a little nervous and yet filled with anticipation. I think the loss of Kiera is on my mind too. I have already filed for FMLA and STD, so just waiting on those final instructions. Thanks again for sharing. It helps to know what I could possibly face.

    Liked by 1 person

  2. Willa Patryn says:

    Congratulations, your descriptions of the procedure seemed similar to many others I’ve read. I’m envious, but deeply happy for You!
    When I was younger, ‘sex change’ carried too much implication as w/transsexual or transvestite. I never wanted to be one of those. I simply wanted be who I am. Confirmation and congruence

    Liked by 1 person

  3. Tanit Richards says:

    I very much appreciate your frank and graphic descriptions – they bring home the actual physical cost of the procedure. I am afraid of surgery in general and your post (and others) may help me in the future. I wish you a speedy, no-issues recovery! Hugs,

    Liked by 1 person

    • cistotrans says:

      Thanks for reading and the wishes! ❤️ I really didn’t want to do this but I reached a point where it felt like the best path forward. No regrets only peace is what I feel now.

      Liked by 1 person

      • sara19719 says:

        GCS can be a scary thought, but it must be well thought over because it is a life changer. When i started my transition, GCS was not on my radar to begin with, but in the end i knew i needed the surgery to survive in life. The surgery is to improve quality of life, but it doesn’t cure all our problems.I too was finally be able to find peace in my soul and no regrets either.


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