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10 Months Post-Op

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Sifan 7/10/2015

Sifan 7/10/2015

I’m not sure what to say, accept that I feel I need to post something.  Today marks 10 months since my SRS and birth into the physical reality of who I am.  Yesterday however, was the 3 month anniversary of when my beloved Lisa passed away.  This post will primarily cover transition.

The entirety of these past three months have been spent in grief, morning and loss.  People say I’m doing better, but it feels even worse than at first.  Nothing in my entire life has been this hard.  This is one of the reasons I could not post until now.  Not sure I’m ready to post now either but I feel I should.

I think I will be creating separate posts to cover the main things I’m going through and experiencing.  Those include the continuing transition (or perhaps it’s post transition now), the grief and loss of my spouse and what I’m going through and what is helping and the many ways that Lisa is showing up and making herself felt.  This last one is quite amazing.  Lisa is being felt by many and I have heard from a lot of people.  This has been an immense relief and comfort to me.

It does not relieve the grief and pain of loss.  After all these years of cuddling every night, all night long – my body experiences this loss so terribly.  But my spirit knows Lisa is with me and I experience her constantly.  These two things continue along at the same time – loss/grief and comfort.

Of course Lisa’s passing has completely eclipsed my transition.  I am very grateful that during this period of memorials, life celebrations and lots of public exposure that no one has ‘clocked’ me, no ‘he’ nor ‘him’ or sideways glances or inappropriate comments or remarks.  Actually I haven’t had anything like that for more than 1/2 a year now.  I’m not sure if that is because of looking more like a woman, acting more like a woman or because of my confidence in being who I am.  I think it’s all in the latter – confidence.  I’m not even thinking about whether I look like a woman or will I be ‘passing’ ok today, etc.   Thanks to my dearest Lisa, I have a confidence now that carries across.

As far as post op recovery is concerned:  wow, they are right – looking back, 6 months was the magical time!  As I stated in an earlier post, it almost happened overnight, the night before my 6 month anniversary.  I no longer used the seat cushion, the remaining pain went away, dilation was much easier, and on and on.

Since then, I have even ridden a bicycle!  Now that was something that the thought of before would send very unpleasant shivers up and down me.

I had a granulation between my labia on my right side that used to bleed now and then back in the months after I got home.  I was very concerned and was going to have my doctor here remove it.  The advice from Chonburi was to just leave it alone.  But I wondered what would become of it:  would it remain as a protrusion?  Would it fall off?  Would it just go back in?  Well now I have the answer – it goes back in.  It’s gone and everything looks good there.

However, my doctor noticed something else – it looked like a ‘Y’ shaped frenulum split my clitoris in half!  Sent off a picture to Chonburi and they said ‘oh oh – that needs a revision’.  Ouch.  The clitoris has ‘legs’ that come down inside the inner labia on a woman.  Apparently those legs are along the inner sides of the inner labia instead of underneath.  These are sensate, but not to the point of pain or it being a problem.  My doctor here said that unless they were effecting me, to not worry about it at all.  She also said to look at it this way:  I have ‘extra’ sensate areas – be glad !!  So, I have a normal clitoris, clitoral hood, frenulum etc., then directly below the frenulum I have these two longish bumps on each side between the upper inner labia that are also as sensate as the clitoris.  I’m happy with that!

For dilation, I’m now down to once every 3 days.  I am on the largest dilator, have been since before the 6 month mark.  I don’t have any problems, no pain and it’s been easy and fast to get to depth.  I will wait for another 2 months (my 1 year anniversary) before I cut down to once a week as recommended for that time and then for the rest of my life.  Trying to figure out what day I’ll do my dilations on when I get to once a week – hummm – Mondays? – nay, those are bad enough ….

I have finally stopped shaving the upper 1/2 of my face!  The electrolysis has progressed far enough along that she now cleans up anything from about midway from my chin to my lower lip and up, then has started on my jaw line and chin and below.  There is nothing to shave above that!  At last – this is soooo good.  However, hair is still growing on my chest and stomach and that is starting to really bother me.  It has slowed down and others have said that it will eventually stop given about 2 years or more of HRT.  But I’m starting to think I might have her do electrolysis there next if this continues.

I’m also having electrolysis on my eye brows and finding that very very helpful.  She applies a topical to numb the area – it’s still a bit more painful than other places but it’s a huge difference in how I look and I don’t have to pluck anymore.  What a relief.

One of the concerns I had recently was how to shave my back.  Lisa used to do that for me – in the hard places to reach, but now ….  Turns out at my doctor’s office they now have waxing and massage.  So I signed up for a waxing for my back, my ears and my nose.  Yes, nose!!  I was pleasantly surprised!  They use a topical to numb the inside of the nose and it really (for me) was not painful at all.  So this will become part of a tri-monthly routine for me now.

My breasts have grown a bit more – I’m a 42B and filling that in pretty solidly now.  I’m glad I did not get breast augmentation when I was in Chonburi – as they had recommended against it and said I would fill out a bit more.  I did and am very happy with what I have.  Mine are ‘on the sides’ a bit, so when I put on a bra I have to pull or tuck them in (and get ‘side’ control bra’s).  This makes them look a lot better as well.  One thing I learned the hard way however – a mosquito bite just under the bra band in the middle of my back is the very worst thing to have!!!  Can’t reach it plus the bra rubs it raw.  ACK !!!!

Finally, my hair is just below my shoulders and slightly wavy along the sides.  I love how it is styled and layered.  Just right.  Ya, I still have high spots on each side of my forehead and therefore have bangs that cover them.  I wish I could use other styles but I do like this one.  I’ve had my hair up and also in a ponytail – always wanted to do that.  I didn’t think I had that much of a ponytail until I caught a reflection in a cornered mirror – wow, it was nice and long – a ‘real’ ponytail at last!  Now if I could just get more hair to cover those high spots ….

I’m settling on a style!  I’m mostly wearing mid to long skirts with tank tops (here in Hawaii) along with cork wedge sandals (1.5 -> 2″) and almost always earrings and a necklace, sometimes a bracelet as well.  I don’t like pants but will wear jeans when I have to (like going to the summit or taking hikes).

Well, here you have it – my first post about transition after Lisa passed away.  Finally, I was able to write.  Hopefully shortly I will write about how Lisa has been showing up to me and others plus a post about grief/loss and coping.

With much aloha,

Sifan

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Post-Opt Depression

depressionThis is a ‘second’ transition – a transition to living a normal life – and this is not talked about or at least not mentioned to the degree that it should be.  In some ways this was expected but perhaps none of us that have gone through SRS really understood the full ramifications of.  That is post-op depression. For some it’s huge.  For me it’s a slight sidelight hardly worth mentioning, but yet, very important to mention…

We have spent an inordinate amount of time and energy planning, researching, questioning ourselves and preparing for transition – taking almost every second of our day and occupying our dreams at night.  Suddenly all that planning etc. is over, done, accomplished – even the dreams stop.  And here we are – marvelously and finally our true selves, whole at last – but all that action is gone, finished, leaving us somewhat devoid and that sends some into a depression or just feeling down.

I use the word ‘we’ as I’m mostly talking about others in the sisterhood (I use ‘sisterhood’ to mean all those that I went through SRS with plus many others that are post-op).

I’m quite active in a number of areas, so for me I was able to simply ease into a relaxed life.  The greatest effect for me was being physically handicapped and unable to do a lot of the outdoor activities I enjoy (hiking, climbing, swimming, kayaking etc.).  But I’m also creative, love learning and do a lot with computers.  So I have many ways that I find rewarding and fulfilling.  I also had spent a lot of time pre-op getting my psychological self in order.

In addition to this sudden lack of intense activity, there is a low level pain that is pretty constant for 4 to 6 months as down there is swollen and still healing. I can see the progress, but it is very slow, measured by the week – not the day.  This has a couple of effects for me.  First it either prevents me from doing activities I love or at best it makes me think twice if I should do something or not.  But the thought is constantly present.

When I was researching SRS, as I was initially looking into the possibility that I wanted to go that far.  I read about the maintenance that is required and was taken back by how much there was.  Dilation for the rest of your life is a big one especially when you understand what and how and how often it must be done.  Add to that the normal but new (for us) activities a woman has to routinely do:  cleanliness, pads/liners, checking yourself/making sure all is ok and how to use the restroom – how to sit, clean, even how to urinate.

All these take additional time that before we never had to even think about.  And now, the time to do all these duties constrains our ability to get into the things that bring us joy and keep us (anyone actually) happy and away from depression.

At times we feel so good, but then something else happens and back we go.  The pain will sometimes abate, only later to come back in a different form.  Just when we think things are getting better something else starts in.  This is a long journey – it’s takes a year to recover from an operation this massively huge.  But relapsing after feeling so good can be very difficult to take mentally.

So we have this seven pronged threat:

  • Intensive mental activity leading up to surgery
  • Physical handicap keeping us pent up and unable to do activities we enjoy
  • Constant low grade pain
  • Things taking so much longer to heal than expected
  • The new duties
  • Maintenance required with our new parts and the lack of time to do enjoyable activities that keep us out of depression
  • Relapses after things were going so good

In a way, it’s equivalent to soldiers coming back from a war.  It’s suddenly over but perhaps too suddenly.  Everything keeps going around in our heads.  It’s hard to let all of that go and settle down.  It happens just too fast.  And the ‘way of life’ is completely different.  Whereas there was so much to do before, now there is a lot to do, but it is totally different.

For my sisters:  this is much larger than you think or possibly can imagine.  This is more than a change of your physical sex.  It’s more than just living as the opposite gender.  It’s also more than how society views you or more importantly, your own insecurities and fears. In addition to all of that, this is a profound life style change – right down to how you ‘wipe’ yourself in the restroom!

My advice for those that are contemplating SRS:  Do your due diligence in researching this.  Join online groups and social media that are targeted for pre-op’s.  Once you settle on a surgeon – ask that clinic what pre-op and post-op social media they have and get invited to those (these are almost always private).  Once connected – read back one year to get a good clear idea of what you are going to face.  You will read about complications, about troubles and issues, but also about marvelous achievements and proud moments.  A word of caution:  everyone is different both in what they experience and the timing for various healings to take place.  Take it all with a grain of salt as they say.  But at least you will have a better idea of the full spectrum of possibilities and outcomes.

A bit of a soapbox moment:  I saw so many sisters that carried high sexual expectations once they completed surgery.  It bears mentioning that around 50% of women (gender) born female (birth sex) ever have an orgasm.  A transsexual after completing SRS is no different and has the same statistics!  We are all sensate (feelings and able to have an orgasm) – but the big ‘O’ is more than just being sensate.  It requires a heavy mental aspect as well.  What it requires is an opening up, being in tune with your body and being calm mentally and letting go.  All of which are completely opposite of what is required of a man and is therefore even more difficult for a transsexual.  My soapbox is this – do NOT go into this for sexual reasons.  You really should only be doing this because you have a deep down need to have your life be congruent, to be whole, to embody the essence of who you are.  Let the rest come – it will.

For most males (birth sex) under the ‘influence’ of testosterone, they have an almost daily urge.  For me this was confusing and at odds to the woman (gender) that I am.  Those urges caused a conflict in me as the male influence of testosterone had it’s way.  This is part of what I called the testosterone poisoning.  Getting on HRT and now completing SRS solved this and got that poison out of my system along with all of it’s effects.  Mind you, if you are a cis male (meaning your birth sex and gender match), testosterone is perfect and wonderful and I appreciate that in others.  However, for me, a transsexual, that was an awful burden that caused great disphoria and conflict.  Of course for some this is a concern – will they still have sexual urges after HRT and SRS?  And for a lot of sisters going through SRS this translated to worries about size/depth (again think testosterone – how many males do you know that are concerned with ‘size’ …) and orgasmic potential (especially after being able to, on demand).  Granted, for those that are young and have or will have a male partner, these things are important – I’m not saying otherwise.  I’m saying these should not be the top priority nor the reason for coming this far.

You are changing into a female (you are already a woman). Your body is now going to act and respond as one.  This includes the much more subtle urges, the relaxed sexual tension (compared to before) and a completely different way that we orgasm.  Many worry (I did) about how will we be satisfied if perhaps we can not orgasm or as often and ‘easily’ as we could before.  When you come out of the ‘testosterone fog’ and into femaleness, the urges change too.  In other words, you are now a female and your urges and abilities will match a female’s as well – do not fret over this, let it happen.  Let me put this yet another way:  your new body and self will match … perfectly!

And for those that have had surgery:  This is HUGE!  You had a major surgery – it does things to your body that take a long long time to heal.  You might feel ok at the moment – but is it not finished.  We need to take this one day and one thing at a time.  Conquer it and it alone, then focus on the next.  Don’t get overwhelmed – it’s so easy to do.  This is going to take up to a year – all the adjustments, all the issues that come up – both physical and mental.  So many times, the clinic has told us – recovery is 90% mental and it’s very true.  I remember the first time I saw blood on my dilator – omg I went crazy worried.  I reread the ‘manual’ the clinic sent me a dozen times.  Did what they said – and no problem.  But the mental anguish was difficult.  Of course now I just put pressure on the spot (always a granulation) and it’s gone and done – not a biggie.  And that is how most of recovery has to be dealt with.  One day at a time, one thing at a time and put-in the time!

For some, this is a difficult period and an unexpected complication.  I have a feeling that this may have been the reason two people I know of that committed suicide. So this is serious.  If this is you – please, there is so much help out here – reach out – please ….  There are a lot of us that have been through this – we made it, it’s more than possible – it’s just more hard work.

With so much Aloha

Sifan

 

Surgery in Thailand – Part 3, Dilation

20140929_155212Caution this post contains TMI (for some this could be “too much information”).  Continue only if you wish – you have been warned.  I will be discussing the routine ‘maintenance’ that I now must do a number of times each day.  I’m writing this for those that are contemplating SRS so they can get an idea of what to expect.

After we arrived at the hotel from being discharged from the hospital, one of the clinic staff came up to our room and helped setup the room for my new daily routine.  Oh boy, life is now a bit more complicated then it ever used to be.  Things like showering and even how to wipe oneself after using the toilet are now vastly different and hygiene takes on a whole new level of importance.  More about this later.

For the rest of my life, I, like anyone who has SRS, must dilate.  Basically the body views the neo-vagina as a wound and will attempt to close it up.  Dr. Suporn’s technique uses a mesh, which new skin grows on, to form the vagina.  It also forms new tissue deeper inside surrounding the vagina as well.  One way to think of this is scare tissue – in some ways it is similar – but not really.  This new tissue will form hard and expand closing the vagina if not countered.  And that is what dilation is all about.

20141014_131948We were given four dilation stents, one small one, two medium ones and one large.  We start off with the medium stent, inserting it all the way back and then applying pressure to the back to keep our depth.  When Dr. Suporn took out all that packing, he inserted this same stent showing me how to do it and measured my depth (I was 6″ in the hospital).  Each stent has markings in both inches and cm.  As you can see in the picture, these are HUGE (both is length and width) and FRIGHTENING at first.  The first couple of dilations I did, I was amazed I could take all that!  At first, we have to dilate twice a day, 30 minutes each – basically I have to go to full depth and then push hard.  That was difficult.  It is somewhere between uncomfortable and mildly painful.  Some people take pain meds before they dilate.  I did at first but quickly found I didn’t need to.  One has to sit up straight (usually on the bed, pillows behind, plastic sheet on the bed and an absorbent bed sheet on top of that), legs must be straight out, no bending and somewhat close together.  Any other position will engage muscles that will make dilation harder.  We are taught that no matter what complications or difficulties we face – we always MUST dilate.  As you will see later – I had complications where the last thing I wanted to do was dilate – but I still did.

We start with the medium stent and later (6 weeks) we graduate to the larger one.  The small stent is used if it becomes difficult to insert the medium one.  We then have to dilate with the small one for 5 mins or so and then move up to the medium and complete the dilation.  The white stent is an extra medium size and is a bit softer.  I think everyone loses a little depth from what was measured in the hospital.  I’m at 5.5 inches and have stayed at that ever since – it could be the way they measured it there vs how I measure.  The important part is to maintain depth.  As I was told, depth will change with the time of day, if we just ate, if we didn’t go to the bathroom first, etc.  So it fluctuates, but again, what is important is that it stays somewhat consistent.

20140918_193204There is an entire procedure surrounding this.  The person from the clinic setup the bed table and bathroom so that everything I needed is close at hand.  As you can see – there is a lot.  The procedure gets better and less intense with time.  But at first, we shower to clean off, using a special surgical soap on our new bottom – and rinse it off immediately as it can actually burn the skin if left on or used to much.  I then lay down as stated above, put on surgical gloves, place a condom over the stent and apply a lot of lube – that last bit is important!

Until things heal enough (Dr. Suporn tells us when) we do ‘static’ dilation which I described above – straight back and apply pressure.  When told to, we start dynamic dilation (about 2 weeks after surgery for me – but that is different for each person).  Dynamic dilation is a bit easier I think.  I start by fully inserting the stent, applying pressure for 10 seconds, then rest, then ‘stir’ it around to enlarge the sides for 10 times.  Then we repeat this for 15 mins and have to do this 3 times a day.  Months 2 and 3 is where the most healing occurs and where this is most important.  The internal tissue is building and this needs to be countered and ‘softened’.  Unfortunately, the nerves are becoming active during this same time …..  I’m 1/2 way through month 2 at the moment – so far ok.

Then we have to clean up after.  This includes douching with warm water three times then a fourth time with a mild solution of betadine.  Then a half shower washing our new parts with that surgical soap.  For the first month we also have to apply betadine to the stitch lines down there and apply a silver cream to the inside of the inner labia.  And then – collapse on the bed and rest!

At home we no longer have to coat the stitches (most of which have already dissolved), but we do need to get a douche kit that fully reaches inside.  As they said – lube plus byproducts of healing inside create an idea culture for bacteria – all lube has to be rinsed out.  Also at home we can use regular soap.

One issue is the trip home vs dilation.  Having to dilate 3 times a day and having a flight home that for most of us is 20 some hours long makes for an interesting dilemma – no we do not dilate on the plane or in the airport!  So we dilate extra long just before we leave for the airport (the van came to pick us up at 4 am … that meant I was up and dilating around 2:30 am….).  Then we need to dilate when we get home.  The trouble is, it’s been a long time, things down there have already started to tighten up and the flight home has made us very tense – what a mess.  So, we are to wait an hour or so after we get home – do something relaxing – have a glass of wine – whatever to relax us.  Then we dilate – this is where some people have to resort to the small stent to get started.  I was ok – my depth went down to 5.1″ but withing the next 2 days I was back to my 5.5″.

Sifan at Thailand airportAs you can see from this picture – there is a lot of stuff we bring back with us (the huge pink bag).  This includes supplies to last us for a month or so after we get home.  It includes betadine solution, bed pads, tons of lube and condoms, a mirror, clock, my stents of course and pantie liners and pads.  They gave us a large bottle of betadine but I also had a smaller bottle.  The airport security ‘found’ the big bottle and confiscated it, but left the small bottle alone … go figure.  Other transwomen were allowed to take theirs – as far as I’ve heard – I’m the only one that this happened to – ratso!

Some last points regarding dilation:

Contrary to what you would think – if you are having troubles dilating, then you need to ‘increase’ the number of times.  They can be shorter in time, but you need to do more of them during the day.

As time goes on, we get to reduce the number of dilations each day.  Until the end of the critical period (month 3) we need to do three a day.  After that we can reduce to 2 a day.  After 6 months about once a day and finally after a full year we can reduce to a couple per week – basically to check depth and then if needed do more dilations.

Also, once past month 3 – dilations become easier and other umm activity can substitute for a dilation, making it pleasurable indeed …

I should also mention some of the problems that could be encountered dilating.  Make sure you use plenty of lube, you could chaff and that’s no fun.  Also a veteran post-opt warned us about the ‘sword in stone’ problem that could happen when you are too tight and when withdrawing the dilator it gets ‘stuck’ (probably because of a vacuum being created above it inside).  Just take it slow and use dynamic dilation to ease it out.  Something else we all find out right away is sneezing, coughing, laughing too hard and a close lightening strike (I found out about this last one the hard way) can all make for an uncomfortable experience.  I wonder if anyone broke things in their room due to flying dilators (to my knowledge only one person said their dilator actually came out – but just barely, mostly it just hurt a bit)!

Another issue is bleeding.  As you dilate, you are basically stretching scare tissue (first 3 months) and it will sometimes bleed.  Also as things heal, little ‘bumps’ (granulation) can poke up and dilating will cause those to bleed.  Counter to what one would think – the solution is to reinsert the dilator and hold it there to stop the bleeding.  I had this happened to me twice.  Others have said they bled the entire 2 months!  Most said they never bled.  Everyone is different and this goes away with time and healing.

I had some severe complications which I will talk about in the next post.  But even during that period of time – I still had to dilate.  It was difficult, but had to be done.  Nothing like complicating a complication ….

With Aloha,

Sifan