Note: I’ll be getting a bit more graphic in this post, discussing some of the more, er, bloody details. If you don’t like blood and other by-products of surgery, you might want to skip this post.
The first few days at the apartment were spent mostly in bed. My wife and a friend became my caretakers, responding to my needs, making sure I took my medicines at the correct times, emptying my catheter bag, and getting me out of bed to walk a few times each day. Getting up to walk was no small feat, as I was connected to two tubes – a catheter and a wound vac. Getting up meant me scooting to the edge of the bed, making sure my tubes were in a good position, and then being helped to stand up. Then both the catheter bag and the wound vac had to be carried next to me as I waddled to wherever I was going – most often into the bathroom to wash hands or brush teeth (while someone made use of the opportunity to empty the catheter bag).
Everything felt so tight down there! I felt like I couldn’t even stand fully upright for fear of pulling on sutures and causing them to tear open. More likely, it was the wound dressing – an adhesive sheet of plastic covering the entire surgical area – it was stuck so well to my skin that it probably was one source of my sense of tightness. Another source was that my neovagina had been packed full of gauze, both to absorb any blood or excretions and to hold my vagina in the desired shape for the first week of healing. Finally, I had a lot of swelling in the area – pretty much everything down there was swollen and stretched tight.
It was around day 5 that I encountered my first real pain. I had been eating normally, and my digestive system was working. This meant that I had some mass in my lower digestive tract. I needed to poop! But with my vagina packed so full, it was constricting my rectum, making it difficult for feces to pass. As the days went by, the sensation of needing to poop became worse, until I finally just had to try. I sat on the toilet, but I could only last about a minute before the pain from pressure on the surgical site became too much. My friend contrived a makeshift bedpan with paper towels and trash bags, and I lay in bed, trying to overcome decades of conditioning to not poop in the bed! When the poop finally came, it was extremely painful – I was having to push pretty hard to get the feces to pass around/through the constricted rectum, and that pushing was putting pressure on my sutures. We used Miralax to try to soften my stool, which did help for subsequent movements.
Seven days after surgery, I returned to the doctor’s office for my first post-op check. The Physician’s Assistant came into the exam room and put me in the stirrups and began to remove the dressings from the surgical site – by slowly pulling this adhesive sheet off my skin! While it wasn’t as painful as the bowel movements, it was still very uncomfortable with moments of shooting pain when some nerve or tender area was pulled on. He then removed my foley catheter, which burned for a few seconds as he did so. And then we arrived at the main event of the visit – he unpacked my vagina.
As I mentioned before, during surgery, my neovagina had been packed full of gauze, both to absorb any liquids which might be secreted, and to hold my vagina fully open as the incisions and sutures began to heal (to keep them from attaching to each other). As the PA began to pull this out – in one single long strand of gauze. The sensation was… different; it felt like pressure being slowly relieved, but at the same time, I could feel the gauze pulling away from the inside of my vagina – I have sensation inside! It felt like he removed gauze for 10 minutes – it just kept coming and coming out. There was a mound of gauze on the tray between my legs when he was finished, and I was much happier and more comfortable!
After I recovered from that, it was time for me to learn how to dilate. Contrary to what many believe, a neovagina is not a permanent wound which never heals, but during the first few months, extra care must be taken to ensure that the incisions heal properly. It is similar to when someone gets their ears pierced, the raw edges of skin must be kept from healing and attaching to each other, otherwise the piercing would heal and close up. In my case, the packing accomplished that purpose for the first week, but from that point on, I need to regularly take action to keep the tissue from adhering to itself; I need to dilate.
As shown above, dilators are hard plastic rods fashioned to fit the shape of my vagina. Three times each day (for now), I insert a dilator and leave it inside of my vagina for at least 30 minutes. As my healing progresses, I step up in size, with the goal of eventually using the largest dilator. In practice, I insert the smallest diameter dilator for 15 minutes, just to get things opened up and lubricated, then I insert each size up for another 15 minutes until I get to the last one for that session, which I leave in for 30 minutes. After about a year, I won’t need to do this multiple times each day, and will slowly reduce my dilations until I’m only dilating once a week.
As you can probably imagine, at this point of my recovery, dilation takes up a major portion of my waking hours. It’s definitely inconvenient, but it’s necessary, and won’t take so much time as I recover and eventually heal completely. While some trans women report that their dilation is painful, mine has not been. I’ve found that I don’t mind it too much, as I still run out of energy fairly quickly, so this gives me some planned downtime throughout the day to rest and recharge.