Editor’s note: I wrote this piece back in mid-January. Before I had my vulvoplasty, I tried to speak to a number of women about their GRS experiences, and more often than not I was told essentially “that happened.” This frustrated me—how could you forget something so significant as GRS recovery? I decided that in my own recovery period I would be proactive and note down incidents and feelings as they cropped up. In the intervening months since I wrote Sutra I’ve come to understand the perspectives of the women I spoke with because I've noticed my own encroaching haziness around the experience. I’m glad I made the effort to record what I could here, both so that I have something to share if anyone were to ask me about my own GRS, and for my own sake.
The patient is a 35 y.o. transgender individual who desires gender-affirming genital surgery. After discussion of available options, the patient elected to undergo vulvoplasty. The patient met all WPATH criteria and provided informed consent after discussion of risks, benefits and alternatives.
A mentor of mine once shared how she cried tears of joy after waking from surgery, relieved to have anatomy that finally matched what she knew about herself. Several hours after my anesthesia wears off, only one clear thought crosses my mind: thank god I won’t have to dilate. Weeks later, another friend in recovery (who does have to dilate) shares with me her same disappointment from not experiencing a moment of catharsis. We recline next to each other on my bed, sizing up the mountain of recovery that we are, at least, climbing together.
After excising the scrotal skin, obtaining hemostasis throughout, we deepened the incision through the dartos tissue in the midline towards the urethra and bulbospongiosus muscle. We continued our dissection to expose the bulbospongiosus and corpus spongiosum.
For the fourth time today I clamber slowly out of my hospital bed onto an awkward wall-mounted toilet in a freezing concrete bathroom. Before I can go home, I’m supposed to void my bladder into a plastic “hat” that rests in the toilet bowl, but again I only manage to produce a shallow pink puddle. I feel around for the muscle that will let me fucking pee oh god I need to pee so bad please please don’t let them catheterize me again fuck fuck. All the old buttons and levers to initiate the process are still there, but they don’t seem to pass the information along. The floodgates finally open when I return to the comfort of my bathroom at home, and it takes me another three days to reliably learn how to pee again.
The left corpus cavernosum was opened down to the level of the proximal crus. The same was done on the right side, and the urethra transected just beneath the glans and separated from the corpora.
My phantom dick has started slithering around on its own. Sometimes it banks right as if pulled by my bandages, sometimes it’s flopped up and airing out. Other times I feel poking or tugging, like when, after sleepy sex, you wake up the next morning and have to peel your underwear out of your sticky penis tip. I reach to adjust but there’s nothing there, just pad and gauze. I slowly haul myself out of bed and as I stand blood rushes to the area, feeling like the World’s Shortest Rock-Hard Erection. I look around, embarrassed that someone might see my bulge, but of course there’s nothing to see. It will take weeks before my clitoral hood starts to look like anything other than David Cronenberg’s idea of a tuck.
Markings were made on the midline dorsal glans and 1cm to each side. The 15 blade was then used to incise the glans along these lateral markings and at midline, and the central bulk of the glans tissue was excised, leaving the corona intact and dividing through the urethral meatus ventrally.
My PA says that I need to start washing my vulva during my twice-daily showers. Showering is already enough of a challenge because the water stings my rash from the wound dressings and I keep losing bars of soap to the distant floor. Pushing through the ache from standing, I lather and gingerly work my fingers down my swollen labia. A brush across a suture line causes signals to skip radially around my labia minora. My middle finger grazes the puffy ridge of my clitoral hood, and a wave of pleasure briefly travels up my body. Bent over and unsteady as I rinse off, I cry happy tears. She’s mine.
The neoclitoris was then affixed to the corporal body stumps with interrupted 3-0 Vicryl approximately at the level of the adductor tendon. Next, the apex of the fold of the tunica albuginea/neurovascular bundle was sutured from its edge bilaterally to the fascia overlying the pubic symphysis to help keep the neoclitoris in position.
So many friends have come to visit, and my metamour gives me a vagina-shaped pillow as a recovery gift. I name her Yoni, and keep her with me at all times. I’m usually not one for stuffed toys, but something about this one makes me feel comforted. The one time I forget Yoni while paying the living room couch a visit, my cat, in an attempt to watch TV with me, decides to parkour off my pubic mound to reach the couch back. I’m more startled than hurt, and I scream, quickly ripping my underwear open to check for claw marks. No harm done, but from then on I cannot rest without Yoni placed firmly on my lap.
The penile skin was inverted and pulled downward over the clitoral complex, then incised sharply at midline to match the clitoral complex. The clitoral complex was then pulled through. 3-0 Vicryl suture was used to approximate the inferior edges of the urethral meatus to the inferior aspect of the penile skin flap.
I’m going stir crazy from weeks of bed rest, and the room I’m in is starting to smell like after-Christmas farts. My wife suggests we get dinner at one of my favorite restaurants on the other side of the river, the one with the padded booths and generous Italian sandwiches. I unexpectedly tear up in overwhelm, threatened by the prospect of leaving the house when I can barely sit in a chair for more than ten minutes at a time. The world seems too unpredictable, and I feel more delicate than I ever thought I would be. We make it to dinner the following week.
The tip of the perineal flap was sutured to the perineal body with 3 2-0 Vicryl sutures. The skin edges of the perineal flap were inset to the edges of the penile skin flap with interrupted 3-0 Vicryl sutures.
Since arriving home from the hospital I’ve found myself hunching over while I stand or walk, but today while getting dressed I straighten up in the full length mirror and take in the view. Over the past 3 years I’ve seen a lot in this mirror: a pilot episode about a girl I would soon meet, a roller coaster drama tussling with the residue of masculinity, a psychedelic art film on primal dykedom. I look into the mirror, and this time it seems to be showing a worn VHS copy of “The Blob.” Not a rerun I want to watch, so I put on my baggiest sweater and slouch away.
The skin edges were reapproximated using 3-0 Vicryl suture. The labia minora definition was then created using interrupted horizontal mattress sutures of 3-0 vicryl through the preputial flap out to the natural sulcus of the penile skin tube.
My chatroom friends are talking about how what was old is new again. Some influencers are entertaining the idea that once you’ve had The Surgery you’re effectively cis because your body and self are in alignment. This same idea had been voiced much earlier by some members of the gender community in the 1990s by people who saw “trans” as more aligned with what we might call “genderfluid” today. As I read the discussion, stretched out in bed with gauze tucked into my shallow dimple, I picture my next physical with my doctor, or a future run-in with the TSA. I feel both queerer than ever, and also wary of how my peers might now think of me.
The wound was then covered with Adaptic nonadherent gauze. Fan-folded roll gauze and an ABD pad were placed and taped down in an "X" pattern with 3 inch wide elastic tape from the buttocks to the abdomen.
The mirror’s story today is simple and gentle: it’s about a woman in her 30s who has a body, which, though currently marred by sutures and scars and rashes and inflammation, looks more or less right to her. I stand up a little taller, in spite of the strain.
The patient was taken out of the lithotomy position, transferred off the table and taken to the recovery room in stable condition. There were no surgical or anesthetic complications.