Stage three, erectile device
You know, they said this was a minor outpatient procedure, and it is in that there is no wound care to do except applying a little bacitracin now and then. There are three incisions each ranging from 2-3″ which I can tell will be hard to find later. I felt most mystified by the perineal incision, since I could not see it and did not know what they had done to me down there.
On the other hand, I have been knocked on my ass by pain in the past week. I get a profound and constant ache where they sutured into the bone, a sharp pain if I get any pressure on the belly, and a searing pain along the perineal incision if i walk the wrong way or move my left leg the wrong way. The left hemiscrotum where the pump is located throbs pain, as the skin is very stretched, and to relieve pressure of the stretch, the pump wants to press higher into the body cavity, so there is constant resistance pain. At a week I can transition to Tylenol/ibuprofen, but if I get behind on a dose, I feel like a wreck. Meditation on the pain as transformative pressure, with visualization, has been most helpful. Also hot showers and a heating pad. The saline implant, on the right side, gives me zero pain curiously, even with a long incision. It’s healing rapidly. Saline feels 98% identical to the silicone AARTs, by the way.
It’s a curious weakness, because I don’t feel weak, say, in my hand, as I did in stage one. My entire body just feels drained by the experience. I find myself needing to lie down for rest in between and before activities. They said standard time off work is 6 weeks for this procedure (!). I’m going to get a return to work at about three and expect I’ll be fine, just on weight restrictions. I really didn’t realize it was going to be this serious. People talk less about stage three challenges than any other, so I imagined it would be about like a mole removal. Ha! 10 lb limit on lifting, so I needed help getting my dog food home once back with my animals. Had to lie down after dinner, wore out. Midday nap essential. Being gentle with myself.
My gait is shortened by the incision on my perineum. It encircles about a third of the “pink” (mucosal genital tissue) of my perineum, adjacent my vagina. The incision follows the change in color and tissue type to help it blend in, in the future. If I move too quick, this one smarts and gets inflamed, so my pace is slow and limited to reduce mechanical strain. Sitting is uncomfortable too. (Aside: when I was in the hospital meditating in body awareness, I thought the burning I felt along my incision must have been an accidental vaginectomy, because I was not expecting a perineal incision area. Reading the op notes, it was appropriate, but I wouldn’t want anyone else to be scared like that.)
SEXUAL – NATAL
Since my procedure spared the vagina but reconstructed the external vulva, there is an oval of pink genital tissue in the middle of my perineum, no labia majora, the tdick, and intact labia minora. Sometimes the labia minora bother me there, mentally, but I understand the boon of a tissue bank for future grafts or repairs. They also say it will protect the perineal urethra from frequent UTIs, which would be a high risk with no labia whatsoever protecting the ureter from all manner or external pelvic flora. If I feel iffy about any part of my surgeries, it has been keeping these, but I understand all of my partners find them attractive and shrug at a point– bittersweet. I have learned that labia majora played a role in pleasure friction during penetration, and penetration feels different without them there. Same with the minora. I know it would be an adjustment if they were gone. Maybe I’ll fix them one day at one of my erectile device replacements. I can live with it.
SEXUAL – NEO
This may seem to be the most obvious thing to anyone else, but having a firm core of the penis feels extremely good. I didn’t know it would! I just thought of the utility. All of the sensation I’ve built the last year, pressed or stroked over that mass is the most 10/10 truly erotic brand new sensation to me. Not just mentally, but in the tissue. Now I “get” stroking and penises like I never did before. I’m not supposed to do any of that stuff until 6 weeks, which falls right about my wedding anniversary, which is on Valentine’s Day. I anticipate it will be a very emotional anniversary. My wife Ashley was extremely emotional when I was the first person to engage with her vagina, and I imagine using my penis fully erect will be emotional for me, too. We get to be each other’s first, this way. The third honeymoon? We have dabbled in penetration pre erectile device, but I can tell this is going to be a different ballgame.
The temptation to inflate the pump when I’m not allowed to yet is intense! Especially when I’m tugging on the pump to pull it back down in the scrotum, I have to keep the pressure from pulling on the pump. Eek, and it’s right there between your fingers! I had wondered if the pump would feel unsexy as an erectile mechanism, but no, it is very inviting to my mind. I guess because I like balls, and it’s like fiddling with balls to achieve erection. The firmness of the Coloplast Titan is storied; the card instructions given to me say that to inflate until it is as firm as marble. Sizzle!! *Eyes wide* well that’s a hot image. No other aspect of this surgery has felt sexy to me, but this stage has given me a strong desire to try it out. It really does remind me of being 15 or 16. Post-op pain is most of what keeps me compliant, along with my rapport with Burnett and Coon, knowing they need me to follow directions. They instilled the fear of God in me: they have had another patient who *recently* inflated early, very rigid, and it rapidly cut off blood supply, eroded into the formerly healthy tissue, extruded through the shaft, resulted in infection and necrosis, and the gentleman lost most of his entire organ (!). So my temptation is gated by the threat of that hell. My sympathies to that fellow. They also emphasized that if I became hurt like that through mistreating myself, opposing instructions, they would treat the wound but they would not reinstall a new device for me if I became noncompliant. They know the temptation is strong. So, just in big black letters, follow instructions. Again, this aspect also feels like being 15 or 16 again.
But I know the six weeks will pass quickly, and I will hope to have the rest of my life and a long lived device, before it needs replacement. Dr. Burnett says he has trans patients who still have an active pump at 15 and 25 years after first installation. He said 80% of his installations are still working correctly at ten years. I’ll accept those odds. The average age of trans erectile device implantation is 38. The average of cis ed implant is 65. I’m interested in advances in pump technology whenever it’s time to replace, anyway.
I almost don’t know what I’ll do with myself now that transition surgeries are “finished”. (My voice surgery upcoming, while it has a component of lowering pitch, is primarily for vocal stress and pain from overuse of my voice.) Life focused just on my career and family and community feels like a huge mental and physical weight has been lifted. We have taken on a new chapter with my elderly dad and a huge historic home restoration with him– and now I can say definitively where my energy would have gone if not to the enormous fight of my medical transition. Family. I look forward to so many more endeavors that were not possible when we were focused solely on health. I look forward to telling the story.
P.S., Dr. Burnett strongly advised me not to repair the small hernia at my nerve hookup incision. It would require implanting mesh directly near the IPP, and he said it would risk both surgeries for a high rate of infection. He said if at a possible, I should embrace it as a symbol of my body’s character and journey. I trust him implicitly, so if this is his counsel, I accept and celebrate being done and living without a flat belly 🙂