Interviews MTF Trans Surgeries

My complex mental process to prepare for surgery

Mental process

Right after genital surgery, and over a year and a half post-op by now, I’ve had a great relationship with my neo-vulva.

Franches
Franches

Franches is a former patient of GrS Montréal et of Dr. Pierre Brassard. She is a strong proponent of self empowerment through knowledge and experimentation. Franches is also the author and publisher of HolaSoyYo.com (‘Hello, it’s me’ in Spanish), a blog where she shares her experiences and thoughts on changing gender expression.


Not long ago, a close friend of mine asked me how to have a natural relationship with a neo-vagina? She was considering genital reconstruction surgery, but she felt uncertain about it. Hence her question to me. She had heard from a few friends that it took them up to 2 years to be ok with their post-op anatomy. That lag from her friends in becoming comfortable with their results made her doubtful.

After thinking hard about her question, I had an answer. I am sure that I have a healthy – good relationship with my neo-vulva (I had a vaginoplasty without cavity) because of my preparation for surgery.

When I say “preparation for surgery” I don’t mean packing my suitcase with everything I needed for the trip. I mean everything that lead me to consider the surgery and live with myself afterwards. Looking back, I can break up this preparation into 3 major phases. They are mostly sequential, but not necessarily. A consistent element through these major phases was making sure I’d answer each and every question I had about the process.

When I was offered to write this article, my first full draft was 7,000+ words long! As you can imagine, that would be too long for a single post. I decided to rewrite this more condensed version. Then I broke up my original long draft into 3 separate posts and linked to them from here. If you want to know more, at the end of each section in this article you’ll find a link to the longer, more detailed version on my blog.

 

First Phase: Unheeding From My Old Ways of Thinking

Where I Was Coming From

Let’s start from the beginning, a time before I even started considering surgery seriously. All my life I believed that changing my gender expression was not in the cards for me. Despite this I always wondered what it would be like to grow up and live in a girl’s body. Cut to 2015 when I started HRT along with changing my gender presentation. At that time, I simply wasn’t interested in genital surgery. I still kept that view after going full time, after having facial feminization surgery (FFS) and after my breast augmentation. It was sometime in 2017, while I was making arrangements for my mammaplasty, that I started thinking about a vulvoplasty or maybe a vaginoplasty. Yet every time I thought about surgery, there was something in my head stopping me from seriously considering it. It felt like I had a lot of questions but wasn’t even sure if I wanted to know what those questions were.

 

Wondering What Would Life be After Surgery

I could not clearly visualize how my life would change after surgery. This was one of the first mental blocks preventing me from considering surgery. Yeah, there were some changes that I was keen on, like not having to tuck anymore, but there were others I wasn’t sure.

An early question I had to answer was if I’d be able to pee sitting down for the rest of my life. Gee, even just writing this makes me see how basic the question was, but I didn’t see it like that then. Though I’d been peeing sitting for several years, I didn’t do it always. I’d pee standing if I felt a situation was too unsanitary.

To get the answer I was looking for I forced myself to pee sitting or squatting for about a year. I did it every time, no exception. Of course, it was possible, just the way 50% of the population has done it all their lives, but I had to experience it. I also wondered how my (scarce) sex life may change. For this one I was already satisfied without getting an accurate answer before surgery. Speaking with Dr. Brassard beforehand, he explained the procedure and how the glans would very likely still be erogenous. At the end I was happy with not knowing for sure but understanding my chances.

 

Rethinking my Relationship With my Genitalia

Here I get really personal, but I feel it’s important to open up. Though I don’t expect everyone to see my point of view, probably someone might relate a little. At the very least opening up helps explain a major hurtle I had before considering surgery. I clearly see now that this was my hardest mental block but then I wasn’t even aware of this. As mentioned above, most of my life I never thought I’d change my gender expression. Part of it was that I was happy with my body and the genitalia I was born with. It never caused me dysphoria or unease. If anything, I was ok with it and had lots of fun with it. Maybe that’s why it took me so long to start considering getting a vulvoplasty.

 

Digging Deep

Every time I thought about surgery, I felt there was something that wasn’t adding up. So I dug deep to find out what didn’t add up. After a lot of soul searching, I found I was allowing my penis to define me. This was a breakthrough because I could finally see what my main mental barrier was. If anything, this speaks a lot about how the patriarchal environment I grew up in affected me.

There was a tug of war in my mind. I wanted to consider surgery but how would I even think of getting rid of what defined me. Again, digging even deeper I questioned why I thought the genitalia I was borne with defined me. As soon as the question was asked the answer appeared: it clearly didn’t.

At that point my relationship with my penis switched from an element that defined me to something that didn’t add much value. I saw that after living full time it kind of got on the way more than anything. From that point on I could seriously consider having genital reconstruction surgery. If that mind shift hadn’t happened, most certainly I would have had a hard time developing a healthy relationship with my post-op physiognomy. You can read more details on some other mental barriers I had and how I dare to consider surgery on HolaSoyYo.com

 

Second Phase: Serenity Through Knowledge (Pre-op)

Once my primordial questions were answered it was time I’d get into the details. I wanted to get to know as much as I could about the surgical procedure. By doing so I could understand better what to expect aesthetically and during recovery. Then and only then I felt I’d be able to make a decision to either go ahead or not. At the end, all this knowledge helped me evolve a natural relationship with my results after surgery. Post-op it helped me get an intimate understanding what was done and how that influences my daily life.

 

Considering Surgeons

When it came to looking at surgeons and/or surgical centres, luck was on my side. My medical insurance covered surgery at GRS Montreal.

However, cost or insurance coverage was not the only or the main factor. The aesthetics of their results, my ability to have low friction communication, and their experience were the other important points I considered. The idea was to have all those elements ensured to feel at ease with the surgery, and more importantly with myself long term.

The patient coordinator at GRS Montreal helped me arrange a consultation with Dr. Brassard. A number of weeks prior to my surgery I spoke with him over the phone. At that time, he answered my long list of questions. This also gave me a small insight into the surgeon’s personality and philosophy. On top of this, knowing that they perform hundreds of genital surgeries a year, both male and female, added to my confidence in them.

 

Thoroughly Understanding the Procedure

As I’ve mentioned a few times, I did not decide on having surgery until I understood the procedure, risks, and recovery protocols. I spent countless hours reading and learning about the different feminizing genital surgery options. Personally, I rather get medical facts opposite to personal accounts from other patients. The main reason is that anecdotal information is always coloured by the speaker. On the other hand, medical documentation is often based on years of impartial clinical observations, for the most part.

I based my understanding of the procedure mostly from the package that GrS Montreal sends its patients. Also, by reading about the procedures on the websites of multiple surgeons/surgical centres helped me grasp the concepts. The information package from GRS Montréal contained invaluable details about pre-op preparations, the procedure itself, and aftercare protocols.

I strongly advise anyone considering genital surgery to read the official documentation. Parts A,B, and postoperative care (Part C) of GRS Montréal’s patient information package are linked off their website. Look for the links at the end of their respective webpages, which are also quite insightful:

I too relied heavily on my discussions with the psychologists during each of my two surgical assessments. Before deciding on having surgery, I went through the assessment process to get medical information, not to get approved. I believe this gave me some clarity because during the assessments I was not rushing ‘to get accepted’. Rather my interest was to learn as much as I could and then make an informed decision.

 

Recognizing and Accepting the Risks

If understanding the procedure and recovery was important, recognizing the possible risks was paramount for my peace of mind. My first opportunity to ask someone qualified about the risks was during the surgical assessment process. The next big chance to enquire about risks and complications was during my phone consultation with Dr. Brassard.

Reading through the GrS Montreal information package and multiple surgeons’ websites I got a fairly clear perspective on the risks and aftercare. I also met with a registered nurse at my local gender clinic before surgery. Chatting with her, plus my conversations with the surgeon and psychologists, and the reading materials I studied, all helped me see and accept the risks.

As a PSA (Public Service Announcement) I want you to be aware of the most common risks and complications in vaginoplasties (with or without cavity). It’s a good idea to familiarize with some of these if you or someone you know is considering surgery:

  • Infection/Abscesses.
  • Hypergranulation
  • UTIs (urinary track infections).
  • Recto-vaginal Fistula (does not apply to vulvoplasties).
  • Prolapse of the neovagina (does not apply to vulvoplasties).
  • Hair growth inside the neovagina (or inside the dimple vestibule in a vulvoplasty).
  • Loss of sensation and inability to orgasm.

Download the TRS Surgical summary sheets from Rainbow Health Ontario and look for the Vaginoplasty sheet for concise clinical information.

You can find more details of how I gathered knowledge and made the decision to have surgery on my blog. Many of those details relate to the pre and post-op planning documentation GrS Montréal provided as well as other sources of factual information.

 

Last Phase: Confidence in Recovery (Post-op)

In my opinion recovery is the Holy Grail. Surgery is just a point in time, a quick methodical controlled trauma. Then recovery starts. All my prior mind shifting regarding my genitals, the learning, questioning, and understanding was to prepare for recovery and life beyond. The first few weeks and months post-op are crucial. From past surgeries I learnt that the more support one can get during early recovery, the easier, or rather less complicated it would be.

By going through my mental shift that allowed me to consider surgery, and learning as much as I could, I was able to increase my confidence in my decision. Following a consistent theme, all these later contributed to my natural relationship with my neo-vulva. All even before I left home to Montréal. However, my recovery’s contribution to the satisfaction with my results built up as it happened. Meaning that for the most part my confidence grew during recovery, and not prior.

 

Not Bothering with Things Outside my Control

Are you happy with your results? How much it hurts? What is sex like? How does it look? How does it feel? These are examples of some of the questions people get post-op. At first, I had similar questions though I realized that the answers didn’t matter. They were really not important because there was no way to know. Someone may tell you their perspective, but creating a personal expectation based on someone else’s subjective narrative, in my opinion, is not a good idea. A very simple example: If you ask me if I’m happy with my results, the answer is yes. Though that answer should be meaningless to you unless you knew what my expectations were.

When it came to things outside of my control, I did not spend much time thinking about them before I had to face them. Another example: I knew I would be uncomfortable and most likely in pain the first few days. How much? The only way to know was to go through recovery and see how much it’d hurt at the time. The way I prepared was by expecting the most painful experience ever, though chances were that it wouldn’t reach that point. Instead of mulling over it before surgery, I’d deal with pain once I felt it.

 

My Past Surgical Experience as Reference

While I was preparing for this surgery I looked back at my past surgical experiences and noted the similarities. Though there are massive differences between the kinds of surgeries, there’s a lot that is shared. In all my surgeries I developed similar relationships with the surgeons and nursing staff. The way I healed was fairly similar between surgeries. How I dealt with pain and my reaction to anesthesia were comparable. Based on all these common elements I could picture in my mind how I’d do for my vulvoplasty.

 

Asclépiade

GrS Montreal includes a few nights at the recovery home, Asclépiade, before discharging their patients to return home. That stay at Asclépiade made the first few days after surgery much easier than all other options. To give you an idea of the impact that Asclépiade had imagine being in a home with other trans patients that went through genital reconstruction. Then add being under the care of nurses that specifically work with these patients, and all your basic necessities (boarding, medication management, wound and patient care) are overseen by the staff. And then compare that package to recovering at home, at a hospital, or a hotel room.

As I went through the experience at Asclépiade it was easy to predict that if I were to have any complication, that it would be minimal. And that peace of mind also boosted my confidence in my relationship with my surgical results.

 

Recovery at Home

I made every effort to make my flight home as comfortable as possible. In general flying after surgery can be tough, specially on long flights and furthermore when the surgical site could make sitting uncomfortable or painful. Also, I had made arrangements at my local gender clinic to see a nurse a few days after my return. The nurse would be monitoring my recovery and aftercare once I returned home. So, even before leaving for Montréal I already felt a certain sense of ease knowing someone could take care of me locally. BTW, this is the same nurse that gave me some insider pointers weeks before flying for surgery.

You can find more details on how I prepared for recovery on HolaSoyYo.com and even how I dealt with an issue I encountered after I got home.

 

Conclusion

As I said at the beginning of this article. I was able to develop a natural relationship with my neo-vulva by answering every single question, even if the answer was “I don’t have a definite answer yet”. This included changing my relationship and understanding of my original born organs before I could contemplate surgery. If I hadn’t done that most likely I would have left doubts in my head that would have undermined my appreciation of my new physiognomy.

Once I was able to seriously consider surgery, knowledge about the procedure, and specifically its risks, possible complications, and recovery were the most important aspects of being happy with my results. If you or someone you know is considering surgery, any surgery, but more importantly a vaginoplasty, please make sure you or they know the commitment it takes.

Once I was able to seriously consider surgery, knowledge about the procedure, and specifically its risks, possible complications, and recovery were the most important aspects of being happy with my results.

If you or someone you know is considering surgery, any surgery, but more importantly a vaginoplasty, please make sure you or they know the commitment it takes. The first few months of recovery from a vaginoplasty can be intense. Any and all support that one can get during that time, should help develop a natural relationship with the neo-vagina.

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