Saturday, 31 January 2015

Dilation FAQ's

I have been referring to dilation even before I had my surgery and it occurred to me that many will not understand what this is or why I need to do it. Therefore I decided to give a quick guide to the ins and outs of the process because something I have found when speaking to those considering GRS, is that the whole dilation process seems to be shrouded in a veil of mystery. 

I have covered the basics here, but if there is anything anyone would like to ask, then please feel free within the comments section or email me here. I will add in anything I feel is relevant.

Why dilate?

The process of GRS creates a vagina from the penile (and sometime scrotal) tissue within a cavity of the body above the rectum. This was never intended for this purpose and the problem is that everything around wants to press in and close the neovagina. Dilation is the process of stretching this tissue and keeping everything open. It also aids in keeping depth for vagina.

Meet my boys!

I have showed these to two people in the last week and they seemed surprised at what they looked like. So here they are for everyone to see. They are hard perspex and very smooth. The two on the right are the 25mm and 30mm that Brighton send you home with and the one on the left is the 32.5mm that I bought and have already incorporated into my regime. I also have three more for the future that go up to 40mm! 

The preparation for dilation:

When you are first taught this process, it seems complicated because 90% is preparation. Once you start, you are pretty much stuck on the bed so having everything to hand is vital. At the moment, I fold our duvet in half and lay out the following on the bed:
  • A baby changing mat to lie on (this is super easy to clean afterwards)
  • A mirror
  • Several sheets of kitchen towel
  • My glasses (I need them for distance and they help me see everything easier)
  • Hand sanitiser
  • The dilators I am going to use, which were cleaned after the last session
  • A small torch (this is to help see when inspecting suture lines on the outside)
  • KY jelly for lubrication
  • A book to read (optional; some find TV a good idea)

I also put on some music, some people say relaxing is essential but I feel it is more about what you enjoy and I find Iron Maiden particularly helpful. I have also fitted a very bright light bulb in our bedroom, it lessens the relaxation but aids in visibility; over time I will probably change this back to a normal light.

The process of dilation:

***Please note***: What I describe is my experience of dilation and will vary greatly to anyone just starting out. I had a good amount of penile tissue to create my vagina and this has made me more stretchy and pliable than many others would be. I am just passing on my experience and this should not be used as a guide to dilation, stick to what you have been shown and modify it according to your own needs.

First, I lie on the changing mat and then I sanitise my hands with the hand sanitiser. At this time, cleanliness is vital because there are open wounds externally and internally and it would be easy for bacteria to enter. Another point to make here is that fingernails must be kept short. Your vanity must be thrown out the window for a time, those claws need to be filed back to the bone! I also take a piece of kitchen towel and place it under my bum, this makes it easier to clean the mat at the end because lube is going to slide down my backside.

I select the smallest dilator I am going to use and apply lube to it. Originally this consisted of placing a large blob on the palm of my left hand (reverse for lefties). I then take the dilator and twist it through the blob to coat it. This was shown to me in hospital and is ever so simple. I now find though that this was very wasteful and overloaded the dilator for my needs. I now simply apply lube straight to the tip and coat it all around with my finger. The last 3 inches of the dilator need to be kept free of lube or else I can't grip it.

I then put a small blob of lube on my finger and then insert this into the vagina to find where I am supposed to be aiming for and also to find my pelvic floor muscle. This step was important at the start because it also added a little more lube inside to help with things. With my finger inside I slide the dilator down towards the pelvic muscle and when I reach this, I have to drop the angle of the dilator so that it is more in line with my body. Gently you then push the dilator until it finds the back (vault) of the vagina. You know when it is there because you can feel it inside and it simply wont go any further. It is described as when the dilator bounces back, but I am not so sure this is a good term because it does not feel like that to me. 

I then hold this dilator in for 10 minutes. It seems a long time, but it passes surprisingly quickly and I have found reading is a good way to pass the time. I still need to hold the dilator with one hand and reading with just the other hand took some practice but it is possible. Once the 10 minutes are up, I gently pull the dilator out and then wipe it clean. It's is wrapped in kitchen towel and I then repeat the process with the next sized dilator. 

When finished, I get off the changing mat and wipe the area gently with the piece of kitchen towel that has been under my bum, remembering always to go from front to back. A quick spray of the changing mat with anti-bacterial spray and a wipe down prepares it for the next session. I then troop off to the bathroom for a shower, gentle clean of the vagina and the all important douche to clear the lube that has been left inside me. When cleaned up, I then take the dilators and wash them with Hibiscrub, an antibacterial scrub. They are wrapped in kitchen towel ready for the next session. I currently do this 3 times a day.

What does it feel like?

The all important question! Some assume that it is an erotic, sensual or sexual experience. This is actually not the case at this time. The dilators might look phallic and dildo-like, but they are surgical instruments and super smooth. They impart very little sensation because of this smoothness. For me, there is no pain whatsoever when inserting them, and never has been. I know some do experience pain initially because of the swelling but because I followed the directives of the nurses whilst in Brighton, I find my swelling has been minimal. The reason some have this initial pain is often swelling on the pelvic floor muscle and this does diminish over time. There is suggestion that long term pain with dilation is the result of not doing enough. It then becomes a viscous circle, who wants to do something painful? The evidence is there though, do more dilation, fight through the pain and it becomes easier over time.

It does have some sensation though, not pain or pleasure but just a feeling. That feeling is still indescribable, probably because it is so new to me. I would say it is more towards pleasant than not. The whole experience is quite relaxing and enjoyable and I have tended towards embracing it rather than see it as a chore. I need to do it, so I make it a part of my life.

Another benefit of dilation:

I have done some thorough research into dilation and found something that really piqued my interest. Research has suggested that dilation has another benefit than just keeping the vaginal canal open and toned. A woman born with a vagina has everything in place to hold its structure and this keeps everything around it in the correct position. Having a created vagina means this is not the case and dilation helps with this. By doing the work with the dilator, it props up the top structure of the area which means the clitoris and urethra are in better positions. Rigid dilation helps with urinal spraying and this I have noticed since the catheter removal. My first visit to the toilet after any dilation (once the lube is removed) is by far the most accurate, with a strong flow downwards. As I approach my next dilation, this flow tends to go a little more sideways. I have also noticed that towards the end of the first week after the catheter has gone, that my flow is definitely improving.

Advanced dilation:

The schedule I was given when I left hospital is very easy going compared to other surgeons in other parts of the world. We are given those two dilators and told that we can explore bigger ones in the future if we wished. I did my research very quickly and because I could accommodate the standard dilators very easily, I then purchased a graduated set. The day they arrived, I tried the next size up and whilst it needed extra gentle insertion, I found it was not difficult in any way. There was no pain and no blood when withdrawing it. I am now slowly incorporating this into my schedule and in a couple of days expect to be using it for all three sessions. I am also starting to find that the 25mm one is stupidly easy to insert and feel in a week or two, I will be removing this one from my schedule. At some point, when the 32.5mm is easy to insert, then I will sterilise the 35mm and try that one out. A schedule I found from a surgeon in Canada reveals using a 38mm dilator in the second month! This makes that 30mm "large" one I was sent home with seem tiny in comparison!

Thursday, 29 January 2015

Living with anxiety - A retrospective perspective

January 13th, 2015 marked a massive change in my life. I am talking about my gender reassignment surgery (GRS), the time my genitals were altered from the male appearance into a female one. This had no bearing on my appearance or attitude externally but inside, I was whole and complete.

Alongside this was the removal of the anxiety I had been suffering from for a couple of years. I do not use the term suffering lightly, because it has connotations of misery and despair. But hey, that was my anxiety in a nutshell. The cause of the anxiety was actually the medical side of my transitioning and it was a flawed medical model that caused this. It might be useful to examine why this anxiety occurred.

Actually embarking on gender reassignment (living full time as a woman) was not difficult. I spent a couple of fantastic years exploring my female identity, disclosed this to family and friends and then went the whole hog of outing myself at work to a very masculine environment of a sawmills, changed my name and lived full time from that point onwards. Although this took some phenomenal courage (and I don't mind admitting this!), in the scheme of things, it was very easy to do.

The medical side of things was much harder and this is where the worry and eventual full blown anxiety started. My problem was that I was a textbook case of someone with gender dysphoria and the gender clinic did not trust me. They assumed that I was giving them all the right answers and just telling them what I thought they wanted to hear. I could not help being who I was and this distrust of me was distressing. I also had other issues with the therapist, and I can only describe her as a liar. I have a very good memory and she backtracked on things she had said previously.

I rightly complained and my therapist was changed, and she was much better. With her experience, she realised straight away that I was not bluffing and was who I was. I was fast-tracked through the diagnosis and told they would be contacting my GP shortly with details of my hormone treatment. Sadly, the doctor forgot to write my notes up and this was discovered 3 weeks later when I rang, asking where the letter was. My trust in this clinic was pretty low by then but the next few months passed by with less worry. 

In February 2014, I was told by my therapist that it was time to put me forwards for my GRS. The doctor concurred and I left the clinic in a dreamy state, finally I was going to get the body I needed. 10 days later a letter dropped on my doormat stating that I had not completed an adequate amount of time on hormones and I had to wait another 3 months before he would start the process. The door was slammed in my face and this left me in a very low place. I waited the 3 months but I had trust issues with the doctor and unsurprisingly, he did not write the letters on time. Even worse, one of the admin staff lied to me to get me off the phone and told me the letters were on their way. Two weeks later when I rang, no one could find any evidence of these letters and they had never been written. My trust was now destroyed and the real anxiety started to manifest. I took the clinic to task and I worked bloody hard at them. I got one appointment for my 2nd opinion within 24 hours notice and my pre-op assessment was also fast tracked. Things were moving again and then the wheel fell off big time with funding issues for my surgery. For 4 months I waited for a phone call to give me a date for surgery and this was about the lowest I could have been with depression. It was however the anxiety that was hardest to handle.

I had never had this level of worry in my life and I struggled to deal with it. I was up and down with my moods and had many periods of crying. Mandy tried to help me and failed. It was not her fault but as a concerned partner she wanted to help. The only thing that would have got me out of this would have been getting that all important date. My friend Susan also tried to help, and she recalls a phone conversation where I ended up shouting at her. Even now, I do not remember this event. There were times when there were glimmers of hope about the whole situation, but they never seemed to have any substance to them. Even when NHS England released more funds for surgery, I typically did not get a date because the surgeon had not released any more than January and February and they ran out of dates when they got to my name. This led to more darkness and more "why me?". I had been assured that I was first in the queue for March but without a date, it meant nothing to me. There are many more facets to this story and I eventually got a date at the end of October. Even then the anxiety did not completely go away. There had been so many mistakes and errors, I could not be worry free. Only when I woke up after surgery could I release myself from the fear it could be cancelled at any moment. 

I was absolutely correct in this prediction. My anxiety did ease a little the week before my surgery. My bloods and MRSA swabs had checked and a pre-op phone call from Liz Hills, the clinic manager in Brighton helped quite a bit. I explained my anxiety to her, and she misread it, thinking I was worried about the surgery. I explained again and she was quite kind and understanding. She told me not to worry, I would be in their hands from (following) Monday and it was going to happen. But it was still only when I awoke in the recovery room and felt that dull ache down below, that I could breathe a sigh of relief and my anxiety drifted away from my mind.

I tried many things to cope with my anxiety in all this time and hardly anything worked. Talking was next to useless although I had a friend who was in the same situation. We sort of bounced off each other through this period but even this became difficult when she received a date for end of November. I was happy for her but inside it was torture. I even agreed to take her to Brighton and this was a journey that was probably going to be the toughest of my life. I had to smile and enjoy the moment for her, whilst being crippled emotionally by not having any closure on this myself. Thankfully I got my date  just prior to taking her there and this made for a genuinely amazing journey.

One thing that did help me through was my running. Coupled with listening to music, those 8 miles every day helped me forget about the the anxiety for 90 minutes and gave me some me time. It was the only activity I could enjoy, everything else seemed dull and lifeless.

I feel free from the anxiety now. Not only do I have no worries about my transitioning, my body is also aligned with my mind. A positive to take from all this is that I learnt a great deal about anxiety and I feel this adds to my empathic skills. I hope I never have this level of anxiety again but perhaps I can get through it better next time. There will surely be worries of various kinds in the future and even now there are small worries with regards the surgery I have had done. I think this anxiety was unique to me due to my gender dysphoria and I hope this means I will not have to experience it again.

Tuesday, 27 January 2015

2 weeks post-op

The last few days since the update have found the whole area recovering very nicely. I do have some suture lines opening and from listening to others, this is actually quite common. At the base of the vagina, there are two pairs of lines of sutures and in amongst this is a triangle of open wound. It is not bleeding and nothing to be alarmed about at this time. The future prospect is that I may get some granulation tissue in this area. It's easily accessible and will be easy to deal with down the line. We have also been concerned about tissue infection due to a light creamy brown discharge in this area, but a nurse looked at it yesterday (Monday) and said it all looked very healthy. I am advised to look for yellow or green discharge and the colour of what is emerging is more brown than yellow. The issue is that I have found just about every colour of the rainbow on my panty liner since the pack removal and sometimes you worry about silly little things.

We also found out on Saturday that we were not cleaning the area properly. For some strange reason, I had it in my mind that we had to leave the clitoral area alone. A re-read of the discharge notes found this was not the case and we had been ignoring this for 5 days. We then had to start over and this was a very interesting experience. Mandy has been doing all the cleaning because whilst I can do it if necessary with a mirror, it is actually much easier for someone else to do it. Now she cleans all the suture lines and then with fresh wipes, works around the clitoral area. Sensitive is an understatement! It is an indescribable feeling at this time, and the future looks very rosy where this is concerned! This cleaning has encouraged some bleeding at night but it is settling down. 

Yesterday (Monday) saw the removal of my catheter. I had been in the unlucky position of having to be re-catheterised 90 minutes after the removal in Brighton but I was optimistic about this time. Already in the few days before this, I had found I could urinate around the tube if I bore down whilst emptying it and I was hopeful that this time it was going to stay out. The nurses arrived at 9.30 and I do not think they were completely comfortable with the situation. Mandy picked up on this too and I am not sure what they took issue with. I led them into the bedroom, explained that I had had GRS and the issues with regards rearranging the urethra and the swelling. I must admit there uncomfortable attitude unsettled myself and we messed up on two counts. I was supposed to have emptied my bladder prior to removal and taken a photo for the next nurse if they needed to put yet another catheter in. None of this was done until after it was out and then it was too late. I felt that their whole attitude was to get the catheter out and get on to the next job. I could feel the removal of the catheter but it was not high on the pain scale, perhaps 2 out of 10 at a push.

I asked them to look at my wounds and they did, they felt it all looked healthy and not really any sign of infection. They gave me the standard advice for catheter removal, drink plenty and to wait until 12.00 if unsuccessful. I was already drinking cranberry juice and continued afterwards. I also had a fairly full bladder but I waited until I was absolutely desperate. The reasoning behind emptying prior to removal is to give the urethra time to settle before then using it but I now did not have this luxury. I waited as long as I could and then went to the toilet. Mandy followed me, she was as anticipatory as I was. I sat and wondered what I needed to do initially. This was all different, I'd had 40 years of a tube to pee out of and for the last week a tap! I kept sitting and nothing was happening, so I gently squeezed my pelvic muscles and put pressure on the bladder. I had to be very careful as too much pushing can cause my sutures line to bleed, as I had when I had my first bowel movement in Brighton. I would also guess that really pushing could even run the risk of a prolapse and this is something I definitely didn't want. I bore down a little harder and suddenly there was a trickle. It was very small at first but I learnt where to apply the pressure and increased it slightly. It did start to get painful in the bladder but I needed to keep going because a partially emptied bladder has more risk of a urinary tract infection (UTI). As it was, this very first time, I did not empty completely. I dabbed at everything with toilet paper and then gently wiped over with a baby wipe. This is advice from Brighton and is to prevent a possible occurrence of nappy rash. Because it goes everywhere initially, this is a high risk and something to be definitely avoided. Slowly as the day went by I started getting more proficient at being able to empty the bladder. I think there was an element of it calming down after having had an intrusion for 13 days and it got easier to completely empty. I also noticed that the flow was starting to get more random in it's direction. The first one was straight down but after it started going down and sideways. Bum cheeks were often left wet and every time became a clean up operation. it didn't matter because after all these years, I was suddenly urinating correctly. I also should mention that the district nurses did give me a call back to check I was ok. Their attitude was definitely offish when they were here but they did have the thought to check up which meant something.

By the end of the day going to the toilet was starting to become a lot more natural and easier. I could sit there and find the correct way to start it all off with much less effort than it had at the start of the day. It is so strange that it should feel so different to get it to work because essentially it's only the end of the plumbing that has been changed, the bladder and exit before the prostate are still the same. But it is definitely a much different experience and one that is actually quite profound. Now going to the toilet is the real deal whereas the forty years previous have been all wrong. Whilst toileting is mundane and trivial to some, for me at the moment it is marking another passage into the world of completeness. There was one moment yesterday when I went and automatically grabbed a penis that was not there to point it down into the bowl although I suspect that wont happen many more times. Towards the afternoon it was sounding correct too. It is a sound that you do not get with a penis and hearing it was another affirmation.

Dilation continues to go really well and a little easier too with the catheter removal. I have significantly reduced the lube I need because I was finding that so much was ending up on my backside. I appreciate that many will need the amount they suggest, but I am experiencing no difficulty of tightness on inserting the dilators. I am also increasing the time with the bigger one, sometimes 5 or ten minutes extra when I feel like it. I am also starting to find a little less blood on the dilators afterwards. To pass the time, I have found that I can read a book whilst dilating. It is not difficult and it make those 2 times 10 minutes a lot more enjoyable. Douching afterwards is now quite a natural experience, it's just something that is a part of the a normal shower. I have been using the trial one Liz Hills gave me and decided yesterday to give the EZ Streem a comparison usage. I must admit that I had difficulty with it due to it's straight nozzle. The new one has a curved nozzle and it was only after a few days of getting used to it, did I realise how much harder the EZ Streem is. It is not a problem, but you do have to remember to angle it in and then straighten once you have reached the pelvic floor muscle. The new one, you do not have to do this, it slips straight in.

Physically myself, I find myself in very good shape. I am obeying the house arrest Brighton but at times it feels like I have to force myself to. Now that the catheter is out, I may if the weather is good, go out for a short walk. I am as active as I can be around the flat and potter around the kitchen where possible. The only issues are lifting and I am obeying the 2kg limit as set out in the discharge notes. Since the day after surgery, I have not felt tired at all during the day and even at home and more active, this has still not been the case. I wonder how much of this was down to my high level of fitness prior to going in?

Hormonally, I have started hot flushing much more in the last few days. These are getting quite intense and it's going to be an interesting week until I restart my hormones. The night sweats are even more of an issue and I wake in the night drenched. My body hair growth has slowed a little but not back to what it was yet. There's not much else to report on this.

Emotionally I am a bit of a mixture. I am tending to be very tearful. This is not an unhappiness but more of a connection to my inner self. Many things make me cry and I can get overwhelmed very easily. Writing about past issues can be very triggering and there have been a few times where I have ended in tears. If anything upsets me, I am crying straight away. In contrast, happy moments can also make me cry. It takes nothing to trigger this off and there have been some bewildered people on the phone recently! This is not their fault but they often take the crying the wrong way and think they have upset me. I suppose it must be difficult for many to understand why this is the case, and hell, even I can't understand it half the time. All in all, I am fantastically happy and contented and I do not think I have been in a better place, ever.

My GRS time-line :

Friday, 23 January 2015

10 days post-op

Over the next few months I'll start to update periodically with progress about how I am recovering following my surgery. It is hard to believe that it was only 10 days ago that I was wheeled off to theatre and "sorted out". The recovery itself has been like the entire experience, amazing. I am sat here typing this and feel able to do anything. This is not the euphoria taking over, I feel so fit and able and the house arrest I am under seems silly. I am more than aware that I do need to rest at times and any kind of lifting is off limits, but I am not displaying any kind of fatigue and able to look after myself really well.

The finished article is healing super quick. I have had a few sutures pop out, particularly around the base of the vagina but none of the wounds have actually opened to any great degree. Mandy helps me wipe all the incisions lines down every morning and this can introduce a small amount of spotting with blood. Most staggering are some small lengths of the incision lines are completely healed. There is virtually no bruising and after speaking to someone yesterday, they likened their new vagina to a purple cabbage but mine is completely normal in this respect. There is some small amount of swelling in the labia on the right hand side but every day sees this dramatically reduce. The swelling that is there is now soft to the touch. 

My pad on my knickers seems different every time I change it. Sometime there is pink blood, red blood, dark crimson blood and brown discharge of several colours. I am advised by the post-op notes to not be alarmed but sometimes all this discharge can be a little unsettling.

The clot covering my clitoris disappeared yesterday and it was visible for the first time. It is a piece of art to be honest, how that dainty little thing can be crafted from the glans of the penis is beyond me. Today has seen some bleeding from that area, it is still visible but not so easily. The issue here is that I still have that urinary catheter inserted and despite me taping it out of that way, it still bumps the clitoris. Oh yes, I can seriously feel this when it happens!

The whole vaginal area is a little sore and can feel tight after washing but it gets better all the time. I am in no major pain and I just take paracetamol to keep on top of everything. Sometimes I get stabbing pains, which is due to nerve endings regenerating. These are interesting sensations and have been dubbed tourettes by the local community as the side effect is often twitching and tendency to swear, literally. I am not sure I follow this usage of the term for this, but it does seem kind of apt.

Dilation at the moment is astonishingly easy. I have no issues with my pelvic floor muscle and this means insertion of the dilators is effortless. I was advised that an 82 gram tube of lube would be needed a day but I am using about 75% of that and reducing all the time. I often leave each one in for more than the 10 minutes too. I have embraced the dilation process as opposed to seeing it as a chore and look forward to my sessions doing this. Reading around, I have found some resources that suggest dilation is too under looked as a way of maintaining vaginal health. Although this article is a little old it feels very relevant and I am taking on board a great deal of what it is saying. Dilation is now a part of my life and although it shouldn't take over, it must factor in a major role. Even at this early stage, I have started exploring the possibility of bigger dilators in the future.

Douching after dilation is also very easy. I was given a new douche to trial by Liz Hills when I left Brighton due to the EZ Streem being discontinued. It has a slightly easier to handle bulb as well as a curved nozzle. It doesn't squirt out quite as good but overall first impressions are acceptable. I have also had to learn how to douche standing, as I was shown how to do it in the bath at Brighton. This was odd to begin with and requires a little feeling around to find the vagina as you can't see anything. Even more important in the shower is to squeeze and withdraw gently as you do so. I am adding Videne to the water at the moment and it makes a mess all over our shower curtains so I suspect we will be buying new ones.

One other physical issue no one really warned me about was the smell. Someone I know did mention it but nothing has prepared me for the sheer stink that emanates from down below. Once you get a whiff, it seems to cling in your nose and take forever to disappear. It is a uniquely horrible smell, impossible to describe and I would not even want to. I think of Lynyrd Skynyrds song, That Smell and this always makes me smile! Someone has suggested it is the videne that may be causing this because they figured it disappeared as soon as they stopped using it. This means another 18 days of it!

Hormonally, I am very good. the testosterone is very long gone but I am not desperate for the return of the oestrogen. I restart this in 11 days but it has not felt a trial yet. I am getting the very occasional hot flush and night sweats every night but that's it. I will be glad to restart, more so for the physical benefits and I am guessing the lack of desperation is perhaps the good feeling I am experiencing.

Finally emotionally, I am also very good. I feel in a fantastic place and life seems so good at the moment. This is not to say that I am not tearful, and I am constantly crying. Very little tips me over and when it happens, I just go with it and enjoy it. For once in my life I can be tearful, it has taken so much to get here and I am just loving being happy and free of the anxiety.

Wednesday, 21 January 2015

An adventure of a lifetime

Yesterday (Tuesday) saw me discharged from the Brighton Nuffield and take the long road home back to Somerset. I felt it might be good to have a little tidy of the loose ends from this part of my journey and reflect back on it all.

Here is what I have written up to now about the last week:
This brought us up to the end of Monday and there was a further dilation. Again, this went perfectly and finished the day much better than the low start with the catheter issues.

Tuesday was discharge day and I was up early. The nurses seemed late with the drugs so I went and found a nurse and explained that I wanted to dilate before breakfast so that I could pack without rushing. She agreed this was a good idea and brought my drugs as well as a cup of tea. I did my dilation, supping tea as I did so - I am finding it that easy! A decent final bath and then I had a break while breakfast arrived.

I then packed and my good friend Susan arrived to take me home. She was early and I was still awaiting Liz Hills to come for a final inspection of the goods as well as needing my discharge drugs. Liz eventually arrived, she had been slightly delayed with the snow we had had that night. We had a good chat, some hugs as well and I expressed my gratitude for everything they had done for me. She was just as grateful saying how good a patient I had been and for doing everything I had been asked. I also mentioned a problem with my douche, but we compared it with another and worked out it was just a slight defect in the manufacturing process. In addition, I was asked if I would trial a new douche and provide feedback to which I had no problem at all. 

Then it was up on to bed to allow her to have a look at the outcome. She was really pleased with how it was looking, I am hardly swollen or bruised and everything is exactly as it should be. She gave me some advice on suture care, cleaning and positioning of the catheter tube and how to stop the white sloughing that was occurring on the wounds. I was also given some pointers on douching and post shower care - gently using a hair-dryer to dry the site.

She was happy with everything and then we just had to wait for the drugs and sadly this was the only issue I had for the entirety of my stay there. We were an hour delayed and this led to frustration as I really wanted to get that journey done. We did get moving in the end and it was careful steps to the car, a reminder that I am not as able as I felt. We got out of the hospital and headed up the hill over the Sussex Downs and there were a few tears as I reflected on the incredible week I had had.

The journey was not too bad. I had to stop a few times for toileting but generally I was comfortable in the passenger seat. It was only the last 45 minutes that I was feeling it and ironically, these were the worst roads we had to traverse. On arriving home, I found Susan and Mandy had decorated the place with balloons and welcome home banners! I walked in and gave Mandy a good hug. We sat down for a little while, with a cup of tea so that I could have a moment to get over the journey. Susan had to go off and check into her hotel for the next few nights and while she did so, Mandy was wanting her look at the finished article. There were some serious tears once she realised how amazing it all looked. There was also another surprise in the form of cake and I don't think I need to elaborate on this one.

My first dilation out of the hospital went absolutely fine with no difficulties and this was the same for the evening one too. I have been warned that the whole area can become swollen for a few weeks post-op but there is no sign of this yet and my thoughts are that it may not be too bad. Even the journey home has not affected things and I am hopeful of a very speedy recovery. There was a small bit of anxiety in the evening just before bed when I found I could get nothing out of my catheter. eventually it started dribbling out before a blood streaked jelly like lump popped out and then it was all moving again. A phone call to the ward was made and we think it may just have been some bladder lining sloughing off. If it were to block completely, to get to A&E and get it flushed with saline. Liz Hills also suggested that gently twisting the catheter can help in this situation. Thankfully today it has been working fine.

So I am left to reflect on a monumental week in my life. It surely has to have been one of the greatest experiences I have ever had. Even with the couple of hiccups, some rough nights and painful trapped wind, there is just nothing that even comes close to how amazing it has been. It's hard to believe that it was 8 days ago to the day that I was put under and operated on, it seems like so much longer. That 8 days have seen so much packed in, even with the days of bed rest. It's been up and down emotionally, but mostly up and the amount of tears that have been shed through reflection and happiness are phenomenal.

Sometimes I forget that I have been through this fantastic mini-journey and almost as a bonus ended with a body that matches my mind. It is still a little surreal when I look down there and find there is no longer a penis and testicles but a vagina instead. It's still a little swollen with sutures sticking out, but it is mine and it makes me feel so good to see it. No longer do I have to be careful what clothes I choose for fear of odd bumps being displayed. No more do I have to look into the full length mirror, gaze lovingly at my breasts and hips and then shudder at the obscenity between my legs.

Of course there is also the very pleasant reality of the anxiety disappearing. I am no longer at the mercy of my gender clinic or NHS England with regards my transitioning. They never had anything on me and I never had anything to hide but I felt the constant scrutiny in my life over invasive and the hoop jumping tedious. My physical transitioning is over and I can look forward to the rest of my life. I have some ideas of what I would like to explore, and it is only with the removal of the noise of transitioning that I can do this.

Sure there are number of things I will have to continue with to remind me that I was not born with this body. I will have to take HRT for the rest of my life, in fact not doing so would be dangerous. This is coupled with all the blood tests I will have to have to monitor it. I will still have to have prostate screening where relevant. I will have to dilate for the rest of my life although the frequency will decrease over time and I will also have to douche every day because my vagina will never naturally clean itself. Any kind of penetrative sex will involve lubricant because I produce none of my own. This whole list makes it seem imperfect but it is far from it. I have reached perfection in my eyes and that is all that matters.

There was also one more event that happened at Brighton and I have not mentioned it yet because it was aside from the whole GRS experience. On the Saturday when Mandy was due to go back home, she proposed to me on my hospital bed and I accepted. As soon as I get my GRC, we will start to plan our wedding. I need the GRC first because the absurdity at this time is that in the eyes of the law, we have to marry as a man and a woman and this is not going to happen. Even more special was a conversation with my father last night. He asked if I would let him give me away at our wedding. His other daughter asked her stepfather when she married some time ago and hearing his upset at this even though it was quite some time ago, was quite upsetting to myself. I agreed without hesitation and to hear my father want to give his other daughter away showed me that he now has made some serious effort to understand who I am. Perhaps he needed the surgery to confirm it in his mind. It shouldn't have needed this but if it helps him, it's another bonus.

So the future feels very bright at the moment. There will be bumps, but I will be better able to deal with them. I have a body that matches my mind and the worry of transitioning is over. 2015 is going to be very good indeed!

Monday, 19 January 2015

Catheter woes and first solo dilations

We removed my catheter at 23.00 the night before. This was a stinging affair, a little like the drains but once over it went away quickly. I settle down to sleep and expect at some point in the night to have to go to the toilet. Given my high fluid consumption, this probably wont be very long.

00.30 was when I awoke busting to go. I got out of bed, sat on the toilet and felt the feeings of going but nothing coming out. I relax and try again but to no avail. I kept this up for 10 minutes but it was not going to happen. I press the call button and the nurse arrives. First she can't believe that I actually need to go 90 minutes into my sleep but I assure her that I definitely do. She suggests a bath and weeing in that, sometimes laying in warm water can relax the urethra and get it all moving. Whilst I do that, she was going to get the ultrasound so she could look at my bladder.

I run the bath, do what she asks but no amount of relaxation was achieving it. I get out, dry myself and lay on the bed. She puts some gel on the top of the groin and starts probing around. I ask whether it's a boy or a girl but she smiles and says it's too early to tell. My bladder has 800 ml's in it and I am going to have to be re-catheterised. While she gets everything, I suggest one last try but this was to no avail.

She starts unpacking everything, and this is when the tears start flowing. It's not the pain or needing to go, but the feeling of setback. Everything else has gone so well and it was hard to accept this little bump. She assures me that this is the one part of the whole procedure that no one can control. You can be the best patient and keep the catheter for weeks and the worst patient will walk out without one. Whilst she says this, she's inserted it! I hardly felt it and I am quite shocked. I couldn't believe that it could hurt more being removed and less reinserted. I can also feel the relief at my bladder emptying and for the night I was on a bag so I can sleep without having to get up. To try to help with the setback she suggested a cup of tea and a biscuit. 00.30 is not a normal time for hot beverages but I could see no harm. She returned with a tray, cup, milk, teapot, the whole experience. It was interesting, that going through the whole ritual was therapeutic and not so silly an idea for a stupid hour.

I slept fitfully and awoke a little tearful. I pulled myself out of it though and decided as soon as the nurse came around with the drugs, I was going to get a tap back on my catheter and retrieve my freedom. Even though I was due to have three baths this day with dilation, I was going to have a shower first thing, wash off the night before and also wash my hair properly because it was getting so greasy and horrible. This was a good plan and that simple comfort helped lift me for the day ahead.

Breakfast was the first order and once this was completed, it was time for the first dilation. One thing I wanted to do today was to take my time because yesterday felt very rushed and I did not get much chance to actually take it all in. I was left with an underwhelming feeling, and to be honest what I had seen was far from my idea of a vagina.

I set out everything I needed on the trolley which included lubricating gel, dilators, paper towels, alcohol gel, wipes and mirror. I also laid out an incontinence sheet on the bed as well as preparing a small pot of warm Hibiscrub solution. I lay on the sheet and put my glasses on, again something I had forgotten yesterday. I hold the mirror in my hand and slowly have a good look around.

It looked completely different than from the day before and is a much more pleasing sight. I take in the labia and although they are swollen, making them look smaller, they do look good. The clitoris is a bloody mess as well as the urethra still having a tube coming from it. It is well documented that this will take some time to come right. I move down from the labia and have a good look at the opening. Yesterday it looked an angry and bloody gash down below but today with good light and vision it looked very real and pleasant.

I could have laid there for some time but there was work to be done. The first job was to take a wipe, dip it in the Hibiscrub solution and wipe down the suture lines, along the labia and down towards the base. This is repeated on the other side with a fresh part of the wipe and more solution. This only needs to be done once per day.

Next is the dilation itself and I get the lube and put a big glob of it on the palm of my hand as I was shown the day before. I unwrap the small dilator from it's paper cocoon from yesterday and lube it up as I was shown. I then dip my forefinger in the lube and start finding the pelvic floor muscle inside myself. I angle the dilator in and then drop it once it is past the muscle and within 5 seconds it is there. No bounce yet (this is the term used to describe it hitting the back and "bouncing" off) but it definitely gets to the end because I can feel it pressing on the inside. Slightly over 10 minutes is counted off and I gently withdraw it. I wipe it down and then the same was repeated for the big dilator and this slides in very easily, much quicker than the previous day. Another 10 minutes and that is withdrawn and wiped. A towel is used to wipe the mass of gel left on the opening and then it's off for my bath. I run the water and prepare my douche. I wash down and probably more thoroughly than the day before because I am much more confident in my new anatomy. I let the water out, douche myself and that's it, all over. I looked at the clock and even with my slow look around, it took 50 minutes all in with absolutely no rushing with anything. So much for the 2 hours I have heard some say.

It's time for a bit of rest and while doing so, Liz Hills pays a visit. We talked a great deal about the whole process and the benefits of doing what the nurses ask. It seems that my current state is far advanced of many, my swelling is low and my bruising is minimal. I explained that yesterday was underwhelming and it was good today to have had a slow explore and that my dilation was very easy. She told me that I will fly through my recovery and everything looks very good for a very successful outcome.

I suppose bleeding is worth a mention as this is now a factor in everything. I now have to wear a sanitary towel to catch discharge and blood and to be honest, blood is the overriding factor. You are taught from the start that there will be blood and it will often look more than it actually is. The discharge notes say the same but yet despite knowing this, it can be alarming when you see it on the towel. Yesterday saw my first bowel movement in since before surgery and unfortunately even with laxatives, I managed to strain my sutures a little. I was getting spotting from the labia and some minor trickling from the base. This did worry me a little overnight and possibly contributed to the general low mood in the morning. Since dilating and cleaning up, the bleeding has slowed greatly and the worry diminishes. I managed another bowel movement this morning and with less strain although it did take some time. Thankfully, no bleeding ensued.

There is also the mobilisation issue and yesterday and today have seen me needing to mobilise and get my fitness back up. I also need to rest and this takes some skill. It's finding the right balance where you are resting but also keeping the muscles and joints active. The body only heals when it is at rest and this is why I am advised to be housebound for the next two weeks. I will stick to this anyway, but a walk around the garden will be permitted.

Lunch arrives and slowly my thoughts turn to my second dilation. I am actually awaiting a nurse to arrive so I can ask for some lube, but to be honest because my obs are so good and I am now mobilising, they seem to have abandoned me for the day. In the end I set out everything else and press the call button. A nurse arrives and I ask for some which she gets. I close the door, lie on the bed again and commence another good scrutiny. I am surprised, since the morning and having had another clean, I find it is looking much better again. It is like a different vagina since the morning. The dilation is perfect again, everything going exactly as it should. The bath was nice and I had a little soak as well as a good clean of my parts. I felt a new confidence and managed to give it all a good clean. Yesterday it looked like it was going to fall to pieces but now I can get my fingers into the folds of the labia and wipe away the sloughing tissue. Douching went perfect and suddenly I felt on top of the world, the pain of the night dwindling.

Cleaned up and tools packed away, I felt elated. I decided that I deserved a treat and this was my last opportunity to go and visit the Costa downstairs. I donned my dressing gown and walked out to the nurses station, down the stairs and into the main reception. It was a little scary, a whole week of being in my room has caused me to have a sense of reclusiveness and being in amongst everyone in normal attire with my dressing gown is a little unsettling. I order my coffee, a full fat latte, and the lady offers to bring it over for me. I sit in the window and it's then that it hits me full in the face. I'm sat in my dressing gown, no makeup and tousled hair and I am not bothered in the slightest. The days of needing to look perfect for fear of being read are long gone and I can sit here in amongst everyone and be myself. This nearly created an emotional moment, but I held that one back. I wasn't ready to inflict that on the outside world just yet!

So all in all, the day started of shit and became amazingly good. There is another dilation to go and again, I am looking forward to it. Slowly my time here is drawing to a close and although it will be sad to leave these kind and caring people, going home is now looking quite attractive.

Sunday, 18 January 2015

Vaginal pack removal and first dilations

I wanted to have a nice catchy title to this post, but my main aim is for people to be able to search this out in the future and the title is critical when it comes to attracting those that are looking into this for their own GRS. I remember struggling myself whilst trying to find such experiences and reading such things vastly improves your whole surgical experience.

The removal itself came much earlier than expected. Two nurses Carla and Emma arrive and I am asked if it is ok for one of them to observe her first unpacking and dilation. I have no issues with this and they started setting about removing my dressings before breakfast had even turned up. They were going to remove the pack as well, but I suggested waiting until after breakfast. They agreed this made sense and I tucked into my bacon, eggs, etc. This was the first fry up I have had here due to being on a special diet up to now.

Shortly after, everything is cleared away and I am laid back and have to spread my legs as wide as I can. The nurse, Carla, cuts the bottom off, pulls the middle out and it slips out effortlessly. The sensation was very unusual, not intense, not pain or pleasure but different. I'm cleaned up a little and this was when I was expecting my first look but I was mistaken because I am seeing a dilator being lubed up.

I am then told she is going to put a finger inside me and feel for the pelvic muscle before she can insert the dilator and that I'll need to relax and take deep breaths. I do this and feel the finger going in, it's not painful and then she readies the dilator. Slowly it goes in, drops down in angle and glides gently to the back. There was no pain whatsoever and the last couple of inches were more pleasant than not.

My hands are cleaned and I am told to hold the end of the dilator. The nurses are off to unpack the lady next door and will be back in 20 minutes to assist me taking the dilator our. I lie there thinking how incredible it was to be here holding a dilator in "my" vagina! The 20 minutes were so calm and serene and I even phoned Mandy to tell her what was happening.

They return well over 20 minutes later and I am encouraged to remove the dilator myself. I pull on it gently and it slides out with still no pain. You could definitely feel it moving, but it was a sensation with no words yet. I'm cleaned up, disposable knickers put on, sat in the chair and it is time to take a breather. A cup of tea arrives and I sit for a while just looking across the downs.

They're back and it's time for the grand unveiling. Carla instructs Emma to hold the mirror and after a few glimpses she gets it steadied and I can see my vagina for the first time. It is quite bruised and swollen but it looks good. It is higher than I expected, which is good because we are warned is closer to the anus than a cis-gender one is but is further away than I expected. There are a fair few clots around and still a catheter emerging from the urethra. The clitoris is just a big red lump at the moment. I am much less emotional than I expected but on reflection, I think it's because I am awaiting my lesson in dilation and this was making me hold back a little on myself.

Carla puts a big glob of lube on the palm of her hand and shows me how to apply it to the dilator (small one). My hands are cleaned again and a small amount of lube is put on my left forefinger. I am told to put this finger inside my vagina and feel for the pelvic muscle. Suddenly I am in at the deep end and an apprehensive poke around begins. It feels so strange and amazing at the same time. I locate the muscle and the lubed dilator is given to me. Again, this is a big moment and I gently insert it in. I find the muscle, angle the dilator down slightly and in it goes with no effort at all. It doesn't bounce at the end as it will eventually but I am more than aware of where the back is and I hold it place. I am left for 10 minutes this time although it was more than 15 by the time they got back.

I gently pull the dilator out and I am wiped down. Now it is the first time for the big one and this time the glob of lube is put on my palm. I lube the dilator perfectly as I was shown and this time I am to insert it without the finger because the first dilator has left it open. I look in the mirror, guide it in and then make the classic mistake of wanting to twist it as I insert it. I am corrected and in it starts to go. This is much more effort, again not painful, just requires a little more pushing although keeping it gentle. I can definitely feel it though, and I manage to get right to the back again. I am informed that not everyone manages this on this day. Again, off the nurses go while I lie there for nearly 20 minutes this time!

They return, I very gently slide the big monster out and I wipe of the majority of the lube. They run a bath for me and for the first time in 5 days I can have a decent clean up. I am not allowed to wash my hair this day but can start doing that tomorrow. I have a soak while I am waiting for them to return and when they do, I am taught to douche. This is the process of rinsing out the vagina, because it has no cleaning mechanism of its own. A large turkey baster type implement is needed for this and Carla fills it with a half cap-full of anti-septic solution and then to the top with warm water.

The bath is emptied but I stay in there and I am given the douche. I have to insert it 3 or so inches in and squeeze all the way until it's emptied. When emptied, I have to withdraw it before letting go or it will create a vacuum and be painful. I proceed and I squeeze so much out of it, I get some air as well which gives me my first fanny fart!

I'm out of the bath and gently drying down, it's into clean knickers with a sanitary towel and a nightdress. I am given the orders to mobilise regularly and I have free run of the upstairs of the hospital although I must listen to my body. My catheter bag is removed and I get a tap instead which means I have to get to the toilet to empty myself now. The catheter is being removed this evening and all being well it will stay out.

There are no more dilations today, but tomorrow sees me start on the process of this three times a day. There is no dread, it is something I have to do and I am quite looking forward to trying it without any guidance.

Saturday, 17 January 2015

Bed rest

Day one post-op - Wednesday

The whole bed rest period follows a common theme, very little happens with the occasional piece of activity to break the monotony up. Wednesday, I emerged from the tough night and actually felt fairly good. Liz Hills arrives early on and soon after she comes in with Mr. Thomas. He said a brief few words about how it went, it was all looking good and because he was off teaching for a time, I was in Liz's hands. He left quickly and I realised I never even got the chance to thank him.

Something I felt from the start of the day was the absence of testosterone in my system. Maths suggested it would be gone within 15-18 hours and I felt that peace in my mind I have felt when on the oestrogen. My skin feels less greasy already and later in the day the hot flushes made an appearance.

After my clear fluid breakfast of jelly, consomm√©, black coffee and juice, the first order of business was a bed bath. This is not an easy task post-op and is made even more difficult by the fact I was having to lie flat to keep fluids from accumulating in the surgical site. Shaving is also not easy on your back but I got through it and then the nurses changed the bedding. 

Everything cleaned up and then it was pretty much wait the day out. My difficulty was passing the time, I couldn't use the laptop on my back, TV was boring and I found it hard to read for much longer than 20 minutes. There was the occasional interruption from the nurses doing their observations but because I was doing so well, they reduced even that. Mandy visited in the afternoon but I was starting to become plagued by a new problem, trapped wind. She went home because I was getting tired and I spent a very difficult evening and night with agonising abdominal pain. I broke down in tears at 3.00 am saying to the nurse I couldn't carry on. This was one time that I actually had a fleeting regret for what I had done. She got some diazepam, we had tried everything else, and that at least got me a few hours of painful sleep.

Day two post-op - Thursday

Even with the problems of the night, I felt better once morning had arrived. Today was still clear fluid diet until the evening so it was still the unexciting jelly, consomme, etc! Once this was consumed, it was a case of waiting for the nurses to change over. I have found during the mid morning, I tend to become very weepy. There is no clear trigger, but it's often after I sit back after breakfast and reflect a little.I am not too sure what I am crying about, but I sit there for a good 10-15 minutes letting it all out. I am not trying to hard to work out the reason, I just go with it. As a rough guess, I think I am releasing all the pain and distress getting to this point.

Today's highlight was the removal of my drains, two tubes draining out excess fluid from the surgical site. I was very pleased to see Vicky at 9.00 opening the door and saying she was looking after me. All the staff here have been excellent but it is inevitable you develop a rapport with one or two. She has to sort other things out and then she arrives with her tray of tools. Not only does she have to remove the drains, she also has to redress the surgical site.

She slowly starts to peel back the bandaging and there is a little twinge as she knocks the two drains. She peels of more tape but leaves the vaginal packing in place. The dressing is pulled away and then it's time to pull out the drains. I know this may hurt because I am told to take deep breaths and relax. Three or four are taken and out comes the first one. It was a very stingy sensation and I was surprised how deep they had been. Vicky says she is on a roll and she'll go for the second one after a few more breaths. We are finally done with this and she holds gauze over the wounds to stop the bleeding. 

It's then time to redress the area which has the double effect of holding the pack in. She places the dressing over the and then places surgical tape from my belly around to my bum cheek. Whilst doing this, she pulls tight with the aim to push the pack firmly back into the vagina. For the first time, I can feel the pack moving inside of me and interesting is about the only word I can use to describe this. It was certainly not painful and was more pleasant than not. Yep, we'll just have to leave it at interesting.

That's the major excitement of the day over and it's wait it out until the next main event, the evening meal. Finally, I get to eat some solid food! It's only some toast, a pot of tea with milk and jelly but it is a real feast after the liquid diet I have been on. I am even asked what I want for breakfast and although it's not quite a full English, cereal and toast still sounds fantastic. My wind was easing and I was expelling large amounts of it which was reducing my abdominal pain. I also had a much easier night, not a massive amount of sleep but pain free.

Day three post-op - Friday

Today was to be another bland day, just bed rest and nothing else. Breakfast seemed a treat after the liquid diet and I was asked what I wanted for my other meals. Having to choose was overwhelming because I was not used to it! After breakfast, I had my ritual weeping session and again, it has no real reason to it. The crying has neither a positive or negative overtone but has a very beneficial aftermath because I feel like I have just given in and accepted my feelings.

Liz Hills popped in again and we had quite a long chat. She told me a few stories of less co-operative patients and they were quite shocking, who would want to put their outcome at risk by not doing what was asked? I talked about my weeping and she said it is common although I do not fit the typical person who would have this so it must run a little deeper. She left, and then returned shortly with Mr. Thomas again. This was a surprise and I actually got a little more from him this time. It was not a chat but I did make a point of thanking him and we shook hands with some genuine warmth. The man is an enigma for sure and I wonder what he is really like?

My bed bath today was an extra treat, the nurse offered to wash my hair. This felt so good after not being done since Monday and with all the grease from the days of testosterone. 

I also had to ask for my pack to be looked at because it felt loose to me, and sure enough, it was. A very experience nurse was called for and she strapped another piece of tape across. I had found it difficult to get comfortable all day, and then suddenly it was much easier to lie in bed.

My lunch was a lovely affair; Chicken, mash, carrots and gravy! Just having a plate of proper food was amazing and I was hard pressed not to lick the plate clean afterwards! I even asked Mandy to bring a bar of chocolate when she visited. Whether this was allowed or not, I was not sure but I couldn't see anything saying I wasn't allowed it! That chocolate was amazing!

After Mandy and Susan had left, I started developing a strange sensation of wanting to wet myself. This was different to the feeling I had had on the day of surgery, where I had an urge to urinate from the appendage of old, this felt like it was coming from the new exit. It got stronger as time went on and whilst on the phone to a friend it became so intense, I felt like I was actually holding my urine in. I called a nurse in, and she emptied my very full bag but it didn't clear the feeling. When the staff changed for the evening, the night nurse introduced herself and asked if there were any problems. I explained and she thought it might be a nerve reconnecting somewhere. She asked me to relax, give in to the urge and try to wee.  I did so and nothing happened although the urge did not go away. At least I knew that I was not going to suddenly be lying in a pool of urine.

The night was by far the best I had had and I managed nearly 6 unbroken and pain free hours of sleep.

Day four post-op - Saturday

I had my early morning painkillers with the advisement that they would help me mid morning when I got up for the first time and sat in the chair. However by 7.45 I was asked if I wanted to have my breakfast in the chair. I agreed it would be nice and we prepared for the massive process of getting out of the bed and walking over to said chair.

The top sheet was pulled out of the way, my catheter bag and tube were unclipped from the bed and I gently rolled over and sat on the edge of the bed. I was being advised every step of the way and I took some deep breaths before standing up. I didn't feel dizzy as was being suggested and I stood there for 15 seconds before starting to move towards the chair. For someone who did a run of over 13 miles three weeks ago, those 4 or 5 short steps took some serious effort. I literally had to command my legs to move. I got to the chair and as I'd been told, lowered myself extremely gently into it. It was not that comfortable because of the pressure of the pack but it was fantastic to have my breakfast sat up in that chair. It was also nice to see the view from the window at a different angle and it painted a lovely frosty scene with the sea beyond it.

Breakfast over and 30 minutes sat with my pack pressing into me was enough. I got back up and to the edge of the bed. I felt comfortable staying stood and we decided to do part of my bed bath whilst I was this way. Semi-cleaned, I got back into bed feeling very satisfied. One of the catering staff arrives and hands me the menu for the day. I am allowed to choose proper food now and it is almost overwhelming! 

The day is a slow day, again not much happens until later in the afternoon where I am sat in the chair again for 30 minutes. This was a little more uncomfortable perhaps because everything is still a little shell-shocked from the morning. 

We get to now on Saturday evening as I'm about to publish and I look ahead to tomorrow. This is a much anticipated day as it's the day of the pack removal and dilation begins. It also means that I finally get to see my new vagina. Exciting!

Friday, 16 January 2015

Surgery recollections

Three days ago I had my gender reassignment surgery. I said at some point I would be back to write about although wasn't sure when I would be able to do so or want to. My recovery has been amazing and I surprise even myself with how well I have done. The big day is still very clear in my mind and I am very keen to write about it.

I slept surprisingly well the night before, getting probably 5 hours. I got in a last minute black coffee before I was nil by mouth and then it was wait out the time to surgery. The anaesthetist saw me quite early and went through my medical history. He was happy with my health and left. Mr. Thomas and Liz Hills arrived just before 8.00 and I signed the consent form. Very little was discussed, I had no questions and that was the formalities over with. At no point was I actually asked if I was sure that I wanted this surgery; it didn't worry me but did surprise me.

9.00 came and in came Vicky who was going to be looking after me the whole day. Her first job was to administer a phosphate enema which would clear out the bowel and remove the need for toileting during the bed rest phase. She applied it gently and told me to hold it in for as long as possible stating 5-10 minutes was good but some manage 30. I did just over 15 and decided I needed to go. I sat on the toilet and expelled a good quantity and thought I was done. Suddenly though, the world starts spinning and I nearly pass out. Sweat is pouring off of me and I was really close to pulling the emergency cord in the bathroom. I sat there for another 10 minutes emptying out and slowly losing the symptoms of my shock. I emerged from the bathroom and Vicky had reappeared. She looked at me and realised straight away that things were not good. 

I improved quickly though and then I had to shower with a special sponge to disinfect my body. A gown was put on, I got on my bed and waited to be wheeled down to theatre. Vicky arrived just after 10.00 with someone from theatre, my name and date-of-birth were checked and then I was wheeled out of the room and off down the corridor towards lesser frequented parts of the hospital. I took in every moment of this journey and I remember smiling all the way. We get to theatre and I am greeted inside by the anaesthetist. He points to my signature on the consent form and asks if this was me? I agree and he starts preparing whatever cocktail he is going to use to knock me out. The cannula is placed in the back of my hand and he starts injecting away. The process is surprisingly slow and I could feel the anaesthetic creeping up my arm. When it got to my shoulder, I then felt it's effects and gently drifted off, a smile firmly fixed on my face.

I wake a little while later, somewhat disorientated but eventually I realise where I am. I was in little pain but could feel a dull ache down below and well aware of all the dressing between my legs. Vicky was there with the recovery nurse and I asked how it went. It had gone well and I had got about 5 inches of depth. Such measurements were unimportant, just hearing it had gone well was enough. To be finally rid of that unwanted genitalia was enough for me, depth and outcome were for later.

I was soon wheeled back to my room with the same smile on my face but I felt very serene. My anxiety had completely gone and it was finally over. I get to my room, drinks are placed in front of me and I am told to get as much into me as I can (they took 6 litres out of my catheter bag by next morning!). I am also given some exercises to do to reduce the risk of clots in the leg (DVT's). This was to supplement the special boots I was wearing that were inflating and deflating to massage my legs.

I was then left and I spent a good 15 minutes crying.The realisation that I had finally got what I needed, a body congruent with my mind, was overwhelming. I just stared out of the window, tears streaming down my face and I felt so good afterwards. All of the anxiety gone and the pain of the depression seemed much lessened.

2 hours post-op
The rest of the day passed slowly and mid afternoon Mandy arrived with my friend Susan who was looking after her while I was recovering. This gave us an opportunity for a post-op photo and nothing shows the happiness more than these photos. I have seen others photos in the past and the peacefulness in them is evident. To see it in my own face was very satisfying.

The rest of the day went along smoothly, the nurses were very happy with my observations and how much I was drinking. I was now on a clear fluid diet so by the evening, I was finally greeted by the Brighton consomme. Everyone says how awful the stuff is, but I found it ok.

My pain was ok, although it was building a little in the evening. Vicky gave me some morphine but to be honest, it did very little for me. It was no massive issue as my pain was very low anyway.

The night was very difficult however. I was getting backache from lying on my back and the night nurse, Tracey was very kind and caring. She worked very hard that night and got me through it in the end. We did try some more morphine in the early hours and this made me drowsy enough to get a couple hours sleep. I also had a couple of injections; antibiotics and something else designed to help the op site stop oozing.

Morning came and even with the rough night, I felt pretty good. The curtains were drawn back and I looked at a new day dawning. Whilst I do not see this as any kind of rebirth, it is however a new dawn in my life and it feels pretty amazing at the moment.

I'll be back soon with more.

Monday, 12 January 2015

Almost there...

It's a little hard to believe but I am actually here sat in my room at the Nuffield hospital in Brighton. The drive up was trouble free and for once I was driven by someone. This was a much appreciated luxury and added to my experience.

I haven't quite been admitted just yet and am just waiting for a nurse to complete that formality. I have had my meal order taken for this evening although being low residue, it is likely to be a little bland.

The clinic manager, Liz Hills, has already been in, welcomed me and talked through a few things as well as giving me a big hug. After all the problems there have been, this meant a great deal to me and I am actually crying remembering it. She let me have my "pack" for discharge and I can see my two dilators and a douche in amongst several other items. It has been very reassuring and the anxiety that has been chronic for months is nearly gone. She commented on how calm I seemed, and yes I am indeed very calm. The next week is full of adventure and even though some of it may not seem pleasant on paper, it will still be part of the experience for me. I intend to fully enjoy it! The reality is that tomorrow, I will wake up after surgery with a vagina! It will be a full 5 days before I can even see it but it so exciting to know that this is going to happen. I feel in a great place at the moment.

I would love to be able to write about it all day by day. It would not just serve as a fantastic resource for any one else intending to have this surgery but also be a good reminder to myself. But I must also be realistic and there is a good chance that I will not be physically capable of writing about it. There is also a good chance that even if I am physically able, I may not want to. I am going to go through a mix of emotions, probably the most powerful ones of my life and I may not want to be writing at this time. 

For once, this is all about me. I talked about being kinder to myself and this is one time where I am going to do what I want to do. If I feel able to write and want to, I will, and if I do not, then I will lie back, relax and take it easy.

So I will be back soon, or not so soon but I do promise to write at some stage in the near future. Rest assured I will detail this as best I can, when I can and I hope you will join me when this happens.

Lucy x

Sunday, 11 January 2015

A final hormone update - 6 weeks

Please also see:
I decided not to do a 5 week update simply on the basis that weeks 3 and 4 were very similar. It seemed a much better idea to wait until near the end and just do a final write up and give my thoughts on it all. Of course, it needs to be remembered that I have to wait another three weeks post-op before I can resume on the oestrogen but in a few days time I will no longer have any testosterone in my system. I will of course update when I can with any post-op updates that I manage.

And I can honestly say to the testosterone that it will be FUCKING GOOD RIDDANCE! I do not say this lightly and as I will explain in detail, it has become increasingly difficult to keep going recently. 

I have detailed the physical symptoms over the weeks and of course the acne continues. It has settled down more recently though, the new spots are now down to 1 or 2 a day instead 5 or more. They are still extremely painful and have a tendency to bleed with the slightest aggravation. My face feels greasy all the time and this is the same with my hair. I do feel hopeful, given that it is slowing down now, that post-op it will improve very quickly; perhaps within a few days.

The hot flushes have all but disappeared. I think my body has become accustomed to it's new hormone and thinks it's back where it should be. I wonder just how this is going to affect me post-op? When you cease the oestrogen, it takes about 5-6 days for the hormone to disappear from the bloodstream. When the testicles are removed, it will take about 15 hours. This means I will have zero hormones in a very short space of time and I wonder how my body will take this sudden cut-off? I will soon find out.

My body hair has now started to grow at a startling rate. My facial hair is even more wild, and I am struggling to epilate it now. I will have to shave around my surgery anyway but the growth rate means there is now just so much to pluck out.

The erections are constant at night and are often disrupting my sleep patterns. I have since learned that they may not be as beneficial to post-op dilation as I was originally told. I will explain at the end of this post.

Emotionally is where the fun has really begun. I have talked about the genital dysphoria and my hatred of what I have now is still as intense. Some cisgender males may cringe at the thought of being cut about in the manner I am going to be, but honestly, it will be a blessed relief.

I honestly thought that with the increased T, I would be much stronger emotionally and it has been completely the opposite. Last weekend saw me at one of my wobbliest times ever. I was all over the place with anxiety, crying, outburst and just about everything else you could think of. I also had issues of a physical nature combined with this that just made the anxiety even worse. It got so bad at the weekend, that I even ended up trying to find someone else who had been through this. It seems that I was a bit alone in this instance. Many have experienced the 6 weeks when on an anti-androgen (T blocker) but without, I could find no one. I got through the weekend and it because my anxiety has eased off through the week, I have found that the emotions have not been quite so wild.

I had my pre-op telephone call from Liz Hills as well on Wednesday and she asked me whether I had stopped the hormones. I said I had and that it had been quite hideous. She asked a little more and I explained about the advice I had been given from The Laurel's regarding not having a temporary anti-androgen. She was not at all happy and said that the post-op benefits of the erections were negligible and that there was no need for me to have endured what I have. She even went so far as to ask who had given me this advice and that after our call, she was going to contact them and make sure this didn't happen again. I said it was too late for me, but that I had been writing about it and it was there for future people to see and make their own choices. 

So, what would I do with hindsight and retrospect?

If we even consider that the erections had a major impact on my post-op success, I would without hesitation opt for that anti-androgen. This has been an extremely difficult 6 weeks and I would never want to go through this again. It has been emotionally difficult and physically painful. Anyone who is about to go through the same, think very long and hard. It is your decision and I can't make it for you but please consider what I have written.