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	amberspace				"Been there. Been that."	Last updated on 2006.08.10.

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sex reassignment surgery (srs)

General overview and thoughts
On selecting a surgeon
Taking care of your health
Planning for your absence
Planning for your return
Packing your suitcase

Part 1: Vaginoplasty
The medication schedule
The joys of dilation
Other post-operative maintenance
Back at work

Part 2: Labiaplasty
The medication schedule

Thank you for reading this section regarding sex reassignment surgery (SRS), also known as gender reassignment surgery (GRS). The following information is designed for educational purposes only and contains graphic descriptions and images. (Please do not copy these images.) If you do not wish to continue please return to the home page.

Additionally, this information does not substitute any instructions from your surgeon, physician, or other health care providers. I am providing this as supplemental notes only. Please make sure to always obtain professional guidance as you make decisions about your health.

General overview and thoughts

I wanted to put together a set of notes that help remove the mysteries about what really goes on and what you might be able to expect for your outcome. I've always been of the opinion that SRS is more of a milestone than a capstone in one's transition journey. This surgery doesn't change who you are nor does it suddenly resolve all the problems in your life. Instead it sort of says to the world, "hey, I've arrived a place of harmony with myself and I'd like you to recognize my new status physically and legally." If you are having trouble full-time assimilating then you may very well find you will continue having these problems.
Having said that, I have come to believe that it is a unique experience that serves as a confirmation of your efforts. For me it was the case that I liked living from the girl perspective but I felt very apprehensive in many social situations: the proof I was trans was right between my legs. I wouldn't date, I wouldn't wear form-fitting clothing, I would be cautious how I sat in group situations, I would dare go swimming. I never hated my penis but having one and living full-time created a lot of stigma. SRS doesn't erase the fact I still am transgendered but at least it doesn't make it immediately obvious, if you know what I mean.
So, you really want to have SRS? I'm sure you've thought it through, right? The possible health complications? The social consequences? The financial responsibility? Realistic expectations? Well then, great! There's a lot of little details. Your experiences are almost sure to vary (as well as your surgeon's requirements). And besides going to popular resources (like TS Road Map) you may find the following notes of my vaginoplasty useful.

On selecting a surgeon

There are a number of very qualified and competent surgeons available to you these days. They all range in cost, technique, and location. Having one that works within your financial constraints and schedule is important. These were some of my criteria when I selected my surgeon:

Distance from home. I wanted someone who was relatively close. How long to you want to spend on a plane and also in terminals transferring flights? And (I didn't initially think of this) since you have to dilate often then if you're stuck in a long transit you may have to dilate in the plane or at a terminal!
Experience. I wanted someone who had performed thousands of vaginoplasty surgeries. I like people who have "seen it all" because human bodies vary so much. As another person put it to me, it's the "Christmas present" effect: you don't know how a person's anatomy really is configured until you open it up.
Recovery center. I had the opportunity to have been to the recovery center (an alternative to a clinical hospital setting) a while before my surgery. I loved the staff, the quality of care, and the condition of the facility.
Doctor-patient relationship. I think it is absolutely critical that the doctor should made the patient feel cared for and important---the so-called "bedside manner". I found my surgeon to be a very warm, patient, knowledgeable, competent human being. This means I can put my complete trust in him and know that his services extend beyond the operation and into the aftercare phase. Today I have no qualms about picking up the phone to ask him or his office any question.

Notice one of the things which I didn't list was the financial impact. This may be of concern to you as your budget may not allow all desired surgeons. I would suggest you try to find the best person rather than the most financially convenient. The reason is that in the long term the money isn't such a big factor and since you can only go through vaginoplasty once wouldn't you like to have your best chance at success? (No outcome is guaranteed in any case but I think maximizing your probability of a successful outcome is desirable.)

Taking care of your health

Being in your best health may indeed help with your recovery. By making an honest effort to change your lifestyle to include a better diet (but not necessarily dieting), vigorous exercise, and ample rest you help maximize your chances. I chose to begin cutting back on junk food, adding more veggies, and exercise hard about 8 months prior to surgery. I couldn't sacrifice my hectic schedule in order to get more sleep; in retrospect that was kinda dumb. Treat yourself better by not overloading your schedule.
After surgery I seemed to bounce back really quickly---your results will vary. I tend to think that the hard training for running races really helped my lungs and boosted my metabolism. I also know of a number of avid runners and cyclists who also recovered very quickly. All of us tended to not use pain medication. So the lesson here may be: the more in-shape you are the less pain and faster healing you may experience.
In the weeks following I also did a lot of walking. That seemed to help reduce swelling, quell the bruising, and lift my mood. There's nothing like fresh air and plenty of sunlight to really make you feel good. As a corollary, maintaining a sense of humor really helps too. That gets air deep in your lungs, helps maintain a positive outlook, and just makes you feel darned good too. (Although I do not recommend laughing while trying to dilate. That just plain hurts.)

Planning for your absence

In planning for when you go away there are a number of things you probably want to consider:

Get your travel itinerary down early! Having your dates locked down gives you one less thing to worry about. Hotel, airfare, transportation, and surgery are much cheaper if you book these ahead of time. Speaking of cheaper, if you use some of the online discount travel sites sometimes you don't get to pick where you stay in your hotel. I highly recommend that you find a way choose your hotel location such that it is conveniently located near your hospital. (This could be even more important if you run into bad weather.)
Stay a few extra days if you can. Some people choose to come back immediately after they're released from the hospital. If you're travelling alone this may be the best option for you since the sooner you get home the sooner you are closer to your local services and friends. But, if you can, I recommend staying a few extra days in a hotel nearby. This will give you a chance to try dilating and taking care of yourself on your own. Also, if there are any additional complications (e.g. catheter has to be put back in) it gives you a chance to resolve them before you return.
Reconfirm with your surgeon's scheduler periodically. Things change on schedules all of the time and a friendly call once in a while helps to ensure you and your surgeon are still planning on the same dates. In addition, this gives you a chance to check that all required paperwork and payments have been filed with their office. (I even called about 1 week prior to my surgery to make sure everything was in order.)
Inform your workplace of extended absence. Be sure to block out any time off way in advance. You may be involved with a project which requires you as a resource and it's no good to them if you suddenly disappear when they need you most. I had informed my manager(s) from the beginning when I was going to be out and then I announced publicly that I was on an extended vacation about 1.5 months before I went. This helped everyone adjust our MS Projects and rotating duties.
Plan or resolve your finances. There's nothing worse than having a big bill come in while you're out on surgery. Try to make sure that you have ample cash in the bank and that all of your payments will be made on time. You might even have a representative look after your finances. In my case, days before I flew off to surgery I did a lot of Internet/phone bill paying to zero out all of my balances such that I knew if a bill came in then I probably wouldn't owe anything---there's no penalty for prepayment.
Travel buddies and friends. If you can, definitely try to get buddies to go with you and come back with you. You're probably going to be a nutcase just before you arrive at the hospital on your surgery day and you're probably going to need help carrying things on the way back. Also if you have friends back at home who can help run errands when you return that would really help! I tried to arrange with my travel buds about 2 months before we left. If you find yourself unable to have someone to return with you try to make sure that all of your luggage can be pulled rather than lifted---you won't be able to lift much when you return.
Update your will and living will. I know no one likes to talk about this but you know that bad things can happen to good people. It's a good idea to get your will in order months before you leave. Remember, the process takes a while to complete and you may also have to involve a notary. It may cost you a couple hundred dollars to get the will completed. Also, a living will is a good thing to help people understand what kind of care you would like should you find yourself complete incapacitated.
Make copies of your information for home. Before going on your trip make copies of all the important information like names and phone numbers of your surgeon, the hospital, any hotels you're staying at, information packets, etc. Leaving this copy at home means if you lose anything on the trip then you have all of your information at home. It's also a general recommendation that when you travel (especially where a passport is needed) that you make copies of your identification and credit cards so that in case you lose them someone can fax a copy back.
Get on an exercise program! Definitely get that ass off the couch! You don't have to do something drastic like join a gym or start a guelling diet. Simply to elect using your car less and being willing to break a sweat do wonders. Please see the health notes above.
Try to get pre-boarding. If you're taking a plane definitely let the people at the counter know you need a pre-boarding pass and possibly their help to move your luggage.
Get some R&R before you leave. This is one of those do-what-I-say-not-as-I-do things. I ran ragged the week before surgery even though I had planned to just chill out. As a result I got kinda sick as well as felt really fatigued. Please give yourself some relaxing Me Time before you leave. Clear off your planner, disconnect from the world (a little), and finish up your household responsibilities early. You're about to embark on something quite significant so being in a positive frame of mind really helps.

Planning for your return

Understanding that you basically be an invalid when you return may make you realize a few simple adjustments will make your life so much easier:

Clean your house. Rearrange your furniture. You will be significantly weaker when you return and you may even have doctor's orders not to lift or move anything! So, be sure that you really do all of your housework, laundry, chores, etc. so that when you return you're coming back to a happy, clean pad. Also, arranging your furniture to facilitate your moving around or hobbling on a cane is important. For instance, I made sure my bedroom had large clear paths between my door, bed, closet, and bathroom. I set up my music keyboard (weighing like 35 lbs.) and guitar such that I wouldn't have to move them later.
Stock up on food. Canned goods, pasta, frozen dinners, frozen veggies, water, juices, soda, cereal. All these have really long shelf lives and you can stock up on them ahead of time. Plus, remember that liquids tend to be heavy and you may not be able to lift them after surgery---see comment above about heavy things. You may find grocery shopping next to impossible. I made sure I had plenty of pasta, frozen meat, and sauces because I go through a lot of them. I also drink lactose-reduced milk which has amazing long shelf life.
Relocate most-used items to waist-level. This was such a good idea. Most of my food items along with my most used pots and pans were at waist level meaning I didn't have to bend much. This includes trash bags, plastic wrap, small appliances, and medical supplies. I also put jugs of bottled water on the counter for later use.
Toilet paper. Paper towels. Lube. Pantiliners. Water. Laundry detergent. Garbage bags. These are things you will go through in amazing quantities and would be possibly too heavy for you to move yourself in the first few months following the operation. Pay attention to sales and stock up early! You will generate a lot of trash in this process, but I think it's acceptable since you're recovering from surgery.
Buy a sitz/peri bottle. Unless the hospital provides one for you I highly encourage you to get a little sitz bottle. (They're small water bottles that have a special spritzing top.) A dab of antibacterial soap and some lukewarm water help totally keep you clean "down there". I was instructed to use it every time after I went peepee or poopoo. Actually, I agree that it works well.
Keep a bit of cash on hand. You may not be able to run to the ATM at will and if you order a lot of pizzas in you're going to need something to pay the pizza dude. I hit the ATM before I left and stored a few hundred in a secret place in my house.

Packing your suitcase

It varies depending on who you go to but I think these things are pretty universal:

Make a list of what you're bringing. Chances you're going to be going out of your mind before your trip and coming back you never know quite what state you'll be in either. I make it a habit to use a packing list just to simplify things. You may want to refer to my vaginoplasty packing list. (A labiaplasty packing list is also available.)
I chose to do carry-on, but ran out of room. I hate checking bags in and it was so much easier when I was returning because I went from the plane out to my car without problem. However, I found that I did need more room than I planned. At the doctor's office they gave me a plushy bathrobe, some friends brought stuffed animals, I got a vase, I got more hospital and dilation supplies, and I also did a little shopping. All of that added up to about an extra carry-on bag. It was a good thing that my friend brought a mostly-empty bag with him! Since you're probably going to be weaker when you return anyways, checking in a large suitcase isn't such a bad idea...
Bring extra cash for tipping. If you have people helping you around you might want to carry a bunch of smaller change for tipping people.
The donut is a virtual necessity. You can find ways of sitting w/out the donut but that's pretty hard on your body. I recommend the foam ones instead of the inflatables because the foam really help distribute the weight evenly as well as not requiring inflation.
Pantiliners are really good things. I brought light maxis but when I got a chance I switched to pantiliners. The liners were more comfy, thinner (so I can pack more), and cheaper. As a recommendation you might try the thong versions instead of the regular ones---I found them infinitely more comfortable.
A retractable walking cane is a good thing. If you plan on using a wheelchair then maybe this is a moot point. However a cane does a lot of things for you: helps you keep balance, gives you an implement to pick things up or push them away, and also lets people know you are not at 100% health---they'll actually do a lot of nice things for you!
Floss and tape are really useful. Don't laugh! Dental floss not only cleans teeth: it makes a really good wire for hanging things or tying things down. And tape is nice because it holds things in place. Consider bringing both of them!
You will be swollen beyond belief---bring really loose clothing. I brought skirts and loose shorts because I thought I would be swollen. Wrong! I was very swollen and couldn't even get into my skirts! The lesson here is when you bring your bottoms make them very loose. Light summer skirts (with a thin elastic waistband), sarongs, and sweats all are great things.
Use separates to make up your wardrobe, save space. I had pink, orange, white, and brown tops; khaki, blue, and green bottoms; two colors of sandals; a blue jacket; a variety of accessories. All of them took very little space (about 1/3 of my suitcase), didn't show dirt that much, and almost everything went with each other creating endless combinations. Since I was in a warm area I also got away without having to bring any socks.
Don't bring shampoo, paper towels, soap. Buy. Instead of filling my suitcase with toiletries I bought those things when I reached my destination. Then on the way back I threw them out. It really helped save space.
When picking up prescriptions always have your insurance card. When/if the doctor's office calls in a prescription or if you have any of yours filled while you are out on surgery be sure to have your insurance card. Doctors don't always phone in the information; you can have some good savings on medication by taking advantage of co-payments.
Bring Ziploc gallon-size freezer bags. If you need an improvised ice pack a Ziploc bag filled with ice and stuffed in a pillowcase makes a great improvised ice pack.

Part 1: Vaginoplasty

My blogs have a day-by-day account of what went on as well! Begin reading entries starting July 2, ending July 17.

July 2004
S	M	T	W	T	F	S
				1	2	3 Arrive
4	5 Pre-op	6 SRS	7 Bed rest	8 Cath cap HRT	9 Drain out	10
11	12 Pack out Dilate	13	14	15 Release	16	17 Fly back
18	19	20	21	22	23	24
25	26	27	28	29	30	31

All travel plans in motion I left for surgery the weekend just before I had to go in. The surgeon required a pre-operative appointment the day before surgery followed by 9 nights in a hospital. So, we planned my itinerary for two weeks:

Day -3: Arrive a few days beforehand on a Saturday to acclimate myself. (Surgery is on Tuesday, pre-op on Monday.)
Day -1: Pre-op appointment and received bowel prep supplies. Spent the day fasting and doing the whole bowel prep thing.
Day 0: The day of surgery. I basically lost this day. First night in the hospital.
Day 1: The day after surgery. Strict bed rest.
Day 2: Catheter capped. First shower. Light walking allowed.
Day 3: Drains removed. HRT resumed. More walking suggested.
Day 6: Packing out. Received dilation supplies and did first dilation.
Day 8: Catheter out.
Day 9: Released from hospital. Technically this is the end of my required stay, but I stayed in town for a few more days.
Day 11: Flew back home on Saturday.

SRS Day. Anesthesia sucks. Zzz...

Day 1: IV in left wrist.

Day 2. Labia is completely sutured up. (Sutures removed later.)

Day 3. Drains removed. Walking increased.

Day 6. Douching kit, dilators, and misc. equipment.

Day 6. Dilators. Note the slight curve at the rounded front.

Day 6. Sutures and packing removed. Catheter still in.

Day 8. Catheter out, shown on right.

Day 29 (about 1 mo.) and Day 62 (2 mos.).

Flying in early was definitely the smart move. It gave me a chance to rest, buy supplies, and mentally prepare myself for what was about to happen.
      The bowel prep day was just pure nastiness. The amount of water you're required to drink is insane. You are supposed to take water every hour from 1:00p to 9:00p in order to saturate your system. Also, at 5:30p you're supposed to drink a 10 oz. bottle of magnesium citrate (a.k.a. magnesium carbonate) which tastes like Sprite with a lot of lemon in it. Then around 9:00p you have to insert a biscodyl suppository. And to top it all off you take 4 enteric-coated biscodyl tablets at 9:30p downed with another 8 oz. glass of water. Bowel movement usually occurs sometime in the next couple of hours---mine was almost immediate.
      On the day of SRS I wore as little clothing as possible and no jewelry. My friend helped me carry and guard our bags while I went into surgery. Once admitted I had to submit a urine sample as well as answer a few questions on my paperwork. All the clothes I was wearing were placed into a bag and I was given an open-back hospital gown, hair cap, some stockings. The nurses also administered some medication prior to me being hooked up to the IV. The surgeon visited me, then the anesthesiologist, and finally I was wheeled into the operating room.
      I woke up dry, weak, a bit nauseous, and very tired. Ice chips were a definite plus at that moment. Once upstairs in my room they had me attached to an IV that included a morphine administration system (with the PCA clicker), a catheter draining into a foley bag, two drains in my labia, and sequential compression leggings.
      The morphine was making me sick even though they added an anti-nausea medication. Since I did not feel pain and didn't use the PCA clicker (patient-controlled analgesia) more than a couple of times we opted to remove it. I also chose not to use any oral pain control medication. While it is generally a good idea to take advantage of any pain control options, one of the major side effects of it is constipation.
      Over the course of the next day there was constant monitoring by the staff taking vital signs and administering medication. Strict bed rest was required although I could move in bed. There were no food restrictions, but I opted to go on a mostly-liquid diet. (After bowel prep your system is virtually empty and so you will have tremendous amounts of gas. If you start eating solid food immediately it may plug up your intestines and not allow the gas to escape, especially if you use a lot of pain medication.)
      On Day 2 they gave me a catheter cap and allowed me to roam from my bed. Walking was difficult but possible, and they also advised us to walk as much as we're comfortable. Since the compression leggings were removed it was a good idea to walk to increase circulation. I was also allowed to begin showering, making sure to pat dry the surgery site. At the hospital I was at they also supplied some light stretch "underwear" which helped hold the drain bags up when walking---otherwise that would have gotten annoying very quickly. Additionally, the swelling was quite extensive and that made the "waddling" even more pronounced.
      On Day 3 the drains were removed without much fuss and almost no pain. With those gone mobility was greatly increased. It was also possible to take a shower without the drains getting in the way. The recommendation was to continue ambulating as much as possible to gather strength. HRT could also be resumed if the surgeon gave the OK.
      It is normal to get bruising around the groin area, however I ended up getting extensive bruising. I was informed that the more you spend on your feet (especially with walking) the more the bruising will migrate from the surgery site downward towards your knees. The bruising didn't hurt; it was just unsightly. OK, very unsightly.
      Another issue was the catheter tube kept bumping against the clitoris. Depending on your surgeon you may or may not have sensation there. I can tell you that area is hyper sensitive and that I was getting very tired of the shocks and jolts I'd get every time something brushed up against it. My doctor gave a hint: cover it with Bacitracin. That not only provides a small barrier against friction but also helps to promote healing.
      Day 4 and Day 5 brought no significant changes. The recommendation is to continue walking around and trying to get stronger. By now your digestive system should be pretty settled, although I always had this "full" feeling probably because of the packing pushing up against the interior organs. Speaking of digestive systems, I had a general plan to get my stomach back to feeling normal:

Day 1: Liquids, small meals, Ensure
Day 2: Breads, salads
Day 3: Meats, veggies
Day 4: Bulky stuff, milk, yogurt
Day 5: Normal diet

The idea here was that initially there would be a lot of gas so liquids would easily move through and fill in the gaps. I had extra Ensure and that is good for supplying needed vitamins and minerals. As the days continued I added more and more bulk, working up to meats and dairy products. All along I was also taking acidophilus tablets to help restore the bacteria balance. (The advice of the nursing staff was to continue acidophilus for about 5 days after the last antibiotic has been taken.) Yogurt also helps restore the bacteria balance. In addition I was required to take colace to soften the stools.
      One unpleasant thing I found was that after getting substantial bowel movements I was experiencing a bit of tearing near the perineum (where the labia join at the bottom, very close to the anus). This was causing a little bleeding that was more unsettling than painful. I checked with the nursing staff as well as the surgeon's office and they said that this was normal. In general, a small bit of bleeding is normal since the groin has suffered so much trauma. However, excessive or constant bleeding is abnormal and should be reported immediately.
      The arrival of Day 6 brought the removal of the packing and the beginning of dilation. First the sutures were cut and the obvious dangling parts cut. (The remaining sutures were left in place as they will dissolve over the coming weeks.) The packing was retrieved using a pair of long forceps---this part didn't hurt but was just the absolute weirdest feeling! However, the catheter remained.
      The nurse who brought the dilation equipment (see right) did a test run with the #1 dilator which is about 1" in diameter. She then asked me to do it. Application of the lubricant (Surgilube) was done quite liberally on the dilator prior to insertion. This causes quite a mess as the lubricant tends to get scraped off on entry---I've since found a less messy way to pre-lube the vagina. When inserting the dilator I was instructed to turn the tip side-to-side slightly to aid getting past the PC muscle (puboccocceygeus muscle) and below the symphasis pubis. Once inside it is a good idea to continue side-to-side turning and also making circles with the dilator handle to help widen the vaginal entrance.
      In terms of keeping the area clean and disinfected for the first couple of weeks the surgeon wanted daily douching, a thin layer of Bacitracin applied to the clitoris/labia/perineum, and using a sitz bottle after bowel movements. After that I was instructed to stop this cleansing routine to help develop a natural bacterial "flora" in the neo-vagina---it should be pretty much self-cleansing like a GG's vagina. Occassionally douching or using a diluted white vinegar solution may be done to correct any bad odors, but the advice was not to do it too much.
      Finally, on Day 8, the catheter was finally removed. Immediately after removal I was instructed to go to urinate as soon as I could and it didn't matter where---bed, bathroom, shower, toilet. The important thing was that I needed to. Following advice of other friends I immediately began drinking a lot of liquid and within minutes I was able to. There was a bit of colored discharge but I was able to get urine out. Had there been too much swelling they might have had to recatheterize me---the surgeon says they'll reinsert the catheter and let you remove it a few days hence. The last advice they gave me was that urinating often helps keep the urethra open.
      I left the hospital on Day 9 and stayed in a hotel for the next couple of days. Walking really helped with the swelling and, in fact, I was able to squeeze into my normal clothes by the time I left---your mileage may vary. Spending time in the hotel helped to make sure I could manage the maintenance routine on my own. It was also good that we didn't have to rush from the hospital to the airport on the very same day.
      I got the patient cost summary from the hospital a little bit later. What's interesting is that out of my $17K for my surgery $11K went to hospital care alone. Yes, that's right. And of the $11K hospital fees, $3K went to "ambulatory surgical care" and $8K to "recovery room". Amazing.

As of July 26 (almost 3 weeks post op, 2 weeks after packing-out), walking has helped redocue the appearance of bruising, swelling continues to subside, and the sutures are at the point of really dissolving now. The labia, while still quite swollen, is beginning to soften and take shape. The perineum still looks quite raw. The clitoris has started to "float" as it hasn't quite adhered to the skin surrounding it---that seems to be causing a bit of spotting and additional discharge. Dilation is continually getting easier with the #2 (about 1.25" in diameter) becoming looser. If that gets loose enough by week's end I might consider moving up to the #3.

By August 4 we've already had a post-op physical examination by one of my doctors. She noted the perineum has indeed split but that was probably unavoidable. She used some silver nitrate to help promote healing of some granular tissue that was forming there. In other news, stitches continue to dissolve by themselves and passing the #3 is getting easier.

On August 10 the #4 dilator (1 3/8" diameter) was successfully passed in to about the 3rd to last dot but not without great difficulty. The circumfrential motions with the #3 really have helped.

A mini victory today. I got the #5 in, but with much effort. This was much harder than the #4. I think it's more a case of the limits of the PC muscle stretching.

Attempting to try dilation 1x/day on October 15. So far so good for the past two days. Depth still maintained and apparently also less bruising from repeated dilation. Also found out the "electricity" works today as well. Very well.

More reports will follow in the coming months/years.

The medication schedule

This medication schedule is very particular to Dr. Toby Meltzer's dosage administration when I went through vaginoplasty in July of 2004. This is mainly for my convenience, but you may also find it helpful. Please consult with your surgeon and staff to make sure you know what your current medicine administration schedule is like!

I found that the medication schedule was just really really confusing because there are so many medications to take and at different times. So this is a chart which I made to sort of detail what is needed and when, starting the day of surgery. Of course, this was very particular to my situation---those who are going through SRS in '04 with Dr. Meltzer may be able to make use of this!
      First, a listing of the medication you'll need. Be sure to follow all doctor instructions and labels on the medication:

Acidophilus. Digestive bacteria.
Taken with meals 2x/day. Stop 5 days after last antibiotic (doxycycline) as the antibiotics may negate the acidophilus.
Arnica Montana. Homeopathic remedy for bruising and muscle soreness.
Suggested using Boiron pellet dispensers. Dissolve in mouth 4 pellets 4x/day, starting the day before surgery, continue until about 1 week after release from hospital (or until bottle empty).
Bacitracin. Topical antibacterial.
For internal use: put a light coating on tip of dilator, apply 1x/day on last dilation, stop 4 weeks from packing out. For external use: put a light coating on clitoris, labia, and especially the perineum, applied 2x/day, stopping 2 weeks from packing out.
Celebrex. Muscle aches, swelling, and cramps.
Taken with meals. 2 capsules (400mg) the morning of surgery, 1 capsule/day (200mg) after release from hospital for 1 week.
Colace. Stool softener.
Taken with meals, 3x/day, stop 2 weeks after release.
Doxycycline hyclate. Antibiotic, especially for urinary infections.
Taken with meals, 2x/day, stop 5 days after release.
Keflex/Cephalexin. Antibiotic.
Taken with meals, 2x/day while in hospital.

And this is the schedule. Note that the date has blanks so you can fill in the actual dates (e.g. 7/24):

time date medication notes

(in days) Acidophilus
3x/day Arnica
5x/day Bacitracin
2x/day Celebrex
1x/day Colace
2x/day Doxycycline
2x/day Keflex
3x/day

Out In

-1 __ / __

0 __ / __ Surgery

week 1

1 __ / __ Bed rest

2 __ / __ Catheter capped

3 __ / __ Drains out

4 __ / __

5 __ / __ Packing out (maybe)

6 __ / __ Packing out

7 __ / __

week 2

8 __ / __ Catheter out

9 __ / __ Release from hospital

10 __ / __

11 __ / __

12 __ / __

13 __ / __

14 __ / __

week 3

15 __ / __

16 __ / __

17 __ / __

18 __ / __

19 __ / __

20 __ / __

21 __ / __

week 4

22 __ / __

23 __ / __

24 __ / __

25 __ / __

26 __ / __

27 __ / __

28 __ / __

week 5

29 __ / __

30 __ / __

31 __ / __

32 __ / __

33 __ / __

34 __ / __

35 __ / __

You can download this schedule to print it separately.

The joys of dilation

I say "joys" will the sarcasm in the world. Dilation just plain sucks. I don't know how else you can describe it. You are trying to stretch and force open a part of your body that was not originally designed to do these things. So, your body will be trying to close up and reclaim all that space that your surgeon just created. I found the following useful:

Always keep your equipment clean. Be diligent about cleaning your dilators and any other equipment you use because it helps reduce bacteria and thus reduce infections. Plus it's just less nasty.
Pre-lube. Rather than pour lube on the dilator (which ends up getting scraped off on entry anyways), I always "pre-lube". I put small pea-sized drops of lube on a finger and insert that finger into the neo-vagina. Maybe 2 or 3 more pea-sized drops seems to be all I need to be able to comfortably slide my finger in and lubricate the interior walls. It also gives me a chance to try to work open the vagina to make insertation easier. And on the dilator I just use enough lube to make the first 1/3 of the dilator pretty slick---a very thin coating. I've found this really saves a me from having a bunch of lube getting scraped off and running everywhere. Occassionally the dilator won't slide in very smoothly. In this case I use a couple more pea-sized drops of lube into the vagina then working the dilator in/out it usually picks up the new lube and slides in pretty easy.
Less is more. Honestly, I found dilating more than 3 times a day to be just a mega-chore. I hated having to interrupt my daily plans just to dilate, plus I was getting sore. So I started switching to a less frequent schedule even while I was still in the hospital. So instead of more frequency I just went fewer sessions but longer sessions---minimum 45 minutes.
Dilate longer than you have to. Instead of the recommended 15 minutes I go 45 minutes to an hour. Besides, it gives you plenty of time to read a book or something.
Let your body tell you when to dilate. Obviously you need to dilate as often as you can afford to, especially in the earlier stages. As I stated, too frequent dilations were making me sore. What I started doing was understanding when my body felt like it had recovered from the last dilation session---when things didn't throb and when they relaxed a little. That was a sign I could go at it again.
Use 3 paper towels between you and a towel when dilating. I've found that when I dilate I end up making a total mess. Even though I use a towel or a baby changing pad, it works out better if you take 3 paper towel squares and put them on top of the towel or changing pad. Also when you finish dilation those towels can be used for cleaning the dilators.
Use baby changing pads. Makes an excellent almost-waterproof barrier between you and whatever you're sitting on.
Work the dilator; when loose move up. Instead of leaving the dilator in one position all the time I moved it around a lot. Since the idea of dilating is to stretch the skin I did a lot of moving side-to-side and circular motions as well as spinning the dilator. At first it is always difficult because the skin is tight. But after a few days the skin gets a little looser and it's possible to begin rotating it. Also doing repeated insertation/removal helped get my muscles used to having to part to accept the dilator.
Resting after dilation. After a dilation session I would remove the dilator and just sit for a while to regain my composure. It felt better as well as lessen the stress from dilation.

Other post-operative maintenance

Dilation isn't the only thing to take care of:

Estrogen/estradiol cream on your labia. Some people believe that applying estrogen/estradiol creams to your labia post-op help with the softening and pinkening of the labia as well as just generally increasing the blood flow. I've been advised to begin this treatment after about 8 weeks post-op.
Leaving self-dissolving sutures in. They really do dissolve. According to my doctor's office they recommend leaving them in there for as long as possible, even months after the surgery. If the strings start dangling out in the open then cutting them close to the skin is advisable.
Additional genital electrolysis. If you are doing a 2-step procedure then between steps 1 and 2 you might require additional clearing around the clitoris and labia majora. I've been told about 1" radius around the clitoris is good. Also, I was advised not to start electro until you've healed quite well---maybe 3 months post-op.
Walking is a good thing! It helps circulate blood, stimulate your senses, and regain your strength. Of course, consult with your doctor as to how much activity is appropriate for you. The down side of moving around is that you may have extensive bruising as the pooled blood/fluids travel down your legs. But don't worry, it's a good thing.
Eat lots and lots of fruits and veggies. As disgusting as it sounds you'll thank me later. Even if you're a meat and potatoes kind of person be sure to eat a lot of fruits and vegetables---or anything with high fiber content. They help soften your stools tremendously.
Watch the spicy foods. If you love spices, curries, and other things that "kick it up a notch" then you might want to hold off on them for a while. Not that you should suffer the blandness of hospital food, but that you may be very sensitive "down there" and spices are the last thing you need to irritate an already irritated area.
Drink a lot of liquids. This is just a good idea in general as well. Going to the restroom often does a number of great things: removes toxins from your body, helps stimulate your digestive system, urine flow helps dilate your urethra.
Don't be afraid to ask for help. This is major surgery so if you need help lifting things, picking things up, and opening doors then don't be shy! You'll be back doing all the normal things soon enough.
Take naps whenever you are tired. Your body is recovering so listen to it! If it says "I need a nap", yield to it. Then again, also try to walk around a bit too.

Back at work

Here's some prep that you might want to do for work:

Bring an extra change of clothes. I've had "accidents" where on douching days water gets trapped "up there" and sometime a few hours later it decides to release. If you keep an extra pair of underwear, hose, and maybe some jeans in the car it would help give you an "emergency repair kit".
Store extra pantiliners/maxis in your desk. You're still going to want to change these once in a while, especially during those first few months of recovery. Rather than overload your purse with them why not keep a few in your drawer?

Part 2: Labiaplasty

February 2005
S	M	T	W	T	F	S
27 Last dilation	28 Surgery

March 2005
S	M	T	W	T	F	S
		1 Release	2 Fly back	3	4	5 Resume dilations
6	7 Back to work	8	9	10	11	12
13	14	15	16	17 Stop mons compression	18	19

Photos before labiaplasty---about 7.5 months after SRS.

Day 1. Really ugly and swollen. Compression bandages on.

A series of "clean" photos about 4 months post-op.

Since I elected to go with a two-step procedure, labiaplasty is the completion of SRS. Some people like the one-step, but I'm of the opinion it's really hard to get things right in a single go when you're rearranging so many things. I'm not saying that you can't get a good result from a one-step, rather I just think the incidence of revisions is pretty high. It turns out in my case that I probably made the right decision because there are a number of things that need adjusting.
In planning the labiaplasty I wanted a few months in between the two to heal up more. I think it's a good idea to let your body come back together and let the swelling subside. As you can see from the photos the incisions healed up pretty nicely and the bruising is gone. Still, the mons pubis is oddly puffy and the clitoris protrudes a bit too much. (Not to mention the fact that my urine stream is going in weird directions and is a bit tight.) Dr. Meltzer said during labiaplasty he'll be looking to fix these things.
The general itinerary we're following for this one is much simpler:

Day -9: Arrive a while beforehand, mainly to be around Kara but also just to settle down and get all prescriptions filled.
Day 0: Prepare in the morning with a triple-analgesic cream compounded at a pharmacy. Surgery in the afternoon. Stay overnight in hospital.
Day 1: Move from hospital to hotel room.
Day 2: Return home.

Also, the updated packing list is similar but had much more room dedicated to 2 weeks of clothing changes.

The procedures being performed for this labiaplasty include a number of corrections as well:

Clitoris repositioning. Dr. Meltzer felt it protruded too much so he wanted to move it in a bit.
Urethra revision. I noted that I was having a little problem with urinating so he enlarged/moved/fixed the urethra to make it easier as well as changing the aiming direction.
Perineal muscle relaxing. Getting the larger dilators in has been a challenge so he wanted to try to relax some of the muscles in the area near the perineum.
Mons pubis liposuction. My mons has been very inflated since SRS, possibly more than usual. So Dr. Meltzer wanted to ultrasonic lipo the area. I now have a compression bandage on and he suggested using control-top pantyhose to help flatten the area.
Clitoral hooding. This is part of the normal labiaplasty procedure to draw the skin over the clitoris.
Labia minora and labia majora definition. This is part of the normal labiaplasty procedure that attempts to create a sort of labia minora and thin out the labia majora.

The first day following labiaplasty was rather painful. I think during vaginoplasty the nerves are in total shock and so I had no problems dealing with pain. However, since we're now working on the surface tissues disturbing the reconnected nerves it gets annoying really quickly. The hospital gave me some Percocet tablets in the morning and that really put me in a happy state. Wheee!!

      I was so tired from the previous few days of no sleep that I must have slept through all the way from the previos day until about 6:00a. A rapid succession of events kept me from getting any more sleep until I left the hospital around 1:00p. I did a few things then crashed out on the beds. I think I woke up a couple of times to go get things to eat and talk on the phone, but I was pretty out of it. A single Vicodin really put me to sleep.
      Day 2 was a lazy morning of waking up, taking a long shower, and trying to cram all my belongings into my bags. Fortunately everything seems to have worked out because I have enough room for it all. After a rushed lunch with Kara and another friend I was off to the airport.
      Sitting on the plane was quite uncomfy as was dinner. When I finally got home I took a much needed shower (and also had a refreshing bowel movement at last!). Then I decided to take pictures. HOLY CRAP. It is absolutely the grossest thing I have ever seen. Gross enough that I refuse to put up any of the pictures---yes, worse than Day 1. What's worse is that according to the post-op instructions I'm to rub the sites with bacitracin twice daily. I can tell you that once is already enough. *shiver*
      The swelling was starting to subside a little and a wonderful array of colors showed up on Day 4. The mons turned an odd shade of yellow-green, the labia contrasting with reds and purples with a fringe of white along the edges. Apparently this is normal. Ugly, but normal.
      Dilation on Day 6 was difficult at best. I've been using the 2-Taper dilator to open and align the vaginal opening under the labia. I'm hoping the stiches at the perineum are going to hold; I'm purposely not stepping back up to larger sizes during these first few weeks. I know that it may result in some loss in diameter, but I'm hoping to maintain depth. The most important thing right now is to make sure the raw sensitive labia edges heal up. I can stretch and stress the skin later.
      Fast forward a few more weeks and by Day 24 the scars are pretty solid, the excessive oozing has tapered off, and dilation is a little easier. Things smell a bit weird down there, but I'm going to say that it's probably related to the aloe vera gel I'm using and not some sort of infection. Changing pantiliners very often seems to help mitigate this. The biggest victory came a few days ago where I tried on an old pair of jeans ... and they fit! Holy cow, I actually was able to get back into normal clothes!
      OK, I'm getting tired of being a host for bacteria. According to my doctor today I have a combination of bacterial infections which need to be treated with Terazol 7 and Cipro. Despite the abnormality of this, she is pretty confident that the end outcome should be decent. I'm debating whether or not to post pictures of this, but we'll see.
      After a very prolonged period I finally seemed to get the upper hand on the infections. It wasn't easy but after about 3 weeks of treatment things cleared up sufficiently for my body to fight back. The remainder of the stitches seemed to fall out in May---finally. And by June 2005 I had gone swimming once without incident.

The medication schedule

Once again, this medication schedule is very particular to Dr. Toby Meltzer's dosage administration when I went through labiaplasty in February of 2005. This is mainly for my convenience, but you may also find it helpful. Please consult with your surgeon and staff to make sure you know what your current medicine administration schedule is like!

time date medication notes

(in days) Acidophilus
3x/day Arnica
5x/day Bacitracin
2x/day Colace
2x/day Keflex
3x/day

-1 __ / __

0 __ / __ Surgery

week 1

1 __ / __ Release from hospital

2 __ / __ Additional overnight stay

3 __ / __

4 __ / __

5 __ / __ Resuming dilations.

6 __ / __

7 __ / __

week 2

8 __ / __

9 __ / __

10 __ / __

11 __ / __

12 __ / __

13 __ / __

14 __ / __

You can download this schedule to print it separately.