I had GCS with Dr. Stiller two-months ago and thought I would share my experience. There is some slightly NSFW/TMI content FYI.

The Tl;dr bits:

Acquired Letters - April 2020 Renewed Letters - November 2020 Sent to Dr Stiller - November 2020 Consult - January 2021 Pre-Op - August 26th 2021 Bottom - August 27th 2021 Top - September 3rd 2021

What I did:

Zero-depth vaginoplasty. Breast Augmentation with 450cc silicone implants over the muscle.

With who:

Dr. Stiller in Spokane, WA @ Deaconess Hospital - Bottom Surgery Whitman Hospital - Top Surgery

Surgical Timeline: GCS pre-op August 26th Bottom-surgery August 27th Top surgery September 3rd Flew home September 13th.

Complications: Small amount of (very very painful) wound separation at the bottom end of the vulva. (Not unexpected and fairly common per Dr. Stiller and Riley)

UTI (also not uncommon) the abx however kicked off a very uncomfortable yeast-infection.

On aesthetics:

Outer labia are symmetrical. Vulva felt like it was too far up in my groin at first, but this was mostly due to swelling. As swelling has gone down the position of the vulva looks more natural.

Another impact of swelling is that the bottom of my vulva is still quite swollen while my labia have been healing much more quickly. For a ~three week period there was this awkward gap where the swelling in the vulva was pushing the labia apart and left a weird space between the lips. This has mostly improved, but there is a still a gap near the top.

The inner labia are symmetrical to each other, however the left inner labia is just barely a ridge visible in my vulva. The right is more prominent, but not enough that it can be seen without spreading the outer labia. Based on the results others have posted it seems like inner labia are a bit to tricky to figure out for many surgeons.

On pain:

Bottom pain: During the first few days following surgery most of the pain is positional with a lot of pain from glue and tape pinching and pulling at your skin. Once the compression garment and various tubes came out there was urethra pain and generalized pain around the site for a couple days that was really uncomfortable on the first day; but improved quickly over the next few days.

Once the wound separation occurred the pain became much more localized and intense with random other aches in different spots.

From day one there is occasional “electric shock” sensations that will randomly occur anywhere within the surgical site. This is from the nerve damage to the site.

Otherwise, at almost 8 weeks things are sore, but not outright painful. Each day is a little better than the last.

Top: The pain here is mostly from skin stretching and the compression bra. Most pain resolved once the compression bra was removed and I could wear a normal sports-bra. Breakthrough pain is well managed with an ice pack, quick massage, and often a positional change. At 7-weeks the pain is almost non-existent. Some tenderness in the mornings when I first wake up.

On functionality:

Urination. This has been fairly straight forward from day one. I have had a UTI (as another local trans woman said to me, “only the one?” So I am expecting more) and the antibiotics from that kicked off a yeast infection which wasn’t great either. There are still some days where I get slightly inflamed and it makes my urine stream spray, but overall it’s getting better.

Sex. Since I had “zero-depth” surgery I do not have a vagina. Instead a “vaginal pocket” was created. This serves as the opening to a future vagina when I have the second stage colon vaginoplasty. I have inserted vibrators into the pocket, but the sensation is minor at best, they seem to mostly stimulate the prostate.

The primary sexual stimulation comes from the clitoris and the nerve bundle running to it. At about two weeks I was able to gently stimulate this area, but was far from orgasm. Too much touch and vibration also aggravated my healing nerves. At about seven-weeks I started exploring more in the shower and soon after had my first orgasm by gently, yet vigorously, rubbing my vulva and simultaneously fingering my clitoris.

During orgasm I still ejaculate (see questions towards the end of this post). I also get wet when I am aroused, around the clitoris and vaginal opening. The orgasm I experience is also now much more full-body and rewarding.

On packing for surgery:

I got a list with my surgery packet from Dr. Stiller of things to bring, but here are some items I didn’t bring and ended up buying that could be worthwhile to bring or at least purchase in advance.

Ice packs: get like 5 or 6 of the kind that are blue and have the canvas feeling outer shell. They are flexible and can put just about anywhere. Your wounds will thank you.

Headphones: A good pair of headphones kept me sane through some of the worst pain. I brought these with me, but I really feel I need to reiterate how important these were for me.

Pillows: can’t have too many of these. Especially one for your lower-back and under the knees. You will spend a lot of time laying in bed.

Entertainment: I brought my iPhone, iPad, and Switch. The best form of distraction was the Netflix account and HBO. I watched a ton of Friends, New Girl, and Arrested Development to see me through this time. While I wanted to game, and did at times, sometimes the pain is too distracting even from gaming. Watching TV is low effort.

Gauze: gauze pads of varying size to pack in the vulva to keep wounds dry. I ended up getting 3x3 pads that worked the best. Band-Aid sells a box of like 50. Given how many you will probably go through you might 2 or 3 boxes worth if you need to keep your vulva packed.

A nice pair of slip on shoes. Trying to tie anything isn’t worth it. Get the slip ons.

Loose fitting clothing. They mention this one, but it is really important and I want to reiterate it. The bandages and dressing make wearing your normal clothes uncomfortable so having something loose you can just slip on is wonderful.

A small battery operated fan. Something that is 6” in diameter or less. I used this for placing between my legs to keep everything cool and dry. It also helped me to more quickly air dry after showers.

I got my initial surgery letter from my therapist and my second letter from a psychologist. My therapist specializes in trans patients so she was able to very quickly print me a letter. The psychologist had never worked with a trans patient before so he was apprehensive about providing the letter, I let him know if he wasn’t comfortable that was okay and I would look for someone else. He reached out to my therapist though and she helped give him some guidance on what was needed and he ended up writing the letter. The final letter of referral came from my doctor.

On November 12th I sent my first inquiry out to Stiller Aesthetics inquiring about bottom surgery. Dr. Stillers office responded fairly promptly to my email inquiry and I let them know I was interested in vaginoplasty and asked if they were still performing that surgery at this time (due to COVID) and I received a response that they were and let me know that they would need a referral letter to get me started. The next day I scanned and emailed the referral letters from my doctor, therapist, and psychologist.

I received a call from Dr. Stiller’s office December 1st about scheduling a consultation visit in-person since I live in Alaska and Dr. Stiller is not licensed in Alaska. The date was set for January 25th.

I flew to Spokane with my wife January 22nd and on the 25th of January I went to my consultation appointment alone as COVID precautions meant my wife was unable to come with me. I met with Dr. Stiller and we “bumped elbows” as has become the norm under COVID. I found him to be very attentive and easily describable as “the nicest person I have ever met”. Seriously, he was very pleasant, as were all his office staff.

At the consult Dr. Stiller asked me the usual questions I had been accustomed to by the medical community, “how long have you known you were trans?”, “what are your transition goals?”, “married?”, “kids?”, etc…

After we discussed my personal history and long-term goals he asked me what I wanted to do for surgery. I feel like it’s important to say that was all he asked me. He didn’t explain any of the surgeries he does or how he does them; he simply let me explain what I wanted and did so without interruption or correction. I explained that I was interested in a minimal depth vaginoplasty at this time as I didn’t foresee a future where I would be having penetrative sex.

He nodded and said that would be a good choice if I didn’t want to dilate. Which I didn’t, so I nodded along with him. He said I could always do colon or PPT later on if I wanted more depth. He does not do PPT, but was pointing it out as a future option.

He asked if I wanted to do hair removal, but I explained to him that it was difficult to access reliable hair removal where I am from and he waved his arm at me and said “then don’t worry about it”. He had me change into a gown at this point and inspected my genital region, took some measurements, and then left the room instructing me to change back into my street clothes so that we could move into the breast augmentation part of the consult.

He asked me what research I had done about breast augmentation and I explained that I had done very little and had only set the consult because his office-staff member who called asked me if I was interested in it. He nodded, seemingly accepting that answer and I further told him that I had no preferences and would accept his recommendation. He recommended silicone implants over the muscle.

He gave my hoodie a look and a slight-frown and asked if I had brought t-shirt or tank-top. I apologized as I wasn’t aware I needed one. He waved me off again and asked his assistant in the room to grab one of his spare scrub-tops and I wore that instead for the next part of the process.

He had me put on a compression bra and would put various implants under the bra and then have me stand in front of a mirror and see how I liked them. On my third set of implants, slightly larger diameter 450cc implants, he said that he felt these looked the best on me.

Looking in the mirror I agreed (and almost cried at how they made my chest look and even gave the illusion of me actually having a waist). We briefly discussed the lifetime care requirements and durability of silicone implants, nothing I hadn’t already heard before.

Before we finished up Dr. Stiller let me know the timeline for surgery was currently a few months out but that they would get started on the insurance authorization which could take 8-to-10 weeks. Once that approval went through someone from his office would be in touch to get me scheduled. With that the consult was over and I left Spokane (though not before getting my ears and nose pierced at a local tattoo parlor).

On March 17th I received an email from Dr. Stiller’s office letting me know that the insurance authorization has been received and that I was ready to get surgery scheduled. After some back-and-forth lasting about a day we set the date for bottom surgery for August 27th. Top surgery would follow a week later on September 3rd.

My wife and I flew to Spokane August 25th and due to Shenanigans from the airline only barely made it in. On the morning of August 26th I had my pre-surgical consult with Dr. Stiller’s PA, Riley. She was very pleasant and we briefly discussed the surgery that would be performed. I told her that due to the letters I had received from insurance I wasn’t actually sure of which surgery was going to be performed, and was especially confused when she started talking about dilating.

I told her about the consult I had with Dr. Stiller and she asked me if I had any hair removal done and I told her “no” as he had made it fairly clear (I thought) to not worry about it. She made a face that seemed to suggest I had just thrown off plans somewhere, “Well, we will have to do a zero-depth if you haven’t done hair removal” she told me. Which is what I thought the plan was anyways, but there must have been a mix-up somewhere.

She told me all about the risk of getting hair in the vaginal canal, etc… which felt moot since I thought we were not doing it anyways. She talked about doing a colon-vaginoplasty later to add depth. My wife and I looked at each other and nodded in agreement, that seemed more than fine by us.

We left the appointment and I had a slight feeling of apprehension over the discussion as I felt a little annoyed and worried that what got discussed in one consult didn’t seem to translate to this consult.

We had been directed by Riley to head across the street to the Deaconess surgery center to pre-register and do a pre-surgical blood draw. That took about an hour and then we went to Target afterwords to get the rest of our supplies for the coming days.

That night I did my first enema (almost didn’t need it due to all the nervous diarrhea I had been having) and hibiclens shower.

The morning of the 27th my wife and I woke up about 4:30AM for my final Fleet Enema (really didn’t need this one) and hibiclens shower.

We proceeded to Deaconess Hospital arriving just about 5:45 AM. Entering the building we went to registration and got checked in before heading up to surgery. We waited in the same-day surgery waiting room for about 15 minutes before a nurse came and got us and took us to another room to get prepared.

The nurse had me remove my street clothes and bag them up. She gave me several packs of sanitizing wipes and I wiped off my arms, chest, back, and legs. My genital region did not get wiped down.

I changed into a gown and a fresh face mask. A different nurse came in and asked a large number of questions, gave me a ton of different pills to take and also instructed me to take the Omeprazole I had brought.

The IV nurse came in next and I told her about my previous struggles with getting an IV started and so she placed it in the back of my hand. My wife stepped out for this part as she doesn’t like needles. The IV nurse told me that the anesthesiologist would be along shortly to go over that and give me something for anxiety.

Dr. Stiller came in and we briefly talked about the procedure, what to expect, and most important; I can poop if need be post-surgery, he recommended stool-softeners. The anesthesiologist still hadn’t come by the time he was done with his portion and he stepped out to ask one of the nurses where anesthesia was. While he stepped out the anesthesiologist finally showed up.

The anesthesiologist and I went over my possible malignant hyperthermia. As a precaution he told me that he wouldn’t use the gas or succinylcholine as that can set MH off and instead he would do IV only. The OR nurse came and introduced herself during this time as well. The anesthesiologist had me sign a variety of forms and then we were off.

I was very nervous and he chatted with me as he pushed my bed along the way and we joked that they needed beds that moved themselves as he huffed and puffed pushing me along and simultaneously trying to make a phone call.

I have had surgeries before in smaller hospitals. This hospital is huge in comparison to the hospital back home and it took what felt like ten-minutes to push my through various corridors and finally through a door marked “MRSA precautions” and into the OR.

In the OR the OR Nurse took over and lined my bed up with the operating table. She had me move to the operating table and sit and dangle my legs over the edge. The anesthesiologist started a round of Valium in my IV and I felt it almost immediately, my mood changed from anxious to giggly within seconds.

With my legs still dangling over the edge of the table the OR nurse told me to give her a big hug and arch my back as much as possible so that the anesthesiologist could start an epidural.

The anesthesiologist had some trouble getting the epidural started because he couldn’t find any spinal fluid. The anesthesiologist was very insistent I tell him if it hurt but it didn’t hurt very badly and so I got “props” from him and the OR nurse for “handling it like a pro.”

Once the epidural was completed my legs went warm and tingling. Before it totally kicked in they had me lay on the operating table and put my arms out. That’s the last thing I remember and I woke up in the recovery room.

The nurse brought me some oxycodone and apple sauce once she noticed I was awake. At some point she asked me if I felt I was ready to go home and I said I was getting there and asked where my wife was. They moved me to another room and had me transition from the bed to a chair (which stung at first, but wasn’t super painful). A different nurse brought my wife in to see me.

I sat in the chair about an an hour and a half with my wife next to me. A different nurse came and showed my wife how to clear the two drains and empty the catheter bag. After another 30 minutes or so we we’re finally released to leave. It was about 2:45 in the afternoon. I was glad to leave, the drugs were wearing off and that chair was starting to hurt.

There is a pharmacy located downstairs in the surgery center, but for some reason my wife and I declined to have prescriptions sent there and opted for a Fred Meyer about 10 minutes away. I waited in the car while my wife ran in. She came out a few minutes later to tell me it would be an hour and we debated dropping me off at our AirBnb while the pharmacy got all my meds together. Luckily it didn’t come to that and I got a text a few minutes later saying that my meds were ready.

I was given: Tylenol, Ibuprofen, an antibiotic, oxycodone, gabapentin, and Zofran. I was bummed out about the Tylenol and Ibuprofen; we had stocked up on them at target not realizing they would be prescribed. But honestly it was like $15 so it wasn’t the end of the world.

Getting back to the Airbnb my wife helped me onto the couch and I quickly fell asleep. Overall my pain level at this point was maybe a 3 out of 10. There was discomfort but no serious pain.

For the most part home recovery went smoothly for the first day. As the surgical anesthesia wore off my pain level increased until our pain management schedule caught up and brought it back under control. I didn’t sleep much that first night and ended up watching Cloudy with a Chance of Meatballs 1 and 2, plus some other shows on Netflix.

The next morning my wife helped me to get dressed so we could go to Dr. Stillers office to meet with Riley. I decided to wear a dress as that would be easiest to maneuver with a catheter in and instead of changing to the leg bag. I just stuck the catheter bag into a tote bag I had lying around and headed out the door.

We got to Dr. Stillers office and they were doing some sort of photo shoot so I ended up waiting in the hallway for a bit longer than I wanted. Eventually though someone came and got me and brought us back to a room.

Riley, checked over my bandages and drains, asked if we had any questions, and then escorted us out. All told we were only in the office for about 10 minutes. And out of the house for about 40 minutes. The roads in Spokane aren’t super well maintained and I felt every bump and bounce going back home.

By the time we reached home I was almost crying in pain and I immediately took an Oxycodone and laid down. The remainder of Day 2 was spent counting down until my next Oxy and then sleeping. I was able to get a full nights sleep however.

Day 3 was also spent in pain. I got strange sensations of specific parts of my penis hurting, such as the glans, the base, the urethra. Even though those parts were in different spots than where my brain thought they were. I was mostly miserable and playing my Switch was difficult as I left my Pro controller at home. Thankfully my wife ran out and grabbed another from Target. During one of my more lucid moments she helped me to get the Switch hooked up to the TV so I could play it on the big screen.

Day 4 I called Dr. Stillers office first thing in the morning advising that I was still experiencing significant pain. I was asked if I was taking my pills including narcotics and using ice packs. Yes I answered. I was told they would get back to me. Several hours later I received a call from the same person I spoke to earlier who said she checked with the Dr and he said that there wasn’t anything more to be done and I would just have to go through it.

Feeling somewhat rejected and cast-off by this answer I spent the next few hours in a deep depression and gritting my teeth through the pain. I was finally able to have a small nap somewhere around 6PM and when I woke up I felt somewhat better, though still off-put by the seeming lack of support from Stiller’s office.

Day 5 was better, however the tape securing many of the bandages in place began to tug and pull at my skin and rogue hairs and was quite painful. I had decided to also start tapering off the opioids so as to preserve their effectiveness for the next surgery I was coming up on. I was mostly unable to sleep without the aid of the opioids, finally falling asleep somewhere around 4AM.

Day 6 it was clear I was ready for the bandages to come off. Everything was pulling and irritated. I was done. Three rounds of opioids did nothing except knock me out for small naps.

Day 7 arrived and I finally had my appointment to remove everything. Getting the tape removed was the worst, especially from between my thighs and around my lower belly. It tugged and pulled at everything. Then came the drains, which I hardly felt. Last came the catheter. A short moment of deflation and then a quick tug that burnt like a mother-fucker. Riley said it would probably feel like I was peeing for a bit afterwords.

“You are right,” I laughed, “it does feel like I am peeing.”

She told me that there was actually a small amount of blood coming out and that was to be expected. I watched her throw away an extremely bloody piece of gauze and I could feel the panic welling up.

“What have I gotten myself into” I was starting to think for, surprisingly, the first time on this trip. I am a professional worrier and it was starting to kick-in.

After she got everything cleaned up Riley handed me a mirror and showed me my new vulva. Shit was looking rough. With the compression bandage off the swelling was already kicking in and it looked like a bruised, misshapen apple with a comically deep canyon running down the center.

Riley pointed out some minor wound separation on the labia closer to the perineum. I could see two large patches of what looked like pus. She explained that it wasn’t pus, but was actually a cap of white blood cells and protein pushed to the surface as a part of the bodies healing process.

She also showed me the clitoris, urethra, and briefly explained how to masturbate. After that i got dressed and we discussed the top surgery set to take place the next day. Riley assured me that everything was going well so far and that I didn’t need to worry, and so I was able to relax a bit before I left the office.

Later that day I pooped for the first time in a week. No lie I was fairly impressed with myself that I went a whole 7-days. Even with the opioids I wasn’t confident I would make it that long but I did. I was scared at first, but between the low-fat, low-fiber diet my wife had been feeding me and the stool softeners I had been taking daily it wasn’t as big a deal as I was worried it would be.

Prior to leaving Dr. Stiller’s office Riley had explained that I needed to pee within 8 hours or else the catheter might need to go back in. I wasn’t successful in peeing with my BM, so my wife helped me into the shower and I was finally able to pee standing up with the shower running.

Day 8: we got up about 3:30 in the morning so I could shower and get ready for top surgery. We left the Airbnb in Spokane about 4:30. The drive to Colfax that early in the morning was eerie. There was not a single car on the road traveling in the same direction and we only passed the occasional semi-truck on our one-hour and ten-minute journey to Whitman Hospital.

Arriving at Whitman the experience was anything but spooky. The town consists of a single main strip and felt like the perfect embodiment of small-town America. Even the hospital, which seemed quite large for the population, was calm and quiet as we arrived. Our car was the only car in the parking lot.

The check in process was quick and all of the Whitman staff were incredibly friendly and nice. Many of the nurses spoke with high regard for Dr. Stiller and were very familiar with and understanding of the bottom surgery I had just gone through.

The procedure was much the same as bottom surgery. I got undressed, wiped myself down with wipes, got into a gown and climbed into bed. The nurse-anesthetist came in and we discussed malignant hyperthermia precautions. Then she asked if I would like a nerve block in my upper back. She in fact highly recommended it so I said sure.

The nurse told me she was going to give me ketamine and some other psychiatric med so that when she starts digging in my back I won’t hate her. After she was done discussing anesthesia she left and the first nurse came back and hung out with my wife and I while we waited for Dr. Stiller and Riley to arrive. At this point we had been at the hospital since about 6:00AM and it was currently 7:20. As of this point we were still the only people there for surgery.

Dr. Stiller arrived about 20 minutes later and he had me repeat back the surgery we would be doing and then he marked out on my chest and underarms where he would be placing the implants and making incisions. After he left I got back into bed and the nurse anesthetist came and wheeled me back to the OR.

Once in the OR they had me get up on the table and roll on my side. At some point she hit me with the ketamine and I entered the twilight zone for what seemed like years, but was really only a handful of minutes as the second medication kicked in and brought me back to reality. The nurse had me breathe in and out while she worked on getting the nerve block started. Shortly after it was completed they had me lay back flat and I woke up in the recovery room.

Once I was more coherent the nurse brought me back to the room where my wife was waiting. They both had to help me dress as the drugs/nerve block were causing me some serious coordination issues. Finally the nurse wheeled me out to the car and my wife and I took off back to Spokane.

The Whitman experience was easily the better of the two hospitals. The staff were incredibly friendly, the environment was calming and far from the hustle and bustle of Spokane, and the drive though uncomfortable is wonderful for admiring the scenery.

Once back in Spokane the remainder of the day was spent sleeping. The discomfort hadn’t set in yet thanks to the nerve block.

Day 9: Saturday

Overnight the nerve block wore off and the pain I experienced for the whole of the day was a nice cross between “excruciating” and “somebody just shoot me”. Top surgery hurt 1000x worse than bottom. Easily. Especially when I needed to stand up, or if I laid down with my arms in the wrong spot.

Day 10: Sunday

I had been sitting up-right on the couch to sleep and it was starting to hurt my lower back, so I got up to adjust my seating arrangement and I felt it for the first time. The pain of stretched nerves across my breasts. So the day before my upper pain level was “somebody just shoot me”. The hot knife of stretched nerves brought my pain level to something so far beyond that there aren’t words to describe it. I slammed an oxy and ibuprofen together and gently massaged the tender nerves until eventually the pain faded and I was able to fall back asleep.

Day 11: Monday

Again I awoke to nerves on fire. More massaging, ice packs, and Oxy got me through the day.

Day 12: Tuesday

Today was slightly better. My wife helped me get a shower for the first time. Taking off the compression bra was wonderful. The straps had been digging into my underarms around where the incision was and had left marks from how tight the bra was. My new breast felt strange and heavy. The skin stretched so tight over the silicone implant that it felt like touching a rubber ball.

Day 13: Wednesday

I had my follow-up for top surgery and Riley said everything was looking good. She looked at the bottom and told me that I needed to keep packing it with gauze to help keep everything dry and promote healing.

Riley taught me how to massage my breasts and that I would need to massage them five times a day for 6 months and at least once or twice a day for every day after that. This would ensure that my implant stays soft and feels more natural. It would also help to prevent capsular contracture, a painful condition where scar tissue encapsulates the implant. She asked if we could come back for one more visit before we left back to Alaska.

Day 14: Thursday

I hung around the house and slept for the most part. I got a shower later in the day and switched from the compression bra from Stiller to a front closing sports bra that we bought. This was so much more comfortable to sleep in.

Day 15: Friday

My wife was dying to go out and do something, so we went to the movie theater to watch Shang-Chi. The big recliners were so comfortable to lay back in. I almost fell asleep.

Afterwords we went to the mall to do a small amount of shopping. I was able to shuffle along fairly well without too many issues. Getting home later that night though it was fairly clear to me just how out of shape and wounded I was. I hit the couch and passed right out.

Day 16: Saturday

I was still pretty wiped out from the day before. I slept most of the day. Later on we went to a Lane Bryant and Torrid and got some new clothes.

Day 17: Sunday

We went out to lunch one last time. Sitting on hard restaurant chairs for two hours was criminally painful, but good practice for the flight back home the next day. We spent the rest of the day packing and cleaning up our Airbnb.

Day 18: Monday

Flight day.

We started by slowly cleaning the Airbnb and packing up the car. My wife dropped me off at Dr. Stiller’s office while she ran some errands.

Once I was back in the exam room i changed into a robe and waited for Riley. I was instead surprised by the man himself came in followed by Riley and another assistant. “So you are having some healing issues” Dr. Stiller stated, sitting down in front of me.

“I am?” Was my puzzled response. I turned to look at Riley and she nodded.

As it turns out Riley wanted me to come back one last time because she had noticed some wound separation and she wanted Dr. Stiller to look at it. He took a look, told me to cover it with bacitracin, and keep applying gauze. I asked if I was still okay to fly and he said yes. With that he left and so did I.

Right up until our flight home I took Oxy like clock work. Any downtime we had I was sleeping. The short flight from Spokane to Seattle was tolerable, but the flight back to Alaska was hot, cramped, and felt 10 hours longer than it really was.

By the time we finally made it home I was in pain and bleeding slightly. My MiL came and picked us up and took us back home. My cat was thrilled to see us.

Day 19: Tuesday

It was clear that the flight was too much for me. The pain today was nearly unbearable and anytime I moved I felt an uncomfortable pressing on my urethra that gave me the sensation of peeing. The wound was lightly bleeding and I tried my best to angle correctly enough to see where to apply the bacitracin, but don’t think I got it in the right spots.

Day 20: Wednesday

More of the same. I was finally able to hold the mirror and a flash light in the right way to see the wound separation. Holy shit. There was an angry red cut about 1” in length right at the edge of my perineum and heading up the outside of the left labia. I covered it in bacitracin and gauze and tried to not put any pressure on it when sitting or lying down.

Day 21: Thursday

The pain today was about the same as Wednesday. However, the bleeding was worse at first. Then at about 3 or 4 in the afternoon I peed and when I wiped a large piece of granulation tissue came with it and the bleeding slowly decreased from that point forward. Later when I applied bacitracin to my wound, I could see that the tissue came from inside the wound and it didn’t look as red or angry as it had been looking.

Day 22: Friday

The bleeding stopped Thursday night and I am now just dealing with the uncomfortable pain when I sit.

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My daily logs stopped here. Since then the wound separation closed up without issue. I got a UTI which was absolutely awful to go through and it took two weeks of antibiotics and one additional week of recovery to clear it up and get back to normal. Unfortunately the antibiotics kicked off a “raging yeast infection” (my doctors words). So another 6 days of anti-fungal oral meds and applying powder directly to the area.

I have been mostly cleared up for the last week and just now reaching a point where I am starting to feel normal again. Pain still comes and goes, and I had a dissolvable stitch force it’s way out of one of my labia over the course of several days. The labia started swelling up and turning red. I could see the stitch and was able to use tweezers to gently pull it out. The swelling and redness resolved within hours.

My primary care physician and her nurse both told me that they were amazed at how natural my vulva appears. So I was very pleased to hear that.

Overall, I would rate my experience working with Dr. Stiller and his team as positive. Having this surgery was one of the best decisions I could have made for myself and I am glad that I did.

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Here are some questions I asked at my various follow-ups with Dr. Stiller and Riley. Their answers are in Italics (summed up in most cases and not word-for-word).

How does ejaculation work now? - Prostate is still intact as an approximation of the Skenes Gland and during orgasm it is possible you will release prostatic fluid. Glands that produce lubrication may respond during arousal and you will notice that you get wet around the vaginal opening.

Done with Spiro? - Yes.

Will the adrenals try to make up the missing T? - Its possible, but the adrenals aren’t usually good at that kind of thing. Have your PCP check your levels and adjust hormones as needed. Adrenal T production usually isn’t enough that you need to go back on Spiro.

Will the adrenals try to produce E? - Not likely, but it would be nice if they did, right?

Where to go Friday? - Main entrance of Whitman Hospital. Can’t miss it.

Hair. Where should I expect it and how should I deal with it. - Follicles scraped; but if hair grows inside the vulva you can use laser to remove it. Wait 2 - 4 months before that.

BA, confirm augmentation sizing and all that. - 450cc implants under the armpit and over the muscle.

Can I get the process started for stage 2 colon? Once you meet weight requirements, yes. You also need to wait a minimum of 6-months between surgeries

What is needed from me to do so? - BMI under 35. Lower is better.

Safest way for me to return to exercising? - Walking

when can I resume biking? - Six months minimum. Go slow and do short sessions until you know how your body is handling it.

Wednesday:

Washed today. Did we compress the bra tight enough? How tight? - Bra doesn’t matter as long as it isn’t too tight or binding, keep with a sports bra.

When can I start wearing a bra with underwire? - 3-4 months, preferably 6.

Or bralettes/sports bra? - Fine now as long as it isn’t too tight and doesn’t have an underwire. Bralettes with lace that directly touch the skin might be irritating.

(Breast Augmentation) Any bandages that need changing? Or only if wound has issues? - No further bandages or dressings required. Keep and eye out for any signs of infection, but risk should be low.

Muscle spasm around chest/underarms. Should improve? Best way to address? - Should improve over next few days. Continue to ice and can gently massage.

Bottom:

Urethra pain today. Urine stream has been weak. Possible minor dehydration/UTI? How to address? - No UTI, wound dehiscence near urethra opening. (Riley scraped some of this away) Will feel better once it had healed some more.

Electrical shock feeling, come and goes. Just a part of life for now? - Normal for up to 3 months, but should get less frequent and less intense with time.

Wound exudate - sort of a green yellowish color at times. Plus several thick “ropey” discharges, normal? - Totally normal, light green/yellow color is normal and not pustulent.

Increasing pain near drain sites, just a part of feeling returning to the area? Something else? Concern/no concern? - No concern, nerves reconnecting.

When can I resume HRT? - 09/18/2021

For either site in the event of catastrophic issue I would proceed to local ER. Should local surgeon call? Or okay to just go fix source of issue as they see fit? - ER doc or surgeon needs to call before anyone goes into fix anything.

Last questions:

Aesthetics: understanding that there is still much inflammation and healing. This seem like a bit of a mess and possibly non-symmetrical. Is that likely to improve any or will it need to be revised later? - Likely to tighten up and appearance will be more symmetrical. (Personal note, at week 8 inflammation is much reduced and result is far more symmetrical)

Breast: feel a lump under one breast. To be expected? The implant itself? Or some other source of inflammation or fluid build up? - Scar tissue/fluid buildup. Massage it out when doing my massages. (Personal note, at week 8 lump has disappeared)

Should I avoid firing a rifle for any length of time? - No, but it will be uncomfortable for a few months.

Do you have any knowledge on the use of estrogen sub-dermal implants? Any resources/brands/whatever that I could point my doctor in the direction of? Injections are fine but I would rather not if I didn’t have to. - Gave me brochure to give my doctor.

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For those that made it this far thanks for reading and feel free to ask any questions.