no preview available
Two months post-op, penile preservation vaginoplasty
Since it's been a little while, as a reminder I had penile preservation vaginoplasty (peritoneal pull-through) with Dr Wittenberg in December. You can read a little more about it in my first post , which also links to all my other posts.
Previous post , one and a half months post-op.
Recovery is going really well. I've been up and about, went out to dinner a couple times, and saw a show. The donut pillow helps a lot on hard seats, but soft seats are alright. I went to the gym a couple times this week and walked a mile on the treadmill and felt exhausted and sore afterwards though so I've still got to be careful. Ice helps. For reference, right before surgery I could run a 9 minute mile on a treadmill.
Pain hasn't been a problem.
I can (eventually) get all five dots in on the green (#3, diameter 1⅜") dilator. While composing this post, I got the orange (#4, diameter 1½") dilator in for the first time, four dots! It hurt, but I'm sure it will get better soon.
Things that have helped for the larger dilator sizes (for me, #1 purple and up):
- Pelvic floor relaxation exercises. Imagine an elevator on the ground floor. Gently squeeze the dilator and imagine it going up to the next floor. Relax and bring it down to the ground floor. Now relax further and bring it down to the basement. It's very subtle, and probably a tightness you didn't realize you were holding. Once you release it, that's a good moment to gently slide the dilator in just a little bit further. Then repeat, since usually it will tighten back up pretty quickly.
- Always start each session with a dilator that goes in comfortably, even when you're working on the larger dilator sizes. I just recently graduated from #P2 (petite orange, 1" diameter) to #1 (purple, 1⅛" diameter) for starting each session, even though I'm currently working on #4 (orange, 1½" diameter).
- Relube relube relube! If the dilator won't go all the way in yet, hold it where it is for a minute or five (if you can tolerate that), then take it out, add a dollop of lube on the end, and try again. Going in the second time will likely be way easier, and you might even get it a little bit further in.
- Relube! With the largest dilator you're working on, relube every 10 or 15 minutes, or it can get really stuck in there and be hard/painful to remove.
- Use a good gel lube. I use astroglide gel. Don't bother with Walgreens brand, it will dissolve during your session and your dilator may get stuck. Non-gel lubes have caused the same problem for me.
- Be gentle with yourself. Forcing will just make your pelvic floor tighten and make things more painful, and in turn cause more tightness. I had this problem with the purple (#1, 1⅛" diameter) dilator initially myself, and as a result getting to that dilator from petite orange (#P2, 1" diameter) was the hardest of all the size increases. So focus on those relaxation exercises and be patient with your body.
- IF/ONCE you are able to get your pelvic floor to relax, a little extra pressure will help, but as soon as you feel yourself tighten, STOP and hold it until you regain control of your pelvic floor muscles. Reducing pressure or even backing off when this happens can help a lot too. Patience.
- If it feels extremely tight, try to hold the dilator where it is as long as you can stand it, then slowly remove it, take a few breaths, relube, and try again. It should be easier the second try. You won't tighten all the way back up right away.
- Don't forget to breathe.
- Twisting the dilator about 45° to each side slowly can help to loosen things up and spread the lube around. Slow in and out motion can sometimes help too.
- When moving up to the next dilator size, it can help to tilt your pelvis up (lifting your butt slightly) and hold the dilator with both hands while staring straight at it (head raised off the pillow) and focusing on relaxing your pelvic floor. I have no idea why this helps since it seems like that should tense things up, but it doesn't for me. Your mileage may vary.
Edit: I want to be clear that I also have a fairly high pain tolerance, and even following these suggestions you should not necessarily expect to get to orange in two months.
The complication I mentioned where pee leaks into my vagina from my bladder seems to be improving. It only comes out when I squeeze as I finish peeing. The consistency seems more viscous than originally, and it doesn't turn as orange as my pee when I take AZO Urinary Pain Relief, which I've taken on two separate occasions to try to get a sense of what's going on. Anyway, it doesn't seem to be coming directly from my bladder or urethra like I originally thought, but instead kind of collecting in my vagina over the course of hours and just coming out all at once. I'm a lot less concerned than I was, although I'll still want to get this fixed if it doesn't heal on its own.
I've added a little vinegar to my douche solution, about 10:1 or 20:1 ratio. I actually premix the vinegar with the peroxide in a small container that I keep in the shower so I don't have to futz around with too many things when I'm preparing the douche solution right before I douche. I'm still douching every time I shower so I don't forget, which Dr Wittenberg said is fine.
Despite my instructions, I have had two orgasms. One was fully vaginal, and both were while dilating. I was able to avoid a full erection, which would pull at my stitches and scare me and ruin the mood. I'm feeling a lot less pent up now than I had before, when it had been over 7 weeks since my last orgasm. That was a LONG TIME for me. I'm still trying to avoid doing anything though because I want everything to heal nicely.
I have a little granulation around the entrance, but it hasn't been bleeding or bothering me.
The orchi stitches have fully dissolved and fallen out. Dr Wittenberg says to wait until 3 months to use any scar creams to try to loosen the scar, which is pretty tight. I can't imagine scar tape working well because the scrotal tissue is way too mobile.
I've been using ScarAway scar tape on my belly incisions, and cleaning them about once a week.
Next post , four months post-op.
I am one of Dr.Bonningtons patients for a ppt vaginoplast so, similar enough insides and I had a question about your sizing up. How long were you working from going from p2 to 1? Its been about a week for me and I feel like I am not really making progress, it just ends up feeling super super tight at dot 3 (max is just before the last dot) I was also curious how you were divying up your dialating time. I am doing the first 25 on p2 then 10 more on 1 presently.
I'm sorry, I don't recall how long that took, but #1 was the hardest to master for me. I think when I was working on that one, I was doing 30 minutes #P2 (to maintain depth), then 15 minutes #1, then another 15 minutes #1 after relubing if I had nothing better to do. I know I relubed a bunch on the way in, so if you're not already doing that then that might help.
Best of luck! 💜
:) asking around it sounds like relubing is something I need to try. Thankyou for taking the time answer and good luck with recovering!
Thank you! You too!
Wow, I am in awe! Knowing this is a available procedure makes me so happy.
When comparing your photos to others who had the same procedure, I noticed major differences with the overall visual outcome of the neo vagina. Were you able to choose (even to a small degree) the ascetic outcomes of your procedure? Such as preservation of your scrotal tissue, height/depth of the opening and canal, or the creation of (or declination) of any the labia minor or major tissue?
I'm sure A LOT of this will vary depending on the person, but my fear would be the doctor not taking any of my desires into consideration and just do what they want and create a visually unappealing vagina.
I did discuss priorities with Dr Wittenberg at the consultation, and then again at the pre-surgical appointment. I was not overly specific about aesthetics, as I planned to do this as two stages (I'm planning a labiaplasty in a year), and I'm always hesitant to tell an expert how to do their job, but I did express concern about scarring. Specifically, I wanted to avoid scar lines along or near my inner thigh, because I felt like that would be an unpleasant place to have weird sensation forever. She said she could keep the incisions more central, and in fact she managed to avoid incisions in that area entirely as you can probably see.
I am hoping to get the labia done by Dr Avanessian, whose specialty is plastic surgery (rather than gynecological surgery), and I have a consultation scheduled with her late this year. My hope is she will have some good ideas for how to achieve what I'm looking for aesthetically.
Awesome results so far . Dr A is a very skilled and artistic surgeon. She did my surgery.
Thanks! And so I've heard/seen!
2 months without even an erection :( not sure if this is for me anymore
I had some erections, just not very big ones. You shouldn't worry about it, when they start to hurt they go down on their own.
Just out of curiosity, why did you chose to preserve the penis? (I’m a trans guy and don’t really know much about MTF surgery, I’m sorry if I said something wrong)
Thanks for your question! I don't get dysphoria from my penis, and I'm fond of it. I do also appreciate being able to pee standing (although temporarily that's not possible because of the bladder complication I described), and erections feel good for me (and maybe one day I'll even be in the mood to top someone, though it's been a very very long time since I've done that).
I always wonder. How does that feel?
I don't know how to answer that 😅 Very...full. I can feel the dilator as it goes in, and all the pelvic floor muscles when they squeeze. There are more different muscles than I realized before surgery. It's way less sore than it used to be when it was newer.
Does it feel good?
Sometimes. It's hard to get in the right headspace when stretching things, and rigid plastic is not very comfortable to clamp down on, but I'm looking forward to trying out softer toys like silicone dildos and similar. I did have my first vaginal orgasm on a dilator though!
Cool! I didn't know you could feel anything in there but I'm glad you are and my ignorance has been cured. Thank you
Yeah, it's like there's no tactile sensation, but I can feel pressure and the muscles for sure can feel what's happening, like how you can feel food go down your throat when you swallow.
I’m jealous of your canal positioning, for some reason surgeons always do it way higher for just SRS where they don’t preserve the penis - do you mind if I ask how much depth you have?
Thisss!!! I can’t even do doggy style because my vagina is too high to be found from the back
Right there with you. I LOATHE where they tend to put it, and I'm going to have to argue that with a surgeon when the time comes. Otherwise it'll really mess with my head as I have phantom genitals that it needs to match up with
Hey, it sounds like you feel very strongly about this, and of course you should since it's your body and you have to live with it. I would just recommend trying to frame your needs in terms of priorities when talking to your surgeon. They are likely to be very proud of their work and expertise, and there is a very real professional risk to working with patients who come across as unprepared for potentially disappointing results. I know it's not fair, but arguing is probably not an effective strategy here.
Thanks for the advice! I've spent the last 8 years searching for surgeons, letting the techniques advance, and doing literally everything in my power to improve the final results. It's not been easy, but I feel it'll be worth it. I've done as much preparation for this as is possible, and I'm willing to take the risk of a disappointing result.
The thing with phantom genitals is that if it doesn't match up, it'll be like a splinter in my brain for the rest of my life, in a way dysphoria never has been. I'm as prepared as I can be for it, but it's still something I worry about. Now my biggest obstacle is cost.
Yes! That's a huge concern of mine when thinking about this.
Thanks! The position seems to vary by surgeon, so it's probably worth discussing in a consultation if that's a concern for you (if you haven't already had surgery).
I have about 15cm/5.5". I can get the fifth dot in on all the dilators except the orange #4.
Did you get orchi too?
Yes, and that part was optional.
Hi, first I want to thank you for taking the time to post and reply to all these questions you're getting about PPV. It's very helpful, informative, and encouraging to see. Next week I'm having a consultation with Dr. Bonnington about this exact procedure. I hope I'm not asking repeat or uncomfortable questions, if so I apologize.
-Did you need to get hair removal?
-I guess this depends on how much pain tolerance and strength you have, but were you able to take care of yourself (cooking, bathroom etc) right after being discharged or did you need help for that first week or so?
-Were you able to dilate without needing anyone else to help after being discharged from the hospital? Same for changing dressings, did you need any help with that?
-Do/did you feel any mental fatigue or lack of energy afterward?
-Besides getting insurance figured out, was there a long lead time before the surgery date? Or were you able to get a date scheduled while figuring it out?
-Before going into surgery did you have any specific goals in mind like depth for example? Is there a sort of tradeoff with this and does it depend person to person what is achievable?
-For the labiaplasty that you plan to get in the future, would that likely use scrotal tissue? It seems like a good idea and something I may end up doing!
I'm glad to answer your questions as best I can!
-Did you need to get hair removal?
Dr Bonnington will give you the hair removal instructions, but it's basically everything underneath. I had full body laser hair removal years ago though so there wasn't much to clear.
-I guess this depends on how much pain tolerance and strength you have, but were you able to take care of yourself (cooking, bathroom etc) right after being discharged or did you need help for that first week or so?
You'll be restricted to 10 minutes of standing/walking three times a day for the first three weeks to help prevent swelling. So I'd recommend a caretaker. Bathroom wasn't a problem for me though.
-Were you able to dilate without needing anyone else to help after being discharged from the hospital? Same for changing dressings, did you need any help with that?
I could dilate without help, and there was no dressing to change. The wound vac takes care of it, just try to be careful not to break the seal.
-Do/did you feel any mental fatigue or lack of energy afterward?
Two months out I'm still lacking much energy. I've also taken some naps recently.
-Besides getting insurance figured out, was there a long lead time before the surgery date? Or were you able to get a date scheduled while figuring it out?
I scheduled the surgery at my consultation, about 9 months out. Then I had a conflict and had to reschedule, again about 9 months out. During that time I got insurance figured out.
-Before going into surgery did you have any specific goals in mind like depth for example? Is there a sort of tradeoff with this and does it depend person to person what is achievable?
I wrote up these at the time:
Priorities - Maintain as much sensation and original skin/material as possible. Preserve penis and scrotal tissue. - Scrotal tissue should be used to create labia, keeping as much sensitive scrotal tissue as possible. - Depth. - Orchiectomy. - Aesthetics.
Goals/Expectations - Reduced dysphoria. - 6-12 months between vaginoplasty and labiaplasty. - ~3 months recovery. - Labia should feel like my scrotum currently does. - No decrease in penile sensation. - Erections still possible/comfortable, same as currently on HRT. - Hopefully wetness. - I want to be able to receive sex comfortably, with lube if necessary. - Ideally I want it to look natural (if unusual).
-For the labiaplasty that you plan to get in the future, would that likely use scrotal tissue? It seems like a good idea and something I may end up doing!
That's right! I'm hoping for Dr Avanessian to do the labiaplasty, since she is local and a plastic surgeon (rather than a gynecological surgeon).
Good luck with your consultation!
Thank you for replying! I have a few follow up questions
For hair removal do they know of places that are willing to remove hair around that area? I'm not sure how difficult it will be to find a place near me, but maybe it won't be too bad since I'm near Chicago.
I saw you mention a wound vac before. Is this something that they give you or just something that they recommend and you buy?
Also thank you for laying out all the goals and priorities you wrote out, it got me thinking more about the bigger picture and what to tell them overall. I think for the most part I feel the same way.
I'm a college student and hoping to be able to not this summer but next summer when I'm not busy, so hopefully that will be enough time for hair removal and getting everything sorted out. I look forward to hearing more about your recovery in the future!
For hair removal do they know of places that are willing to remove hair around that area? I'm not sure how difficult it will be to find a place near me, but maybe it won't be too bad since I'm near Chicago.
I don't know about Chicago, but it's probably worth calling up places and asking. I'm in NYC, and my electrolysis tech would do that area but not in preparation for surgery because of some bad experiences with other clients. It's a touchy area.
I saw you mention a wound vac before. Is this something that they give you or just something that they recommend and you buy?
You'll wake up with it attached. It sucks up all the excess fluid and helps reduce swelling in the first week. They'll give you a carrying case for it so you can get around on your own. You'll give it back at the first post-op appointment.
I'm a college student and hoping to be able to not this summer but next summer when I'm not busy, so hopefully that will be enough time for hair removal and getting everything sorted out. I look forward to hearing more about your recovery in the future!
If you start the hair removal now you should have plenty of time, especially if you're going with electrolysis. Just remember that hair follicles have a lifecycle and you can only kill them while they're active, so the hair will keep growing back for a while.
Best of luck! You'll do great. And please feel free to reach out directly if you'd like.
Congrats on achieving orange!
Thank you!!
I’ve seen some of her photos and your outcome looks the most promising.
Thanks! I'm sure part of it is luck, but also I get the impression that a lot of her other patients had very specific ideas of what they were looking for in terms of labia, and wanted her to attempt that with the first surgery. Dr Wittenberg told me labiaplasty done at the same time as penile preservation vaginoplasty would likely lose definition, and Dr Avanessian (plastic surgeon in NYC) told me the same thing in my consultation with her. So I listened to the experts, and I'll get a labiaplasty in a year.
I'm actually planning to go with Dr Avanessian for the labiaplasty if I can, since she's much closer to me and also her specialty is plastic surgery. Dr Wittenberg is a gynecological surgeon, and although I think she has had some pretty great labiaplasty results for her patients who opt for a penectomy/clitoroplasty, I want to hire the appropriate expert for each job if that makes sense.
Didn't know this was a thing
Is it possible to have this done and keep the testicles?
Yes. I had them removed so I could stop taking spiro, and I would likely have to lose them anyway to get a labiaplasty in a year (although maybe there is a way to stash them somewhere else if you want to use the scrotum for labia).
Do you know what the options are for labia when keeping testacles/scrotum?
I'm unsure, but it's probably worth asking Dr Wittenberg in a consultation. It might be possible to stash them in the inguinal canals permanently for example, although that sounds potentially uncomfortable to me. Or there might be other places they can go for all I know.
Best of luck with your journey!
What's involved in getting one of those? Do you need to be actively considering it (its a long way off for me)? I am international and doing informed consent, so the whole referral and letter process (plus $?) might be a bit much just to ask a question.
For me they tend to slide into the canals temporarily when I'm (pleasure) massaging the area, but I can't get them in for tucking - uncomfortable and doesn't want to go, certainly won't stay. Not sure I would want them there permanantly!
The consultation was by telehealth, and I believe it was about $250. I didn't get my letters in order until after the consultation.
I would agree with you! But then I got mine removed and tossed in a medical landfill 🤷♀️
Thanks! Sounds worth doing down the track,
[deleted]
Insurance agreed to cover it after a nearly year-long fight, yes.
Everyone's anatomy is a little bit different, but I suspect if Dr Wittenberg said to go to a plastic surgeon that the canal is in the right place already and it's just the entrance that needs adjustment. She knows a lot about anatomy.
Did you also preserve the scrotum?
We can see it right there
Yes
Great! How much did it cost overall? Is there additional sessions remaining?
With my insurance at the time, it cost me less than $2000. For my insurance I think it cost closer to $100,000.
What do you mean by sessions? If that was a typo for surgeries, I do plan to get a labiaplasty in a year with Dr Avanessian.
Yeah, I was referring to Labiaplasty when I meant sessions. Love to see your results once that is done too.
all 53 comments