This is an account of my 2022 stay at Kaiser's hospital in San Francisco after full-depth penile inversion vaginoplasty (PIV). It’s specific to the facility rather than a description of the surgery itself. Surgeons were Dr. Ali Salim (plastic surgeon) and Dr. Carl Thomas (urologist).

The attraction for me of a hospital room vs. a hotel room, guesthouse, etc. was knowing I'd get immediate care should any complications arise. I’m in very good health but older. Am a Kaiser member and volunteer, and it’s close to my home.

After it: What I wish I had known before checking in, and some tips.

I hope this is helpful!

TL;DR Great care, and a good place to recover after full-depth vaginoplasty.

Outcome

Almost 8 months post-op. More energy now than before surgery. No complications. Vulva looks great: tissues healthy, symmetrical labia, no visible scars, cute little fourchette. Everything functional. No noticeable swelling (Dr. Salim had said expect swelling to resolve in 6 months to 1 year). Dilations ahead of schedule; times to full depth consistent. Depth is last dot on Soul Source #4 (orange) dilator at the introitus, about 5.5 inches. Main issues: recouping lung capacity (took about a month) and energy (took about 3 months). No narcotics, pain easily managed with acetaminophen (stopped it 1 month post-op). YMMV.

Day 0 (operation)

Woke up in a recovery room after about 5.5 hours under general anesthesia. It’s a large but thankfully quiet space.

After an hour and a half of pleasantly drifting in and out of being present (Dr. Salim came by to say it went well but I didn't notice) my room was ready. Once there, I shuffled a few steps onto my room's bed and dozed off again.

On waking in an hour or two I realized I had several new companions.

Four of them lines: one from a shunt on my wrist to an IV pole with antibiotics, another from the Foley catheter in my urethra to a drainage bag hooked to the side of the bed, and two short ones from the surgical site to a pair of drainage bags tucked under my bandages. Plus compression cuffs on my lower legs.

All of them would have to be wrangled in order to get out of bed which I thought I'd like to do sometime but not just yet.

Texted a friend to tell everyone I was recovering. The solid food that evening was bland but welcome after the two days of starvation and that jug of vile pre-op bowel-prep solution. Surprisingly for a coffee person like me, Kaiser's was pretty good.

Was asked many times during my stay to describe my pain. That helped my care team understand if my recovery was normal or if there's a potential problem. My pain levels varied from 0 to 2, spiking briefly to 3 if I did a long walk. Other peoples’ experiences with pain are all over the map.

Day 1

Massive amount of gender euphoria kicked in as I woke up. It’s stayed with me since.

This morning ventured some 200 steps from my room to the nurses’ station down the corridor and back, just me and my new besties.

People bustled in and out of my room checking vitals, lines, giving me my meds. I mostly dozed.

General anesthesia has risks (stroke, among them) and side effects. These diminish as the anesthetic drugs gradually leave your body.

One of the side effects for me was a brain fog like jet lag that persisted into this evening when I fell for a nurse's telling me my second cup of coffee would cost $5. Took several seconds of looking at her smile to realize it was a joke. I had to get back at her right then, and did. I loved our laughing together. It reminded me of my friends among whom I'd be soon.

After which got out of bed and into the bathroom to go through the motions of brushing my teeth and hair and called it a day.

Day 2

Walked about 300 steps in the morning.

Finally started in on the surgical team's multi-page instruction sheet left with me. Much of it exhorted me to daily walks starting immediately, what would happen over the course of my stay, tips on after-hospital care and hygiene, and a forthcoming rigorous (no kidding) dilation regimen.

Noticeable surgical site swelling but per the instructions began icing every few hours which helped reduce it.

Noticed more blood in surgical site drainage bags after my morning walk, which the nurses said was normal.

Began exploring my room. Small, private, with a window looking out onto greenery. The hospital itself was built in 1952 but it’s been renovated. My room and bathroom looked nice though institutionally bland. Everything was super clean. The OR, from what I saw of it, looked brand new.

Day 3

Upped my walks to twice daily. The first one about 600 steps, really needed to rest after.

Able to sit in a chair for about 3 hrs. today.

I had held off buying a doughnut cushion. On one of Dr. Thomas's visits he said that sometimes a cushion compresses a wound in a more painful way and that patients should experiment on how to sit. Turned out I was fine without it.

An energetic physical therapist stopped by. He wanted to watch me walk up and down stairs right then. Only had to do half a flight to satisfy him.

That afternoon I stood in the outdoor stairwell at the end of my floor. No matter the uninspiring view of dreary Geary Boulevard's traffic, the wind from the Pacific Ocean felt really good, another reminder of life outside. I added this to my daily rounds.

Uncomfortable trying to urinate, which taught me to better monitor my companions. I ran into two issues: (1) the line to the Foley catheter's bag became kinked, obstructing flow, and (2) the catheter's balloon in my bladder which keeps the line from slipping out got out of position and obstructed flow. Walking a bit reseated the balloon.

Able to clean my teeth completely, closer to my normal routine, wash my face, etc. But standing at the sink for 30 minutes was enough and then I had to lie down.

Day 4

A lot more energy, finally. Alternated between sitting in a chair, walking and bed, no longer treating the bed as the default option.

Over the course of my stay had multiple visits from doctors Salim and Thomas, as well as one from another doctor who does trans surgery, Roderick Simonds, and the nurses from the transgender surgery team, two hospital doctors, and the hospital pharmacist.

Nurses were always available via the speaker phone by my bed to their station just down the hall. They were trans knowledgeable, which proved helpful more than once.

No one reminded me to walk. I was doing so much of it that on one excursion around my floor an older patient called out from his room, “There she is!” I gave him a nice smile through my Covid mask.

A friend left a present for me at the first-floor reception: a club sandwich, salad and dessert from a favorite restaurant. A nice morale booster and another sign of the outside world awaiting me.

Finally felt like movies. Watched “The Little Foxes” with a feisty Bette Davis and the usual great writing by Lillian Hellman.

Day 5

No more IV pole! A lot easier to move around connected to only the Foley catheter and the two little surgical site drains. I had given up the compression cuffs as the risk of a stroke from general anesthesia is greatly reduced by about Day 3. The shunt on my wrist stayed till check out just in case.

Researched WPATH & UCSF protocols for post-op estrogen dosages and decided on my own to reduce it. Accordingly, I emailed my primary care doc that idea and asked her questions about circulating estrogen levels. I got a quick approval from the medical director for transgender health care. The nurses were happy; one had been worried when I had refused that little blue Estradiol pill she offered me that morning.

Four walks today.

After which bed and another movie.

Day 6

Unpacking this morning.

First out were the surgical site drains, removed by an RN in Dr. Salim’s practice while Salim watched. No pain. Then snipping the stitches holding labia closed. Several sharp little pricks. A second set of stitches. Ditto. Then a short sharp whizz to withdraw the Foley catheter, painful but mercifully very quick. Followed by the extraction of an interminable amount of the packing tape.

Dr. Salim explained how to dilate and watched as I did.

Lunch, then one more dilation which I could have done on my own but asked a hospital nurse to watch just to be sure I was doing it right.

The last requirement before leaving was showing Kaiser that I could urinate and defecate. I had to produce a minimum amount of urine into a little cup that sits under the toilet seat.

The great poet Dante wrote in his account of escaping Hell, «e quindi uscimmo a riveder le stelle» (and once again we beheld the stars). It was only mid-afternoon when I left the hospital, no stars I could see, but I felt just as happy as he to be back in the land of the living, in my sister's car heading to her place for a week of good food, sometimes good movies, and our always great conversation.

Overall, my experience was excellent. Everyone there was competent, caring, friendly.

A few knocks about the place:

• Don't count on getting on an elevator right away. The public ones seem to be powered by wisps of leftover 19th century steam.
• Plenty of outlets to keep my devices charged, and fast and reliable Wi-Fi in my room. That was good because the old-school TV had only a handful of channels (Fox News instead of MSNBC, unbelievable--it's all I can do as I type this to not go into a rant about them).
• Hospital food OK to meh.

What I Wish I Had Known

• Knowing how to describe my pain levels as numbers. You'll be asked! My room had a little chart on the wall but I should have known this before going in. Here's a guide: https://connect.mayoclinic.org/blog/adult-pain-medicine/newsfeed-post/what-to-expect-at-my-pain-medicine-appointment/
• Using the incentive spirometer on my bedside table. Blowing into it is an exercise that helps keep your lungs healthy. I neglected it and regretted that the first time I walked up a hill at home.
• Planning out a menu on Uber Eats, Grubhub, etc. to supplement the hospital meals. San Francisco has so many good eateries.
• I had laid in supplies at home but had forgotten bed pads and didn't have a towel for that purpose. Dilation's a bit messy.

Tips

• Vaginoplasty is major life-affirming surgery. Own it. Think of questions to ask. Get in as good physical shape as you can before. Get a full blood panel done before if you have any medical issues, and get up-to-date on your vaccines.
• Be honest and transparent with your care team, especially about what you want. They're there to keep you safe. Leave any embarrassment at home.
• Consider recovering without narcotic pain meds if you can. I managed fine without them but again, YMMV. Before checking in I asked and found Kaiser‘s default protocol was to have them on the IV pole in my room.
• Bring earplugs and easy to slip on sandals. Hospitals can be noisy and as others have noted you may be awoken often for readings of vital signs like blood pressure, temperature, etc. I slept well thanks to those earplugs. The sandals made my walks comfy.
• Friends are a huge, huge plus to recovery. Mine had fresh food waiting for me when I got home, did food runs, bought extra maxi pads, underwear (a size larger is better until swelling's gone down), supplements like cranberry capsules (may help prevent UTIs), and more. Best of all was peace of mind knowing they had my back.
• I asked one friend to be my main contact to tell the others how I was doing. That saved me a bunch of typing.
• Be as friendly as you can to everyone you see while you're in the hospital. Helps reduce their stress and makes you feel better, too.