[CN: Depression, Suicide, Pain, Surgery]

This month it will have been one year since I flew to Thailand to receive a vaginoplasty (aka SRS) from Dr. Chettawut. (Which I am affectionately referring to as my vagina-versary.) It is one of the most difficult, rewarding, and life-altering experiences I have ever had. Some obstacles were a complete surprise, but many could have been mitigated or prevented if I had been given a head’s up.

So I feel it’s my duty to try to ensure my fellow trans sisters seeking vaginoplasty don’t make the same mistakes I did. Let’s let our hair down, cut the bullshit, and talk about things that really need to be mentioned but no one else will.

1. Money, Money, Money

In between making my non-refundable deposit to secure my surgery date a year in advance and the actual date of surgery when all of the money was due, I was laid off from my job. This resulted in me and my former partner begging and borrowing from anyone we could in order to make sure the thousands already spent and borrowed weren’t lost and I could go through with my procedure.

I have only told this in confidence to a select few before now, but during that crucial time I feared what I might do to myself if surgery was snatched away from me at the last second.

I got lucky, very lucky, time and time again leading up to and after surgery.

Please don’t put yourself in that same situation. Make sure you have enough money for the entire surgery, hotel stay, and airfares before you make a deposit and lock in a date.

Or, if you have a sudden change in income (like I did), then immediately contact your surgeon to reschedule. Many surgeons are willing to do so if it’s three to six months in advance because they can still have time to book someone else for that date. I was too embarrassed and ashamed and spiraling into mental illness at the time to have that foresight. So this is me telling you that the embarrassment and heartache of rescheduling and still keeping your money will be nothing compared to losing it all and having nothing.

And while we’re on the subject, please ensure that you think really hard about any financial obligations you go into with another person. It puts both of you up to a lot of risk. If there was one thing I could change about everything I did, this is what still keeps me up some nights. But my former partner is one of the most gracious men I’ve ever known and trusts me to pay him back even though I’m currently in poverty and trying to get back in school.

I got lucky. Again.

2. Papers, Please

There is a lot of bullshit paperwork you need to do in order to have surgery. And if you’re leaving the country to do it, there’s twice as much bullshit paperwork.

I applied for my passport six months in advance and still didn’t receive mine until two days before my flight because of the trans-antagonistic policies of the US State Department. I threw several different documents from several different professionals at the passport office and none of them were accepted. I then had to fight them to give a passport with my assigned gender on it instead. They literally didn’t want to give me any passport unless I could prove a doctor said it was okay. But I stayed in their national office in my metroplex until they gave me one.

I got lucky. Again.

I don’t give a fuck what anyone else tells you, including employees at the local passport office. The only, and I do mean ONLY thing the passport office will accept to change your gender marker for your passport is an original hand-signed letter from an MD who will swear an official oath that you are what you say you are. Monica Roberts of Transgriot already has a blog post with the LITERAL AND EXACT WORDING your doctor’s letter needs to have.

In addition to that letter for the passport office, you’ll also need two to three original documents signed by a therapist, a psychologist with a doctorate level of certification, and possibly your endocrinologist or regular MD. Check with your surgeon to see exactly what they require and if possible ask for example letters to provide for your uninformed professionals. You should get all of these like a year in advance instead of scrambling the last two weeks before leaving like I did.

When I landed in Thailand I technically only had one acceptable form of verification because another wasn’t the original. But my surgeon made an exception for me. Probably because I’m young and pretty and white.

I got lucky. Again.



3. It’s Dangerous To Go Alone

Because of aforementioned financial strains, my original plan to take my sister or friend with me to Thailand was scratched to tighten the budget. And like a fool, rather than tell either of them that I couldn’t pay for their ticket but would still like their company if they could pay their own way, I just said nothing until it was too late for anybody to do anything. For the love of whatever you believe in, don’t do this to yourself.

I know a month doesn’t seem like a long time in the grand scheme of things. But a month in a foreign country by yourself while going through a drastic medical procedure and grueling daily physical therapy can feel like an eternity. Most days I barely spoke more than a dozen words to anybody unless I spent money on phone minutes to call people back home in the middle of the night. Walking a block to the nearby shops to get food took nearly all of my physical strength many days, but I had no other option because I was alone.

My day consisted of watching whatever movies or shows I could pirate on the spotty hotel internet or watching the truly terrible shows on the only local English TV channel while obsessively checking and posting on social media for some kind of connection. All the while I was taking pain meds that didn’t help with my pain but did make me nauseous, dilating three times a day (which was awful), and sleeping like 14 hours a day. I was not in a good way.

When I met my neighbor my last week in Thailand my mental health improved greatly. Just being able to talk about something in my own language was a treasure, but a girl my own age dealing with the exact same things made it even better. If you can, try to meet the other girls nearby. It’s a pretty unique bonding experience and you can laugh at your predicaments together.

4. Bed Head

I know this will sound silly and minor, but trust me on this one. Before you leave for surgery either cut your hair short or braid it. You are going to go a week in a bed without a shower after surgery. If you do not do something with your long hair you are going to have a fucking nightmare on your head you have to deal with while fucked up on pain and pain meds.

Either chop your hair off or braid it before surgery. You’ll thank me later.

On a vaguely related topic, don’t stress out about “losing your dignity” or whatever when it comes to receiving a sponge bath in the hospital. Trust me, you will give so few fucks when that time comes you’re going to actually get excited about it, because it means you’ll get to feel kinda-sorta-cleanish for a while.

5. Pain Hurts. Chronic Pain Kills.

I used to foolishly believe that I could sympathize with friends who have chronic pain. I thought, “Well, I know what pain feels like and that’s awful. So having it all the time must be just like that.”

But it’s not. It’s so much more…insidious than that. Yes, there will be moments of intense pain. But between those will be a dull, possibly even mild, but constant and never ending pain as your body recovers. Because what’s awful is you try to adjust and compensate for it. You start telling yourself that what pain you have right now isn’t “real” pain and you need to get over it. You go through steps you’re not even aware of to try to mask the pain or act like it doesn’t affect you. You start to become really freaked out when House M.D. episodes dealing with his pain start to make a little more sense than you are comfortable with acknowledging. You do everything you can to stay numb because it’s a vacation from pain.

But it’s still always lingering just around the edges. And when it finally begins to fade, you worry if it’s real or if you have tricked yourself into believing you’re well only to come crashing down again. Because when pain is constant, our brains do some really fucking weird things. I knew all of this already on an intellectual level due to my training, but it wasn’t until I was riding that train that I fully appreciated it.

Be gentle with yourself. Be forgiving. Surround yourself with loving and affirming people and allow yourself to be completely honest about your body with them. Learn to speak your truth about your body in the moment. It was the suffering in silence and trying to be brave that made me extra miserable at this time. Be honest and love yourself. You just did something incredible. Give yourself a fucking break already.

6. Fuck Layovers

Flying to Thailand takes forever. But you know what makes it take even longer? Having two or more layovers of several hours each between Thailand and home because you wanted to save a couple hundred bucks.

On the flight there, it’s not a big deal. You’re excited. You’ve finally left the country for the first time. It’s a big adventure and you can’t believe it’s really happening and you’re ready and emotional and just thrilled to be alive.

The flight back?

You’re miserable, you hate life, it hurts to sit and it hurts to stand and those are the only two things you can do for the next three days because your cheap ass didn’t want to spring for a direct flight. Which means it’s going to be even longer before you dilate which means it’s going to be fucking awful when you do so for the first time at home. Don’t you feel like a foolish person right about now?

Seriously. At least for the flight back home, get a direct flight. And if possible, spring for a class above coach so you can at least attempt to stretch your legs. Failing that, call the airlines in advance and tell them that your flights back will require handicapped accommodation. Your surgeon can provide you documentation for when you arrive to go home. Oh, that reminds me…

7. You Will Be Handicapped. Plan Accordingly.

Prepare to confront your own internalized ableism because, goddamn, you are in for a time in your life when it might be all you can do to sit up, choke down food and pills, and sleep again. And that might be the case for a lot longer than you think.

You might foolishly believe that you have a high tolerance for pain. That you’re Wonder Woman and you can do anything. That you’ve already dealt with other painful experiences better than most so this will probably be the same. You will totally rock this and be back on your feet in a month. Two months, tops!

You’re lying to yourself.

Girl, you just had your genitals and several other nearby organs cut apart and rearranged and put back into their original in-utero configuration! Why don’t you really take a moment to fully appreciate that, and say to yourself, “You know, it’s okay if I can’t do everything I used to be able to do right now. I am recovering and I am allowed to live at a pace that is right for my body’s needs.”

So when you go to the airport to go home, take the fucking wheelchair and don’t try to be a brave little soldier like I did. Don’t sheepishly say you’re not “really” handicapped so you shouldn’t ask the airlines for accommodation. Fuck that ableist garbage. Take care of yourself and respect your limitations.

It took me a good six months post-surgery before I felt like I recovered most of my mobility and energy. Until then, I took a lot of non-prescribed drugs and alcohol and other things in order to cope rather than, oh I don’t know, seeing a doctor about it?

At the same time I was also going through a massive depression and dealing with several other related and unrelated major life changes. It was pretty fucking dark. I really don’t recommend it. Be kind to yourself and your body. Remember to treat yourself the way you would your best friend. Especially if you are like me and self-love is something you have to actively work on remembering to do.

Take that handicap letter your surgeon gives you for the plane and ask for several copies. One for school, one for your job, one to have on you at all times if you ever need it, and one for travel. Use these any time you feel that you need to because you have just as much right to accommodation for your medical needs as anyone else. Care for yourself. Accept your abilities in the moment. Love yourself.

I made the mistake of believing I could take on my usual full load of obligations and activities when I got back from surgery. I had to drop half of my classes in order to be able to function and now I’m still dealing with ramifications from that. So be realistic and if anything overestimate how daunting this task is going to be. SRS is a fucking monumental thing to put your body through. Give yourself time to recover and be patient.

8. Your Life Will Change Forever

I really hate the “happily ever after” way that SRS is treated in the media and by cis people who believe all trans people want SRS and after it all of our problems are solved forever. That is all horseshit and I will be the first to tell anyone that is horseshit.

That being said, when the reality of my body finally being whole sunk in, I started to realize the ways I had been coping with my dysphoria all my life and how unnecessary they were now. My first moment was when I was finally able to take a shower after surgery for the first time, and I stepped into the shower wearing panties, as I had been doing for nearly two decades of my life. Right before I turned on the water I realized I didn’t have to do this anymore. I could be completely naked and comfortable for the first time in my life. I had a fucking break down right then and there.

I thought I always had a pretty good handle on my dysphoria, that I didn’t really let it affect my day-to-day life or self-concept or ways of thinking unless I dwelled on the subject. But I was wrong. I realized much of the life I was living was not the life I really wanted. It was the life I thought I needed because it made me feel more affirmed in my gender in a way I felt necessary at the time.

I realized the nagging suspicion I might be a lesbian suddenly had a lot more weight to it then I was comfortable dealing with but could no longer ignore. I went back to America after a month and even though I landed and went to my home it no longer felt like my home. I was suddenly a stranger in my own life. That nearly crushed me. There were several times I wanted to die because I didn’t want to lose who I was before. But I had so many people worried about me and looking after me that I was able to stumble my way into a somewhat stable living situation by now.

I got lucky. Again.

I went through a pretty massive depression after surgery, which is not uncommon for any kind of surgery, so this is not a sign that you’ve made a huge mistake. Post-surgical depression happens.

And putting aside psychological and emotional changes, there are also permanent physical changes to your life after surgery (beyond the obvious, of course).

There will be basic bodily functions you have to relearn, like figuring out when your bladder is full and how to relax your urethra. Honestly, I am embarrassed at how long it took me to feel confident about being able to pee. It took a lot of practice and pads and self-depricating humor. I was also not prepared for dealing with wearing a pad day-in and day-out around the clock for many months. (Incidentally, I highly recommend buying some nice reusable pads since the disposable ones started to give my vulva an awful rash after a while.) You also have to dilate at least once a week for the rest of your life from now on. Which brings us to…

9. Dilation Sucks.

I know, you’ve probably already heard dilation sucks. But really though, I wasn’t prepared for how much I would hate it. There will be times when it will feel traumatic because it is so painful. Depending on what drugs your on to deal with the pain, there’s a good chance you’ll suddenly be flooded with lots of emotions and memories already associated with past traumas, and to be dealing with that while penetrating your own vagina is…unpleasant. I don’t want to sound dramatic, but I do want to try to prepare you for what surprises you might not be thinking of.

But also, if your surgeon tells you to dilate every single day for two whole years (as mine did) he is not being completely truthful. You can drop it down to once or twice a week after about six months. So long as you are still able to dilate at full depth every time, then you’re fine. Also, you can just do one long session instead of three mini sessions after the first couple months and it works just as effectively.

Only having to dilate once a day will be a vast improvement from multiple times a day. Only once or twice a week is way better than every day. I know dilation sucks but it does get easier. It just might not seem like it for a long damn time. Oh, and you don’t really have to douche, that’s just male doctors being male doctors. My nurses gave me the skinny on that one.

My recommendation is to find ways to make dilation as much of a pleasurable (or at least tolerable) experience as you possibly can. Because, much as it fucking sucks, it is a form of self-care you have to get used to if you don’t want your vagina to collapse.

I like to think of it as three hours of required, uninterrupted, “me time” I can enjoy so long as it can be within my arms reach from my chair. Give yourself lots of rewards (intoxicants, video games, new books, whatever) for engaging in this difficult but necessary self-care.

10. Feel However the Fuck You Want

This may sound strange, but when I was confronting my depression in the midst of recovery from SRS I found a lot of similarities with women experiencing postpartum depression. These are both monumental physical, financial, emotional, and psychological ordeals which require over a year of stress and work to pull off. And both a new baby and receiving SRS are expected to be the happiest times in each particular woman’s life, even though you are pushed beyond your limits and can’t even describe how fucking exhausted you are.

Your body feels like it’s been violated. You have a ton of new responsibilities and sensations and shit you weren’t really prepared for despite your best efforts and research. And yet all the while you feel the need to perform happiness because so many people you love and care about have made so many sacrifices to get you to this point, and anything less than ecstasy feels like the worst form or betrayal to them. So you keep your feelings inside and beat yourself up until you can’t stand living.

The reason why I bring up the comparison between post-surgical depression and postpartum depression is because it might feel like you’re the only person who could ever possibly understand, but I promise that is not true. It might take some courage and some talking to others about your truth, but you can make connections you wouldn’t expect. Take a chance, you deserve to be validated by others.

Whatever kinds of feelings you have after SRS, those are 100% okay feelings to have and you have a right to express those feelings. If you can’t express them to people you know, then start seeing your therapist again. Trust me, she could be your fucking lifeline. Go into her office and tell her all of the things you’re afraid to say to other people because you worry they’ll use it as ammunition to discourage medical care for other trans women. Do what you have to do but goddamn, please, please, do not try to do it all by yourself. You can’t. It’s too much.

Above all else, be kind to yourself. I can’t repeat that enough.

You have gone through something very few people can ever achieve. The obstacles you have overcome (assuming you’re not fabulously privileged in some other fashion) were damn near superheroic in scale. Odds are good this has been a goal of yours for a very significant portion of your life. Give yourself a pat on the back, girl. You have fucking earned it.

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