New Year, New Peen

Whoops, it has been a good few weeks since I updated this blog. That's mostly because things got a little stressful after my VCUG and I stopped wanting to think about surgery for a little bit (even though I was/am also thinking about it all the time, still). But some time has passed and I have lots to update, so I wanted to jump back in. 

I flew back to Michigan on Thursday, December 16th for my second post-op appointment on December 17th. This post-op happened at the main hospital where I had surgery, rather than the smaller clinic where I had my consult & first post-op. Flying was fine - I still had my suprapubic catheter and leg bag in at the time, so I just pulled my pant leg up to go through security and had no problems. For my flight there, the (older, presumably male) TSA agent said something along the line of, "Don't worry, I have one of those too" which was so sweet and affirming. It was mildly uncomfortable to sit upright for 1.5 hours at 4 weeks post-op, but not horrible. 

My post-op on Friday morning was wild. I was scheduled for a RUG, like I've mentioned in my past posts, but ended up doing a VCUG instead. I was brought back for vitals/history, then brought back into the x-ray room for my procedure. I changed into a gown and got up on the table - there were like five nurses/techs in the room so I was a little nervous but mostly excited. They all thought I was having a RUG, so they started preparing me to inject dye into the tip of my penis through my new urethra by washing me down with Betadine and getting the syringe ready. However, once they got me up on the table Dr. Hadj-Moussa came in for a second and said, "You can start filling now," to which the nurses/techs were like ??? the order is for a RUG? and Dr. HM said whoops nope, it's for a VCUG,  so they switched gears and started filling my bladder with a clear dye solution. They hung the solution from a drip and hooked it up to my SP port so that it would start slowly filling my bladder. They had to move the x-ray machine around to line it up with my pelvis, and they tilted the bed alllll the way to an upright position, so I was essentially standing against the bed, about 1-2 feet in the air. It was quite the position to be in. 

Dr. HM came in shortly after that to take a look at everything and ask about how I was doing. She said things were looking great - I was worried about my mons incision and she said it's totally fine and will close up on its own. We noted plenty of remaining swelling on the phallus. She asked if I had accidentally had any pee come out "Like while pooping?" so I was happy to hear that it wasn't a ridiculous thing that happened to me the week prior! I told her about that situation and she was glad to hear that pee had come from the tip, that's a promising sign. At that point she was like, "Alright, so you can go for it whenever you're ready... and if you need anyone to leave that's also fine, I know there's a lot happening in this room right now." which was kind, but I told her it was nbd - I was so excited to actually experience the sensation of peeing that I didn't think anything was going to get in my way. And I was right! Pretty much as soon as my bladder started feeling slightly full I decided to give it a go. I was holding a portable urinal underneath my dick, with the x-ray machine to my right and Dr. HM watching from the front. The sensation alone was very weird - the dye fluid was room temp, so it felt cold coming out of my body! My pee has definitely never felt cold before. I was pretty anxious but once I started peeing it was fine. I could feel it coming out of my tip, though it also felt to me like a little bit was coming from between my legs as well. Dr. HM was watching for a visual and checking the x-ray and said that she only saw urine coming from the tip, and nothing weird showed up on the x-ray. She said that with a weaker stream it's normal for some to drip down the scrotum, which would result in the feeling that some was coming from between my legs. 

So that was that! It was only a small amount of pee (will be relevant later). She told me she'd want to see me in 2-3 months for another follow up and to check in about stage 2. I was instructed to get my catheter removed back home in two weeks, at 6 weeks post-op. I thanked her for everything and she was on her way! They "capped" my catheter with a small yellow plug and instructed me to pee normally, let my bladder fill normally, etc. Dr. HM told me that it might "feel like you have to pee forever" because of my bladder contracting against the SPT as I empty it, and that some bloody urine, weird colors, burning, etc. is normal for the next few weeks while my new urethra clears things out. I was very excited about all of the good news, and very hesitant to totally accept it at the time.

Fast-forward to later that afternoon, I'm out getting pizza with my dad (who accompanied me to MI) and I go to pee. I sat down because I was out in public and didn't want to risk making a mess of the bathroom/myself. This time my bladder was much more full after drinking a bunch of water, so my stream was stronger. I immediately noticed some dripping coming from between my legs in addition to most of the stream coming from the tip, and when I "pushed" a little bit it became more of two streams - one from the tip, one from my natal urethra. It was hard to see things so I wasn't totally sure what was going on, but I was pretty sure what I saw/felt. My heart sank, even though this is what I had pretty much prepared for throughout recovery. The same thing happened later that day at the airport - though I didn't "push" at all, so it was only a drip coming from my natal urethra (~5-10%) and the majority of my stream coming from my phallus (90-95%). That's when I could tell I wasn't making it up, and started feeling pretty fucking devastated. I messaged my surgeon (though didn't expect to hear back because it was like 4:00 on a Friday) as well as a few other people who have more or less been mentors in the bottom surgery process who have gone through similar things. Peeing didn't really hurt, but it felt really scary because I was worried about hurting things more. 

Rough stuff. I continued peeing from my phallus on Saturday and Sunday, though carefully. I was able to pee standing up by pulling my pants to my ankles and almost straddling the toilet - still the same ratio (90/10) of pee came out of my tip vs. my natal urethra. During the weekend my pee started becoming weeiiird colors (think brownish, ice tea color) and smelled pretty gross, so I was worried I had a UTI. I felt anxious but also loved seeing pee come out of the tip of my dick so much - 100% makes having had UL worth it, even with the drip. I was operating under the belief that I was most likely going to have to go back to using the catheter, so I took several videos of myself peeing and reveled in the fact that my new UL was at least partially working. It feels like magic to me - I can't believe that part of my cheek is now in there and allowed urine to pass through. So incredible. 

Dr. HM called me Monday morning to respond to my MyChart message. It meant so much for her to call me rather than message me back - I know that the bar for trans surgical care is often low by design but she consistently surpasses my expectations and makes me feel so confident in my choice of surgeon. She asked me about what I was seeing, noted that it's ideal when things show up right away on the VCUG but that's not always how things work, and told me that she's not concerned about a UTI because I didn't have any burning/pain while urinating. She instructed me to go back to using the catheter for a period of "urethral rest" until eight weeks post op - four more weeks of catheter use. I wasn't surprised, and somewhat relieved to not worry about worsening the possible fistula by peeing through it. She told me that they won't even call something a fistula until 8 weeks post-op because there is still a lot of healing left to do, and that if it is a fistula then they'll loop in the gynecological surgeon to assist with the repair. We left the call on a hopeful note, and she told me to try peeing again at 8 weeks and let her know what I find - since I'm so far away she didn't want me to need to fly back just to try peeing again when I can visually determine what's going on. She also had me start using the estrogen cream again (which I did but it sucked post op - it always kind of sucks, but was way messier and annoying. So I had her prescribe the estradiol tablets which have been wayyyy easier and more comfortable. I'm definitely sticking with these for life) as a way to strengthen my vaginal mucosa and help healing that tissue. If I have a fistula I will have to come back, but that's a bridge to cross at a later time.

So I went back to catheter use. I ordered a set of flip/flow valves on Amazon so that I didn't have to pull the cap out of my catheter every time I had to pee, and I'm very glad I did! Since going back to the flip/flow catheter I've had a lot harder of a time with bladder spasms than I ever did while I had the bag. Part of it is letting my bladder fill more, which it hasn't done for four weeks. The past (almost) four weeks have honestly been really rough with the catheter, more than I could have anticipated with how easy it felt in the initial recovery stage. AZO stopped working in the same way, and I felt anxious about drinking too much water while leaving the house so I did the opposite of helping myself - I drank less fluids, which certainly makes the spasms worse. My spasms have also changed a lot in nature; I sometimes have bladder spasms so strong that I pee my pants (which sucks!), I've had an on/off feeling of stabbing pain in my urethra, and have a ton of general discomfort in my whole bladder/urethra area most of the time. It gets worse when I do pee triggering things, like dishes (hot water on my hands and sound of running water), being too close to the bathroom, or moving too much. Sometimes it happens randomly. Tbh, it sucks.

Healing has otherwise been pretty solid these past four weeks since my second post-op. My mons incision continues to close and look better - the scar is a little wider than my other incisions, but it's no longer bleeding and I'm confident that it will soften and look just fine with time. My other incisions are all closed, and most of the dissolvable stitches have made their way out at this point - though I still see a few in the middle of my scrotum and think I can feel some in my phallus. Swelling continues to go down but I think I still have a good amount left, mostly in my dick. My foreskin is still a lot thicker than it used to look, which I believe will relax in the next few months. 

I've been feeling anxious about the shape of my dick, hopefully because of the swelling. It looks awesome from the front, but from the side it has a sort of cone-shape to it, and I can't really lift/angle it upwards (yet?) because of some tissue pulling it taught to my scrotum. I know I'm still early as far as swelling goes, and that the tissue will soften a lot with time. It's hard to not feel anxiety about it though! Coupling that with wondering if I have a fistula and will need an additional surgery, plus going back to work/life, this feels like the most stressful part of my surgical recovery so far. And I'm almost two months out! Woof. I know it's a long process, so I am trying to keep that in mind as much as possible.

So, where I'm at now: I will be trying to pee again in a few days, most likely this weekend because that's when I'll have time/space to deal with whatever outcomes I have. I'm still in the process of making an appointment with the local urologist to have my catheter removed, which will hopefully happen next week (at a little over 8 weeks post-op) as long as I'm able to fully empty my bladder on my own when I try. I'll let Dr. HM know whatever the case is with my peeing, and we will make a plan from there. I know she's willing to do repair surgeries earlier than 6 months post-op, but because of work I wouldn't be looking to schedule my next surgery until June. So, come June, I'll either be having a repair surgery (stage 1.5) to fix my possible small urethrovaginal fistula (and possibly any minor aesthetic things), or my second stage to complete the complex VY scrotoplasty and put in implants. If I have stage 1.5 in June 2022, I'll hopefully be scheduling sate 2 for ~November. The logistics are really overwhelming, so I'm trying to not get ahead of myself and take things one step at a time. 

I'm still so, fucking, happy that I had metoidioplasty. Even with the complications, it feels like an actual dream come true. I wouldn't trade it for the world, and I know that even if I do have to have an extra surgery (or extra surgeries, who's to say!) it will be worth it and I will get the outcomes I'm looking for in the long run. I'm pretty obsessed with my dick - I love looking at pictures, checking on it, thinking about it, etc. Lol. I'm very excited for the aesthetic changes of stage 2, so I'm hoping I can get that sooner rather than later! Hopefully I'll feel up to writing an update sometime next week after I try peeing again, but I'm not making any promises. All for now!

Sidenote: it's a conscious decision to not show pictures here, but I'm more than happy to share if I know you IRL, if you've found me in a common Facebook group, or if you're in any bottom surgery discord. Don't hesitate to ask (respectfully) and I'm most likely totally down. I wouldn't assume this about all post-op people, but as long as you go about it in a reasonable way I'm fine with sharing. Like I said, I'm pretty obsessed with my dick lately. Same goes for any questions that you might have!