Bottom Surgery at WIH

On the 5th of June of this year, I had bottom surgery at WIH in Thailand. It still doesn't feel real. This post will hopefully help me process it, and with luck, help it feel more real as a result.

First off, if you haven't had a look, the Opinionated Guide to SRS with Dr. Chet has some good info. NB: Dr. Chet recently changed his name, so I'll use the short form he uses that covers both.

How did we get here?

Before I talk about the surgery itself, I should probably first talk a bit about how I got to this point. Something I talk about in my recent poetry collection a few times is how long I've had bottom dysphoria. Like other kinds of dysphoria, bottom dysphoria is the disconnection between what you see and feel between your legs and yourself. For me, it started around 10 years old. At 23, I started looking up surgery options. By 30, I was actively talking about not wanting what I had anymore.

This is both a blessing and a curse. Waiting so long means that the amount of negative thoughts and feelings surrounding what I had impacted me and my relationships. It also meant that when I would have surgery, that I'd have to deal with a set of side effects as a result -- but let's not jump ahead.

The treatment for bottom dysphoria is surgery. Satisfaction levels of 97% for gender-affirming surgery put it as a clear solution for those who have access to it. The bittersweet thought that carried with me through the whole process was that it isn't available for everyone who needs it, something which I hope changes as medical care improves and anti-trans sentiment recedes.

But surgery isn't a button you press and come out with something different and go about your life. In this post, I'll be giving a frank account of my experiences in the hopes they're helpful.

Why WIH?

Here in Oceania (specifically Australia/New Zealand), we don't have ready access to good quality surgeons for bottom surgery. Instead, we look to other countries. Very quickly, both through searches and in talking to girls who have gotten surgery, you learn that Thailand is the home of some of the best surgeons available. For us, that's about an 8ish hour flight, which is certainly doable for something this big.

WIH provides both good accomodations as well as a full 30-day hospital/long-term stay so that if you have any complications, they can attempt to catch them and fix them before you leave. For me, and other girls, this was quite helpful.

WIH, and Dr. Chet specifically, also worked on a number of girls I had a chance to talk to. Knowing they were largely happy with his work, aesthetics, and function meant that I had a decent chance of similar experience myself. As with anything, picking your surgeon is a calculated risk.

Which surgery?

At the time of this writing, WIH offers four main styles of bottom surgery for transfeminine patients:

• Non-PI (Dr. Chet style scrotal graft)
• Laproscopic colon
• Laproscopic peritoneal
• Zero-depth

Each style has its advantages/disadvantages, including a pretty wide range in cost of the operation.

For mine, I chose the laproscopic peritoneal version, sometimes abbreviated PPT. I wanted natural lubrication and hopefully long-term healthy flora, though these certainly came with a much higher price tag than the non-PI surgery.

Pre-surgery prep

In addition to the battery of tests you need to go through, there are multiple psych evals and bottom hair removal.

The psych evals were at times unnerving, touching on parts of my life I don't often share. I saw them the same way I saw other stuff: working through the steps to get to the goal.

By far the hardest prep was bottom hair removal. I spent many sessions over a year and a half getting ready, and even then was unable to fully get all the hair permanently removed.

Dr. Chet now offers an additional surgery you can add on that is full electrolysis under general anaesthesia. It's not cheap, but if you haven't quite finished, for me at least it was a no-brainer. Better to have no hair than hair growing inside your vagina.

Bringing someone

I opted to bring a friend of mine who I'd been friends with for fifteen years. I'm trying to imagine what this would have been like without familiar support there.

Even still, it was rough. Rough to the point my friend and I decided to not chat for a while after the month had finished because of the strain on our relationship. To call it a trial-by-fire feels like a bit of an understatement.

More pre-surgery prep

Once I was through the homework and pre-paid for the surgery, I was good to go. We flew into Bangkok and then met up with our ride to the hospital. We got settled into our room, and I started sleeping where I'd sleep for the next 30 days: and electronic hospital bed. I had to learn quickly how to get comfortable.

Right after getting there, they also put me on the cleanse I'd need for surgery: a multi-day liquid diet and bowel cleanse. And when I say cleanse, I mean it. By the last day the nurses were checking to make sure what came out of me was nearly transparent.

I found the liquid diet to not be too bad, but the cleanse itself rather taxing. I had to push a lot of water and laxatives to get to the state they wanted.

Finally, after the hard work, I got the a-okay for surgery the next day.

Surgery day

Surgery day started off simply: no food no drink. After four days of strict diet this almost just felt like more diet. I pushed a bit extra right before the cut-off time and then just... waited. And waited. Terrified.

See, I may sound a bit nonchalant in the recounting, but the entire idea of surgery has always been scary to me. Would I die? Would I have life-long complications? Would I have to get a painful revision? Would I no longer be able to orgasm?

All of these worries tumbled around in my head as I waited for the hour of surgery, try though I might to distract myself.

When the hour finally came, I felt myself get pulled into a well-oiled machine. They took me on the gurney bed. Through the halls to another bed. Through many more halls. To the point where I was so dizzy and turned around when we finally got into the operating theatre.

I was in. I was committed. And scared to death.

I will say, the anaesthetist was a sweetheart. Very gentle. Very friendly. He helped put my mind at ease, giving me something to help calm me. Then, a few moments later, letting me know it was time to put me out.

The next thing I remember was waking up to "you're all done". Luckily no nausea. I laid in an observation room for two hours before they wheeled me back into our room.

Initial recovery

Initial recovery from surgery was absolute hell. Coming off general anaesthesia while having a fever made me hallucinate. During the surgery, my tailbone got re-injured (sadly a recurring injury I've had to deal with for years), so I kept having to ask the nurses to help position me to relieve tension on it. On and on.

While I managed to sleep the first night immediately after surgery, I stayed awake all of the second night. My brain was stuck in a state of permanent panic, assuming that if I let myself relax, I would die. I wish that were hyperbole, but it was quite real. I had trouble breathing, which kept recurring, and the whole experience wound me up incredibly tight emotionally.

Dr. Chet came to see me the day after my insomnia to see how I was going, and I admitted to not being able to sleep. He gave me something for it, which was quite effective. Again, a good reminder not to hide symptoms from the staff but to instead let them treat you. Sleep was important not just for my physical recovery, but for my emotional ability to get through what I was going through.

As part of the post-surgery setup, they also strapped automatic massage devices on my legs to help prevent blood clots while I was immobile. I hated them, but my friend hated them even more as they were loud enough to interrupt her sleep.

The first few days were them fighting my fever, checking my drain tubes, emptying my catheter bag, and checking my blood pressure. Rinse and repeat. It was clear they knew what they were doing and had done it many times before.

Next recovery stage

After the initial recovery, which took roughly a week, they began removing things they'd put on me after surgery. Some of them were the drain tubes from the surgical sight. One of them, I think was some kind of stress monitor. I remember this thing beeping at me when I'd push myself too much to adjust in bed or move a pillow.

As part of this, the packaging got removed. After this, dilations began. I remember still having my catheter in while having to do my first dilations.

Dilations

Dilations. The "flossing your teeth" maintenance that I was going to have to do for the rest of my life. Even knowing what I was in for didn't really prepare me. Though, let's be honest, I'd never had a vagina before, how would I actually know what to expect?

The dilators are hard tubes with rounded fronts that you insert for some number of minutes to help stretch and keep both depth and width of your vagina. For the first few years, you have to do this pretty religiously (though some folks find their own rhythms much sooner than that). After that, a few times a week, you dilate.

Dr. Chet's dilation schedule is... brutal. I'll just be honest. After a few days of doing it, I was already holding in the dilator for 120 minutes at a time before switching to morning/evening dilations.

Something I hadn't known going in was that the PPV meant dilations were going to be significantly more difficult. The peritoneal donor tissue sits at the back of the vagina and is prone to scarring pretty quickly. My initial depth was 6 1/2", but we never managed to dilate that far.

Which brings me to a story. When I first started dilating, the nurses would largely do it for me to show me how it was done. When the nurse working on me hit the back pocket of the PPV I started shaking and told her to stop immediately. In theory, I should have been able to push the dilator in to get the full depth. But I physically and emotionally just couldn't do it. So, rather quickly, I lost half an inch of depth from not dilating in that area.

(Worth a note: because of travel and being inable to always achieve full depth, I've lost another half an inch and am down to 5 1/2". I continue to work at this hoping to find a way to fix this, but I seem to just heal quickly.)

I'm still trying to learn the lessons about how best to dilate, so I don't feel ready to give tips here other than to say: breathe, listen to your body, and use good lube.

Getting around again

Noticing that my emotional state was bad and that I had a series of physical discomforts, Dr. Chet had the nurses get me standing and walking early. This was a mixed bag. I hadn't really eaten any real food in a week at that point, perhaps longer, so just the act of standing was rather taxing.

By the second day of trying I was able to take some steps and then soon was back to walking and being able to empty the catheter bag on my own. Just this bit of mobility helped my mental state noticeably.

It was slow going, though. Get up and walk to the bathroom a few times a day was plenty. Little by little I could go further, but if I pushed it, I'd have to take a day to rest.

Getting discharged

Finally getting the catheter out (which hurt like hell), I could be discharged from the hospital to the long-stay. Nurses would still come by, but only twice a day, to check on me. At this point I was to ramp back up onto solid food, be dilating to the schedule, and be managing pretty much everything else -- including the pain and anxiety medication they gave me.

It felt like switching from one set of priorities to another. Working on walking, recovering my energy, eating, restarting my digestive system, hydrating, dilating, trying to stay positive, etc.

I wish I could say that at this point things felt like they were looking up, but I was still struggling with anxiety. I was still very much "white-knuckling" my way through, trying to get through each day so that I could go home.

My friend managed to get me out a few times to go to the market, or the mall, which was good. I needed that. But more than anything, I wanted to go home.

Trying to go home early

Word got back to the nurses that I wanted to go home early, which then brought Dr. Chet. He wanted to give me a thorough check to see if I could get cleared. For that, they brought me into the operating room again, which pushed my anxiety sky high. I lasted as long as I could, but the pain and pressure of the speculum on top of my anxiety made me beg for them to stop the examination. Luckily, he had what he needed, so we wrapped and then I got the news.

Nope, I wasn't ready.

I had some unexpected swelling in my labia, which he wanted to treat through medicine first, and then surgery if that didn't work. Back on antibiotics I went, with a new set of cleaning tasks the nurses would help with.

You do it because it needs to get done. At least that's what I told myself.

Finally going home

Day by day, we managed. Finally, at last, it came time to go home. I woke up incredibly early (2am), dilated, then got ready for flying.

Flying sucked. Even though I knew it would and got us business class tickets, so I could recline the seat. I can't imagine flying after surgery with a seat that doesn't lean back far enough to take the pressure off the surgery site. Lots of drugs and bleeding it sounds like from other folks.

I also made sure I had wheelchair service. That ended up becoming importamt because I was coming to grips with a fact of life: I am now disabled. And will be for a few months.

My partner met me at the international hub in Australia and helped me get the rest of the way home and has since been my carer. It's been an adjustment.

Things we've had to figure out so far:

• How and where to buy lube that works well
• How to sleep in a way that doesn't cause additional pain
• How to get in some affection with my limited mobility
• How much I can reasonably do for myself and how much I can offload onto her

All of these things are on-going adjustments.

Where I'm at now

Dysphoria

I wish I could say getting surgery cured my bottom dysphoria. It has to, right? Isn't that what it's for?

Yet, that's still a process. Seeing my reflection does help. But all the nerves still send signals that my brain processes to be the thing that used to be there, not what's there now. I still feel what was there, like a phantom limb. This takes a while to improve, I know from talking to other girls, but it's left me feeling more than a little disoriented.

Pain

Pain and discomfort are regular guests, and ones I try to manage by finding healthy ways to rest. I also have to learn how much I can do before I have to stop. I don't use the meds often, but I will from time to time to help.

Emotional state

Going through surgery, and the resulting anxiety, was not without emotional cost. I'm still trying to pay that down. I still wrestle some with anxiety, though luckily far less now. I'm wrestling with other aspects of emotional health, too. Knowing that surgery isn't a fix-all and coming to terms with it. Knowing that I'll need to faithfully dilate as well is something I'm also coming to terms with.

Recovery definitely puts a strain on my body, which puts a strain on my mind and emotions. I'm still learning how to manage this, but it's very easy to see why depression can hit after you get home. It's a lot.

Was it worth it?

A question like this is far too early to ask. I still have months before the stitches come out. I'm still in the early stages of dilation training. I still regularly deal with pain and discomfort.

In short, I feel like I'm still in surgery and haven't fully come out, yet. I don't know what I have, I just know what I have to care for.

Day at a time

Just as last month and going through surgery prep and surgery, I continue to get through each day one at a time. I believe that things will get better. I look forward to all of this feeling more natural as my brain rewires. More than that, I'm looking forward to it all just becoming second nature.

We'll get there. It'll take time, but we'll get there.