The Basics

What is the procedure: Vaginoplasty with vaginal canal, using the penile inversion method

Who was the surgeon: Dr. Pierre Brassard

Where was the surgery: GrS Montreal (a subsidary of the CMC), in Montreal, Quebec; about two hours from where I live in Ottawa

When did it take place: June 19, 2023 at approximately 8:30-10am

Pre-surgical diagnosis: Gender dysphoria

Here is a link to an info sheet from Johns Hopkins University. Some minor things will definitely differ; but this is an excellent resource as it shows colour-coded anatomy diagrams that will show you the before and after for each section of genitalia. 

The Planning Stages

I had been seeing my endocrinologist for just over a year before began the application process, and my psychologist for just under a year. They had to team up on the application, as it was required for me to get two letters of recommendation as well as fill out a pre-authorization for surgery form. It's a rigorous process requiring evaluation that the surgery is necessary and in my medical and psychological best interest. They started the application in August on my behalf, and it was submitted in late September, 2022. I am so very thankful of the hard work my endo and psychologist did to assist me in this. I realize it took immense amounts of behind-the-scenes work; and I am forever grateful for the impact this has resulted in for my life.

I was notified that the application was approved on January 23, and had a list of documents that I needed to send. These included current medication list and history, medical questionnaire, consent form, medical disclosure (in conjunction with a physician), and image release forms.

In mid-March, I was contacted and had a phone appointment with a preoperative nurse. We reviewed my health information and I answered her questions that were necessary to proceed.

Eating Disorder and Surgery Prep - NOT AN EASY READ!

For those of you who don't know, before my transition, I was quite large. I never felt comfortable as myself and drowned that sorrow in food. I ate and ate, I hid my eating, I ate past the point of fullness and to horrid discomfort. I was miserable and I didn't know what to do about it. Eating seemed like a solution; a sort of temporary comfort. This happened for years; but most frequently my late teens.

Because of this, I ended up being over 600 pounds. 

As my gender discovery began, my eating changed as my view of my body and self image tanked. I ate less, did meal replacements, and eventually stopped eating. I starved myself for over a week at a time. I lost weight rapidly, noticeably, and the most important: unhealthily. I had no energy, could not complete tasks, and was at risk of serious medical complications. In a year, I went from 600lbs to 250lbs in the worst way possible. Since that, while heading into remission, I gained some weight back. I started to eat healthy and gained my strength and stamina back, all while in the early stages of my transition. In short, starting to transition to female singlehandedly solved my eating disorder.

After disclosing these struggles to the preoperative nurse, she took absolutely no sympathy and demanded I lose more weight before surgery could be scheduled. I reiterated the presumption that forcing this onto me would be harmful to my health considering my fragile state fresh into remission, and has a strong potential to worsen my eating disorder. She informed me that it was a requirement, and there are no exceptions other than to "achieve a weight to attain a BMI acceptable for surgery". Regular weight check-ins occurred by phonecall up until five days before surgery.

She was incredibly rude, unsympathetic, and disconnected from the circumstance and issues present. Unfortunately, my predictions were accurate. Due to GrS's harsh judgement, strict and unnecessary needs, and refusal to schedule a surgery until their punitively menial needs were met, this unfortunately backed me out of remission and worsened my condition severely.

Because of their frivolous and uncompassionate needs, I went back to starving myself, vomiting, skipping meals and nutrients; and for the first time participated in physical self harm which involved cutting, bruising, pricking, and other self-imposed measures of purposeful injury. It is immensely clear that their refusal to listen, care, understand, and quite frankly give a sh*t about anything to do with my health other than the pending surgery brought back and worsened my previously nonexistent symptoms. 

What was I required to lose? Twenty-five pounds.

Scheduling Surgery

After confirming my weight was "appropriate", my name was transferred to an administrative assistant who booked my surgery. I received a call on April 20; and they offered me a date at the start of May! In my mind, I wanted it that soon but knew it would not be feasible for me. It was too soon to get my affairs in order! I didn't have aftercare materials, time off arranged, or the mental capacity and strength to go through such an intense ordeal.

I decided June would be more appropriate; and ended up picking June 19 which happens to be my dad's birthday.

What is the Process? What Were the Pre-Surgical Requirements?

8 months prior: Receive referral for surgery by endocrinologist

6 months prior: Approval for funding from the Ministry of Ontario Health, and referral passed to the hospital; GrS Montreal

5 months prior: Health status meeting with GrS along with requirements to move forward stated. Pre, during, and post-op documentation received

3 months prior: Confirmation of health status, medications, and other necessary information

2 months prior: Scheduling of the surgery date

1 month prior: Travel plans arranged and postoperative medication fees paid

3 weeks prior: Stop feminizing hormones (in my case: Estradiol and Progesterone). They can have an increased risk of blood clots and surgical complications

2 weeks prior: Hotel bookings planned

1 week prior: Confirmation of surgery time and date for intake and discharge

5 days prior: Touch base with the clinic about final details and extensively review and confirm health status

3 days prior: Travel to Montreal

2 days prior: Take Covid PCR test

1 day prior: Complete 2 enemas, shave and chemically depilate the surgical area; from the pubis to the anus. Shower with chlorhexidine 4% antimicrobial soap

Morning of: Wake up at 4am, shower with chlorhexidine soap. Be at the hospital for 5:45am. Remove all piercing jewelry and be in the care of the hospital staff

What’s the surgical date and hospitalization like?

8:10 - Transfer to pre surgical waiting room. Only the patient is able to move to this stage; so I gave one quick hug and kiss through masks to Elijah as I moved onward

8:30 - Transfer to surgical theatre. When I arrived there, there were between 4-6 staff there preparing the room and surgical instruments. I removed the robe and was hooked up to an IV by the anesthesiologist on the left arm, and vitals checked by a nurse on the right, while another nurse hooked the oxygen tube around the ears and under the nose. After these, I was prepped for the epidural: crouching forward, dropping my shoulders while hugging a pillow. The anesthesiologist sanitized the area and felt for the appropriate insertion point while a nurse held me forward to stabilize me. I felt no pain from the needle’s insertion due to pain relief in the IV. This is the last step I was conscious for

The above times listed may seem quite early; and it’s because they are. I was the first surgery of the day

POST-SURGERY

10:10approx. - I awake in the post-surgical recovery room. I’m quite loopy; but recover in good time with staff by my side. I was iced on the surgical site, I had leg compressors hooked up to a machine that alternated compression between legs, a catheter in, my IV still inserted in the arm (now the needle was replaced with a plastic tube), and was very loopy

10:30 - I’m transferred to my hospital room, same as I was in earlier. I have the strength to call those accompanying me that my surgery is done, and after that I called my family (Mom, then Dad, and finally Grandparents). I am still quite weak; but the pain is minimal due to the anesthesia which lasted about 12 hours after surgery

11:00 - My partner Elijah came back to the hospital and was able to visit me in the hospital room

11:45 - My best friend Tanya came to visit me in the hospital room

12:30 - Unfortunately I was drinking too much water; was very nauseous, and vomited quite a bit. This was, even more unfortunately, my roommate Mena’s first encounter of me after her surgery as she was being wheeled in to our shared room mid-vomm

12:45 - I was administered anti-nausea medication through my IV and have felt better afterward

15:00 - Elijah and Tanya cam back to visit; one at a time

18:00 - We were served our first meal: bowl of chicken broth, saltine crackers, and a piece of cheese. Believe me, it’s more than I needed

20:00 - The anesthesia had worn off, and I was in significant amounts of pain accompanied by tears and screams. I ended up requiring two oxycodone to be able to alleviate the pain enough to sleep

I also had a laughing fit this evening (because I think I’m so hilarious) and caused quite a bit of ruckus. The severe laughter unfortunately resulted in bleeding from the operative site and I got a lecture from the head nurse about it. Apparently intensive laughter is frowned upon when you are still in a volatile post-surgical condition

Throughout the day, the nurses checked in to see how we were doing while the anesthesia wore off. They would take a bag of ice and lay it on separate areas of the body to see where we regained feeling. I first regained feeling around my stomach, then around my hips, outer thighs, knees, shins, ankles, toes, then the groin area. This whole process of regaining some feeling and motion happened over about six hours. After dinner, I was able to stand with the assistance of two nurses

June 20 - Day 1

6:00 - The nurses come to check vital signs

6:45 - The surgeon comes to check on healing and assess preliminary results

7:45 - Breakfast arrives

8:15 - Morning anti-inflammatory, antibiotic, and pain relief medications delivered

From now on, meals consistently arrive with antibiotics, anti inflammatory, and pain medication (extra strength tylenol). Extra pain medication (tramadol, oxycodone) may be requested and is given upon discretion of the nurse and severity of pain.

Meals are now substantial and regular. They focus on incorporating fruits and vegetables as well as proteins to regain your strength. Breakfast always comes around 8, lunch 12, and supper 5:30

On this day, I went for three walks; the latter two unsupervised. I still required assistive devices to do so

In the evening, a medical aid helped us to remove some clothes from our luggage to prepare for the upcoming day where we change from hospital gowns to our own clothing, and also from the hospital to a recovery home

The IV was removed this evening as I was deemed stable

June 21 - Day 2

After breakfast, we packed our things and changed into our own clothes. Up until this point, post surgery we have been iced on the surgical site 24h a day; but for the exception of walks. The catheter was removed from the collection bag and replaced with a valve. We collected our things and headed over to l’Asclépiade, the convalescence home which is conveniently next door. Our bags were marked to identify them, and brought over at a later time.

What is the care home? How does it differ from the hospital? What happens each day during recovery?

The care home, or l’Asclépiade, is a section of the CMC which is also staffed 24/7 by nurses. They are there to aid you when needed and provide you with hospital medications, however it focuses on helping you regain your independence to care for yourself in a controlled environment

June 21 - Day 2

After being transferred from the hospital, we were briefed on the changes in the new facility and given a short tour. We are now able to walk unsupervised; however it is tricky and stairs require slow steps and use of railings. It is simple to go to the washroom with the catheter attached to a flow valve; but I don’t end up pooing for a couple more days despite the constant doses of stool softener. My pain is low; and with that I am very mobile. I end up completing a lot of laps around the centre up and down both sets of stairs. Nurses continue to deliver breakfast, lunch, dinner, and evening meds (Tylenol, antibiotic, stool softener) as well as others as needed (oxycodone or tramadol and for me: frequent doses of Benadryl as I have a mild reaction to the antibiotics)

I also had the blood drain removed on this day. The drain was attached to a valve and plastic catcher which were inserted on the upper part on the mons pubis. The tube and rod were removed with a mild amount of pain. I would bleed from this wound for a few more days, so it was required to keep it bandaged

June 22 - Day 3

This was a sleepy day for me, it seems everything has caught up with me. I spent most the day sleeping or calling family or responding to messages to friends. I enjoyed laying in bed and taking it easy. I also had an incredibly small bowel movement; like the size of a chocolate almond. I thought I would have more after meals as well; but ended up just being incredibly gassy on the toilet instead

June 23 - Day 4

Unfortunately, this was a very high pain day for me. As the thick external bandage is stitched on above the lips, while it dried since it’s been un-iced it created a lot of stretching and pain. It makes it difficult to move. For context on the stitches, this is not skin stitched to skin next door with a small bandage in between; it is a stitch connecting the two labia majora around a very large piece of gauze. The scar from one end of the stitch to the next will likely be permanent; and are approximately five inches apart.

Today was the day I had a colossal poo: the first since the Sunday enemas. 

I felt a lot of abdominal pressure; so they offered me a suppository after breakfast. Once waiting the required amount of time, I did not feel the need to evacuate the bowels. After lunch and supper I tried again; but only a very small amount and the World’s Biggest Fart™ came out. It is important not to strain as to not rip any stitches; including a dissolvable one which connects the rectum to the vaginal canal. A couple of hours later, I sat on the toilet. It all fell out of me. I swear it was about a quart’s worth. Definitely a two-flusher. Thankfully due to the softener, it was quite soft. The stitches made it difficult to sit on the toilet. Due to the continual poo situation and worry that I might sh*t myself after the suppository, I didn’t get much walking in today

June 24 - Day 5

It’s here: external bandage day!!! Unfortunately I woke up with a ton of pain. I received some meds and waited for that to pass before heading to the examination room to have the stitches and bandages removed.

Five stitches that hold the bandage over the lips and vaginal canal were removed. It felt like freedom to be able to walk and move with less constraint. When the stitches were cut, I could feel the immense physical relief. At this time, it was also the first shower after the procedure. It felt like a relief to cleanse, but I was clearly not fully clean. My mobility is still extremely limited

June 25 - Day 6

Today the final external stitches were removed, as well as the stent in the vaginal cavity. These held the lower portion of the lips and perineum closed, and was very tense. The two stitches were removed; and finally I could have more mobility; yet still with caution. The stent was removed with little feeling.

June 26 - Day 7

I received a wake-up call just past six; it was time to get the catheter out! I headed back down to the exam room for gauze and catheter removal. Two internal stitches in the urethra were removed (the rest of the stitches left in me are dissolvable). The catheter came out quite swiftly with a quick pinch of pain. I headed back up to rest and ice before collecting my urine, the first time peeing completely independently! I had to collect it and report the quantity. I gave the nurses a call to have a bladder scan, which revealed I am able to urinate fully on my own. I was safe to return home with no catheter!

That evening, a surgeon (Dr. Alex Laungani) came by to perform a discharge follow-up. I was in good shape, and asked my final questions to him and the team. The nurses provided the necessary discharge paperwork and information for us to be on the road in the morning. Tanya and Elijah also came by as soon as they got into town for a quick visit

June 27 - Day 8 - Discharge day!

After breakfast, I performed my first dilation, had a shower, did myself up, and packed to hit the road! We were out by 9. After a quick stop for coffee, we were on the way back to Ottawa. I was back and comfortable in my apartment by noon. The road was a bit rough pain-wise; but otherwise a smooth trip. Thanks to Elijah and Tanya for helping me with transportation and immense personal and physical support on this journey!

What is Recovery at Home like?

It looks like a supportive partner that would do anything and everything to make my life the smallest bit easier

It’s feeling bad that I can’t pick things up that I drop on the floor

It’s sleeping half the day, and dilating and cleaning myself the other half

It’s being grateful that my mom came to visit and at the same time feeling guilty that I’m not a boisterous, healthy host

It’s realizing that my life is forever changed, for the better!

It’s being disappointed in myself that I can’t clean, cook, or be a functional member of my household

It’s looking forward to the future when I am healed and can see the world again

It’s understanding that blood family means nothing, receiving support and company from only a small handful

It’s struggling to feel adequate when compared to how I function a month ago

It’s learning that going pee will make a huge mess and startling noise every time

It’s not being able to sit normally, or at all and having to lay down at all times

It’s disappointing others because you cannot join them at the dinner table

It’s being confused and solitary, wondering what your friends are doing while you’re forgotten about

It’s being lonely. Tired. Alone. Frustrated. Worn out. Stranded. Confused. In pain. Crying. Yet - Remaining hopeful

All feelings aside, it is getting quite strange having my world reduced from my effervescent city life to the constraints of our one bedroom apartment. I still cannot stand or sit for more than a half hour, I can’t lift anything over 10 or 15 pounds, I have strict cleaning and care requirements for the surgery site that are so frequent they keep me home, and I am grateful for a special five people: my mom, Oma and Papa, friend Tanya, and partner Elijah that keep me sane during such a turbulent and desolate time.

I am currently fighting an infection on the surgical site as well as frequent blood in my urine. As much as the pain, pressure, fatigue, cramps, and problems continue and some even worsen, I continue to remind myself that each day is getting slightly better over time. I slowly regain my mobility and take fewer and fewer controlled pain medications which gives me hope.

Six Week Update

Here’s the updates:

I’m still housebound and only leave home for important medical appointments

I can’t sit for longer than about an hour, and standing for extended time is quite difficult. Laying down is the best choice still

I can’t walk very fast and I still waddle everywhere

I bleed from the vaginal canal daily. This is mainly due to hypergranulation, a raised and troublesome pink/red scar tissue caused by stress and infection. I had to get a section of this burnt off by the nurse practitioner with silver nitrate, similar to how they would burn off a wart

I’m still very tired. I need a lot of sleep to recover, and the dilation combined with cleaning routine is still very taxing

I’ve started physiotherapy which has only now started to decrease my swelling

With all of the recovery going slow, I try and entertain myself while indoors. Other than having visitors over, we have been busy around the house. Artwork and decor goes up on our new walls, and we get up to all sorts of schenannigains too! We have spent time baking, cooking new recipes, watching movies (keep the suggestions coming), and today: JAM MAKING! We completed 14 jars of peach jam and 5 jars of peach-raspberry. Blueberry, rhubarb, and more raspberry are on the ready once I get more pectin.

Thanks for the help!

Going through such a physical and psychological change such as a gender-confirming surgery takes a lot of help. I have some BIG helpers that have made me feel so loved, appreciated, and supported over these past few months, and I know it is never-ending!

The first person goes to my lovely partner: Elijah!

Elijah very quickly took on roles such as chef, maid, shoelace-tie’er, bathtub filler, grocery runner, appointment partner, and the best and biggest emotional support I could ask for. I have had nothing but love, compassion, care, stability, poise, and empathy as I go through this life changing process. They have held me in their arms through pain and caught every single one of my tears. In a life where most of my past relationships were terminated due to my ongoing transition process, having their love only reinforced during this process is truly unbelievable. I really cannot be more thankful for the support they give me, every single day.

I am immensely thankful for the generosity from my friend Tanya. Long before my surgery was even approved by OHIP, she offered to drive me and pick me up. This has been a lifeline as if I were traveling alone, I would have been in Montreal before my surgery and starting my recovery alone. This way, I could have my best friend and partner with me at the most intense, stressful, and painful time of my life.

I’ve also been very grateful for my grandparents, Oma and Papa, who have stayed in constant contact with me. We talked daily while I was in the hospital, and they check in extremely frequently during my recovery to make sure I am doing well as well as provide wonderful entertainment!

Two Month Update

Today marks exactly TWO MONTHS since my vaginoplasty surgery. A lot has happened this summer, and I am very happy for it all.

We decided to celebrate and join in the festivities by taking in the fun at the Capital Pride Pageant! This is my first major outing for the summer, and a perfect time to celebrate the recovery milestone. Eli and I headed out for dinner and can now once again, with strict limits, begin to have life as quasi-normal: in very short spirts and increments, pain permitting. In short, I can’t head anywhere more than a few hours, and not without an assortment of pain medication options, handful of pads, and a spare pair of undies - just in case!

The day-to-day:

I am still fairly incontinent. I have to use the bathroom frequently and have soiled my pants numerous times

I still have open wounds and sores, and with that the surgical site still bleeds and oozes daily

Pain with dilation and sitting hasn’t decreased. Standing is still limited, so laying remains my best option

Physiotherapy has decreased the swelling and helped me be more mobile. Despite that, I still remain quite swollen and my mobility remains limited

I can only leave the house for appointments or short outings. I tire easily and the next dilation and cleaning is only hours away

Dilation needs are still three times daily. This means that 6+ hours daily are required for care, maintenance, and hygiene of the surgical site alone. More time is dedicated to physiotherapy stretches, staying mobile, and self care. Essentially, the recovery is still EXTREMELY taxing!!!

There is still occasional blood in my urine and stool, and creating both remains uncomfortable

I’m still using steroid cream to help with the hypergranulation removal’s pain and bleeding

Some two month milestones after surgery:

I can resume swimming and light exercise

The dissolvable stitches are finally gone

I’ve met with my endocrinologist to assess my recovery progress and hormone medication. Due to the surgery, my body now has no gonads to create the body’s natural hormones. With the commitment of surgery, this means I will need to remain on HRT with regular check-ins for life to remain healthy

It’s time to start with Vitamin E to help the scar healing. Daily, I use Vitamin E oil on the thick, external scars to help aid recovery and decrease the scars’ appearance over time

What have I learned?

I had to learn what a vagina looks, feels, and smells like. I didn’t know much about what to expect beforehand and despite all of the unknowns, pain, and slow recovery, I am confident I made the right choice

I remember being in the hospital, worrying that I didn’t have a clitoris and talking to my roommate about my fears multiple times a day. Funny enough, I didn’t even know where it was, where the urethra opened, the location of the canal, or much else. It didn’t help that it was bandaged up and swollen for so long. Now, I feel comfortable with my new genitals. I can see different parts as the swelling has decreased. I can feel around and start to explore. The transformation is truly magical. I am grateful for the chance to have this surgery. It truly feels like everything has clicked into place; like I’m living a life that accurately suits me

I’ve finally learned how to love myself, how to take charge of my life, and be comfortable as me. This is all, of course, in the early stages. It feels so surreal to not constantly worry, stress, and panic over the thought of having a penis. Having a vagina removes at least 25% of my daily stress and mental discomfort

General update, and: What is Dilation? What’s the Purpose and How does it Work?

Three Month Update

It’s been three months since I’ve left the hospital, and a LOT has happened! It is about time that I’ve started making progress in my recovery. Finally, this has begun! What’s new?

-Dilations have changed to two times per day. This significantly clears up the middle of my day so I can focus on doing physiotherapy stretches and incorporating more light activity

-The chronic pain has decreased significantly. Now it is normally just triggers that cause me pain and discomfort

-Sitting is the most difficult activity for me. Sitting for more than an hour causes me to start bleeding again paired with extreme amounts of pain

-Second to that is stairs. Going up is easier than going down, where I have to pause step by step. Thankfully our building has an elevator and most places I go also have one, have few steps, or a ramp

-I am still surprised by how rocky my balance is. Walking down the sidewalk is still difficult. I seem to zig-zag all around. It is incredibly challenging on uneven surfaces like slanted sidewalks or pathways

-Last week, we established a treatment regimen: I have to return to the Nurse Practitioner weekly for treatment of hypergranulation tissue. It must be burnt off by silver nitrate. I have quite a bit of affected tissue and this causes the pain and bleeding with dilation. The weekly visits will continue for 6 weeks or longer

-Another small complication: I have some hair growth in the vaginal cavity. This is quite common as the skin used, as mentioned previously, is from the scrotum and inverted penis. If a few follicles were missed in the cauterization process, it can cause hair to grow in the canal. These are simply removed during a vaginal exam or, in the case of extensive growth, re-cauterized

-At three months, you can have penetrative sex again. Of course, we are being careful… I don’t want to get pregnant!

Exploring, celebrating, and getting to know my body over the past few months has been the single best experience of my life. I feel like I have truly come alive! Of course, there is still so much to go in the recovery: more time at home, endless dilations, and a year or more of time to be patient as my body recovers. Despite the journey experienced and what uncertainties lie ahead, I can truly say that the chance to undergo this major surgery was certainly worth it. I look forward to future improvement to experience life with more normalcy!