SRS Followup

SRS can have a range of complications, although most of the common ones are fairly minor issues. There are a few complications that people justifiably are scared of because they can make your life anything from a short term misery to something long lasting.

A lot of us end up with one  or more incisions opening up to some small amount. The most typical place (as I best understand this) is right at the perineum where there is a fair amount of force. Mostly this sort of thing is just left alone and kept clean. They heal by themselves without too much fuss.

Infections can happen. My surgeon had me on a vancomycin drip in the hospital and then I was on cipro (I think) for the next couple of weeks. I have no idea how common these are, but clearly something to not get – not that you would likely be volunteering at the post op infection window.

My complication, a narrowing of the vagina, mostly happens when people don’t continue dilation properly. Not dilating can result in losing depth and width, and in some cases you basically lose your vagina. Correcting minor cases can be done by resuming dilation, although depth is very hard to regain.

In my case it wasn’t a lack of dilation, just bad fortune that a thick and hard scar formed.

The nastier complications include necrosis of various parts due to a compromised blood supply. You can lose just about anything “down there” from this.

Probably the worst complications are fistulas, a fancy word for there being a hole where none should be. The two that can happen (very rarely) are one into the rectum or one into the bladder. My surgeon had two of these over his history and both were self inflicted from the description. One woman dilated too aggressively trying to get more depth and managed to open a fistula into the bladder. Another wasn’t dilating correctly. The wall between the vagina and the rectum (cis or trans) is exceedingly thin and she pierced this.

OK, enough with the horror show. Many people my age can end up with a minor complication, but the odds were good that I wouldn’t have anything major. But I did end up with the narrowing at the entrance.

I visited a gyn yesterday and things seemed ok other than being somewhat raw and the scarring. She gave me a nice set of silicone dilators they use with people who have various vaginal surgeries, need rehabilitation or (and this was interesting) to ease losing their virginity (it was a great conversation).

Unlike the solid nylon dilators (as uncomfortable as it sounds) the silicone dilators are a little soft – I’d call them firm – and each one tapers about 1/8″ which means that there is never a “jump”. Until I can get a revision scheduled I’m using these to keep things workable. In addition I found out that if I want the estradiol cream to do any good it has to be used every day.

Fortunately we’ve had a change locally around Boston. Boston Medical Center now has transgender plastic surgeons (I understand it is more than one) and I can have the revision done there instead of flying back to my GRS surgeon (great guy, but the flight, hotel, and car would be at least $1000).

I’ve started that process. Since I’ll need general anesthesia I will probably have a couple of minor other revisions done that I would have ignored otherwise.

I think it’s important to count blessings. This isn’t something I wanted, but at least it should be corrected fairly quickly.



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