hysto consult (long time no post!)
I could’ve sworn I’d updated this blog since I had my hysterectomy consults but it seems I haven’t. whoops.
I’ve had 2 hysterectomy consults so far. The first was mid December 2022 with someone in Maryland who decided that it didn’t seem he was the right surgeon, based on my chronic health issues & what my primary doc at the time was leaning toward for me. He referred me to his partner, the second gyn surgeon I saw. I’ve had one consult with her, which went really, really well. I’ll copy/paste that recap from a facebook post, with a bit of editing.
**CN: gyn appt w/ exam (includes details re: trauma-informed approach, my CP, etc) & Pap smear, discussing gyn surgery.**
**CW: multiple mentions of rape(s) (maybe one detail?) & sexual assaults (no details?), many mentions of the clinical term for front hole.**
I gave details about the ways she did the exam in case any of y’all are planning on having front hole hysterectomies. Bonus points if you also have cerebral palsy like I do.......
My second hysterectomy consult last Wednesday, Feb 22, went super, super well! I decided I am gonna go to that surgeon, Dr. D. I had zero panic attacks — just a lot of anxiety initially but I settled down once I got in the room. Dr. D’s medical student assistant, A, was super kind & helpful, as was D herself. I had 20-21 questions in total to ask Dr. Dieter, and she answered every single one, and her medical student assistant took notes of her answers in my yellow notebook with dinosaurs on it.
Dr. D seems very competent and on top of things, she was kind & empathetic, very patient, trauma-informed & a mix of empathetic and matter of fact, she explained things and answered clearly, & was trans-friendly and nonjudgmental including about me being off of T periodically including right now & body dysphoria being /kind of/ second in my reasons for wanting a hysterectomy. And she was good about all my disabilities that I mentioned. She has never done a vaginal hysto on someone with CP, so I will have to see if I know a spastic CPer who’s had that done, to see if they have any advice.
She and the medical student A were both fantastic, including very gentle, empathetic and kind whenever I brought up my PTSD from two rapes & multiple sexual assaults. I asked if she had any ideas for how to accommodate my PTSD if it’s aggravated by post-op pain, and she recommended pelvic physical therapy and starting that /before/ surgery and continuing during recovery and probably after that periodically (if I bottom for front hole sex again). I also need to ask her at some point to put in my chart for the hospital that I need nurses / staff to knock and make sure I’m aware they’re there before they touch me, and to tell me what they need to do before they touch me “down there”, etc.
I wish I’d remembered to use trigger warnings with them when I mentioned r*pe & SA. I’m sure they’re probably used to hearing about those things, but still. At least I didn’t talk about how young I was the first time.
Dr. D let me choose whether I wanted to have the exams done that day or some other time, so I decided to have a pelvic exam and a Pap smear done by her. (I hadn’t had a Pap smear since 2015!) The exam and Pap were actually totally fine PTSD-wise because I’d settled down, plus she was very good at doing them in a trauma-informed way: being careful, telling me what she was doing & what I’d feel, letting me see the equipment when I was curious. And they were not that physically uncomfortable. I asked her if she could see any internal signs of damage (scars) from my second r*pe, & she said she didn’t see anything, & that vaginas heal themselves really well since they’re designed to push out babies. She said the left side of the wall of my front hole is pretty spastic (from my CP), the right wall not as much. (The left side of my body overall is more spastic.) Not surprised. Not sure how or whether that’d affect my hysterectomy, and Dr. D didn’t say if it might or might not. Also she measured the depth of my bits with some sort of tool, since she’d said I’d (probably?) lose some of that depth from surgery (I think from not having a cervix anymore). She tested my nerve signals outside of my bits & they were fine even though my CP was acting up a lot and the surgeon and her medical student assistant had to help me with moving my body. Tentatively, she said everything looked fine, but I have to wait for the results of the Pap smear to know for sure.
Dr. D didn’t balk at all at me when she asked and I explained that my primary reason I need a hysto is trying to avoid pregnancy (& an abortion while trans) if I’m r*ped again, and second is dysphoria overall.
The whole thing went really, really well. She is not quite sure what surgical method she’ll use — totally vaginal, or vaginal plus laparoscopic, or (maybe, if my pulmonologist says it’s okay) fully laparoscopic if it’s difficult for her to get my fallopian tubes out — but she’s cool with doing the surgery so far! We both decided that, provided my ovaries are healthy (& provided I don’t have BRCA), I need to leave at least one of them in. Also, my primary doc had strongly suggested that I try to have spinal anesthesia, but I dunno, it makes me nervous, and Dr. Dieter and I talked about that.
She needs me to do a lot of stuff pre-surgery for her! I have to: find a new cardiologist (done & I’ve got an appt so hopefully it’ll go well!), have a full check-up & discuss a hysto & get a medical clearance; go to my pulmonologist for a check-up & a discussion and medical clearance & to try to figure out which test results and reports Dr. Dieter will want; see my primary doc for a medical clearance and to talk about T post-hysto; go to a reproductive endocrinology office she referred me to so I can see about egg freezing; go to a pelvic physical therapist; and get genetic testing done for BRCA (a gene mutation that ups the risk of breast and ovarian cancers).
That appointment really could not have gone better for me.
I was so stoked about the second hysto consult. but then the results of the Pap smear my current surgeon did in February came back positive for high risk Cervical HPV from this gay cis guy Joseph who I was in a really bad relationship with last year consent-wise and safety-wise. I had no external signs (no warts), it’s just in or on my cervix I guess. I know that it’s from Joseph because every one of my previous Pap smears had been negative for everything. being positive for high risk cervical HPV means that, even after I’ve had a hysterectomy including removal of my cervix, I will still have to have yearly Pap smears (they’ll just swab my front hole). my friend, a sex educator who’s had similar stuff going on and had the same surgery, they said even if I have a vaginectomy, a doctor will still have to swab whatever little bit of tissue is left to test yearly. knowing all this seriously fucks with my body dysphoria and my CPTSD. and that former partner doesn't even fucking care.
