So I am currently 8 days post op from getting the inflatable 3 piece pump. I’ve been kept erect for over a week and I’m gonna be flying out to London tomorrow for my early morning post-op appointment on Friday.
The pain during the first few days or so was pretty bad, mostly around the incision on the right side of my lower abdomen. As instructed, I was careful about not picking up anything too heavy or putting much strain on it.
Now that the pain from there has mostly faded, it’s my right testicle that’s really playing up. I believe that’s the one where the bulb is located, which will be used to inflate/deflate the pump. I’ve heard this isn’t uncommon. The pain isn’t unbearable, but it is a very persistent, throbbing ache that has made me edgy and affected my sleep. I’ve been taking painkillers very sparingly and they've helped a lot.
The erection hasn’t been too difficult to hide. Baggy tracksuit trousers and a baggy hoodie seem to do the job. I’m looking forward to getting it deflated though. Fingers crossed my recovery afterwards goes smoothly.
As many of you know due to my complications it has set me back a little physically and financially on getting my implant so I did order the elator as a temporary solution. I ordered it two weeks ago. I did order the free measuring package first, this was extremely helpful! After placing my order it arrived in 3 days. Unfortunately it did not fit correctly, the length was too short and the ring behind the head was too loose. I was very discouraged by this but the owner was extremely helpful and we got it exchanged. My new elator arrived today and it fits very well! It does seem a little tight around the head but I know it won’t come off while in use so I am not too worried about it! I obviously haven’t gotten a chance to try it out yet so I will make another post on how well it worked once I have the chance!
So, my surgery in London to get the inflatable pump is on March 10th 2019.... I'm pretty nervous, ngl, mostly about infection and stuff and it having to come out. Fingers crossed it goes smoothly.
I really want this done and I don’t think I’ll get that feeling of “completeness” without it. I want to start dating (tinder, maybe?), and even though I’m looking for emotional intimacy and not just sex, it would still be a real weight off my chest to be on a date with a woman and knowing that everything downstairs is working, so to speak.
Something I’ve never really thought about in depth before, but I think I might carry some guilt over my exclusive attraction to women. There was a dating advert on TV, and my mum casually asked me what kind of woman I’d be attracted to, and I got super flustered, like she’d brought up some kind of forbidden subject. But I’m not 100% sure if it was just really guilt or just normal embarrassment. It’s tricky to navigate my thoughts.
It’s comforting to just think of myself as an ordinary straight man, and it’s become a lot easier after the surgery, but I can’t deny being a straight trans man is still a lot different than being a straight cis man,
Ey if youre comfortable answering i wanted to ask how comfortable it is to pee standing up with fly-less underwear at a urinal. It seems strange to me cause in my case i gotta yank down the elastic so far and end up stretching them out. Then again im still relying on gravity
I don’t find it uncomfortable at all. I actually find that trying to pee through the fly of my underwear/pants is more uncomfortable for a few reasons. First, pre-erectile device especially tight underwear with narrow flys could push into the sides of my dick and make my stream a little weaker. Keep in mind that my stream was already weak because of a stricture though so not everyone would have that problem. Second, after getting my erectile implant my dick doesn’t have the same flexibility/maneuverability (ie it isn’t super flaccid) so it’s easier to just pull my underwear down a little. Last, when I pee through the fly of my underwear/pants I don’t have the same level of access to my perineum so I’m not able to clear my urethra as well. This can lead to a few drops of urine coming out in my underwear which can be extremely annoying. Nearly all of my underwear is fly-less so I don’t even think about it most of the time. I just go up to the urinal, unbutton and unzip my pants, pull my underwear down and out a little, and pull the shaft sort of to the side and over. I haven’t had any issues with the elastic wearing out over time.
Stage 1: April 25th, 2016
Stage 2: March 7th, 2017
Surgeon: Dr. Chen in San Francisco, CA.
For more information about phalloplasty you can look through my “phalloplasty” tag and for posts specifically about my surgery/recovery you can look through my “gendercube phalloplasty” tag.
What I had done/background info:
Placement of testicular implants, placement of erectile device (semi-rigid implant), and mons resection
Pre-op appointment (which answers questions about this stage)
How the erectile device is implanted
Surgery day:
My operation was set for 8 AM which meant I had to check-in at the surgical center at 7. My first stage was done at California Pacific Medical Center but because stage 2 is a very minor operation in comparison it was done at the Bon Air Surgery Center which is attached to Dr. Chen's office. This is also where I had my stricture repair in September. I arrived around 6:50 AM and was given the usual pre-op paperwork to fill out (verifying identity, consent to the operation, medical history, medication list, etc). When I handed the paperwork back in the nurse at the front desk said all that was left was a surgical fee that morning for $2,210... which no one informed me of prior to that moment. Because I was expecting to have surgery that morning I didn't have any cards on me or anything I could use to pay that fee. Thankfully after a few calls I got ahold of someone in my family and arranged to have the charge put on their account so I could have surgery and then transfer the funds afterwards. Once that was done the nurse at the front desk lead me to the bathroom so I could put all of my belongings in a locker (pictured below) and get changed into the surgical gown, hair net, socks, and leg warmers. After changing I took a few last minute pictures of my penis and scrotum to compare to later, locked up all of my belongings, and then walked out to the prep area.
In the prep area I was guided to a hospital bed and then answered a few basic questions as the nurse prepped my IV, took my vitals, put the heart monitor stickers on my chest, etc. I was a little nervous because I'd come down with a cold a few days beforehand but she, and the anesthesiologist later on, agreed that because my lungs sounded fine I could proceed. We were all joking around about it because I got the cold from Dr. Chen who got the cold from someone working in the surgical center and everyone was just getting over being sick. Around 7:30 Dr. Chen checked in, answered any last minute questions I had, and then had me stand up so he could mark roughly where to make the incisions for my mons resection. Around 7:50 another nurse and I walked to the operating room. This is where my memories get a little fuzzy. Usually I can remember everything up until the very moment that I'm put under and then have a pretty easy time coming out of the anesthesia but this time was different. One moment I was talking to the nurses and being positioned on the operating table and the next I was waking up in recovery very groggy, very out of it, and for some reason very frustrated/angry about how tired I was. I could hardly keep my eyes open but for some reason kept fighting the sleep. I remember being confused by it in the moment and not understanding why I was keeping myself awake. Eventually I went to sleep and felt significantly better when I woke up. Dr. Chen walked over at this time and briefly went over how the surgery went. He then asked if I wanted to see and when I nodded he closed the curtain around the bed, moved my gown out of the way, and then lifted the mesh underwear. I know I've gushed about it over and over but that was the moment I think I truly fell in love with my results. I finally felt a sense of connection that I'd been missing and I knew having this operation was absolutely the right step for me. There really is a lot of beauty behind these operations and what they can do for a person.
At some point (things are pretty fuzzy here too) Dr. Chen left and one of the nurses gathered post-op supplies while we waited for my ride to arrive. She asked how my pain was and when I replied that it was pretty much a zero she looked shocked and said she has no idea what they're doing differently these days but ED patients seem to have much easier recoveries now. In the past most guys right after surgery would say their pain was at least a 5 out of 10 but now she mostly hears 0's, 1's, and 2's. Moving caused some soreness but for the most part I honestly had 0 pain. When my ride arrived they wheeled me outside and I had to go through the usual post-op motions of figuring out how to get in and out of a car. Once I was home I laid down and mostly rested for the remainder of the day, occasionally getting up to eat since I was on heavy antibiotics and needed something in my stomach.
The recovery:
Because of the delicacy of this recovery I was extremely conservative with how much I moved, in what ways I moved, how often I changed the position of my penis/the erectile device, and to what degree I changed the position. This also meant I was extremely hyper-vigilant about any potential issues and was often looking for signs of redness, swelling, etc that could point to issues such as infection. I'm thankful for this and thankful for how much I knew going into this operation because less than 24 hours after surgery I noticed something wasn't quite right. That night (same day as my surgery) I went to pee and noticed a very very tiny bit of redness at the tip of my penis. I took a picture of this, changed the position of the rod, and told myself I'd deal with it in the morning. It was still there in the morning so I took another picture and texted Ursula who then consulted with Dr. Chen. Both of them agreed that it wasn't severe but we booked an appointment for me to be seen the next day just in case. At this appointment he said he wasn't worried, that I did the right thing by changing the position of the rod (getting tension off of the red spot), to keep shifting this position throughout the day, and to contact him if it gets worse. At 1 month post-op I’m thankful that the redness hasn’t gotten worse and am hopeful it will go away entirely over time. At the time I was also instructed to keep my phallus elevated as often as possible, so that directly tied into some of my issues with mobility.
Mobility-wise, the recovery from stage 2 has had it's ups and downs. I had minimal pain directly after surgery but after the initial pain medication wore off it increased significantly. For the first week or two I felt a dull ache, about a 3/10, in my scrotum and sometimes near the base of my pelvis when laying still. However when I moved to sit or stand the pain was immense and reached somewhere around a 7 or 8 out of 10. Surprisingly the majority of my pain was muscular and focused on my calves, thighs, butt, and lower back. These muscles ached and whenever I moved, even to adjust how I was sitting, it was ungodly painful. When I brought this up to Dr. Chen he was pretty surprised and said it was unusual (compared to other patients). Keep in mind that I stopped taking my pain medications 3 days after surgery, so I'm sure if I stayed consistent with them the pain would've been more well controlled. I stopped taking the medication because it was causing a lot of constipation and after the... ordeal I had with constipation after stage 1 I'm not taking my chances with it. Despite stopping the medication 3 days post-op and taking MiraLax I still couldn't 'go' for another 3 days. Because I had minimal pain when laying down and was instructed to keep my phallus elevated I spent the first 2.5 weeks post-op mainly laying in bed or on the couch with a roll of gauze propping up my penis. Because I had to keep everything elevated I felt a bit housebound because I couldn't really conceal myself under clothes. You're instructed to walk for at least 1 hour a day so I usually got my exercise in by pacing around one floor of the house. I also felt housebound because the house I stayed at has at least 20 stairs leading up to it. Though I could go up stairs it was very nerve-wracking because I didn't want to lift my legs for fear of that inadvertently moving the implant and causing it to detach. I found that going up stairs backwards, using the handrails to help with leverage and leaning into each step (pull myself to the right when going up a step with my left foot, push to the left when going up with the right), or lifting myself up as much as possible by going on my toes helped with this. It looks silly and takes forever to get up the stairs but it gives me peace of mind. Unfortunately I learned about 3 weeks post-op that I avoided using those muscles to such a degree that when I finally did it was extremely painful - much like how it felt to walk for the first time after stage 1. For about a week I had to slowly and carefully practice lifting each leg throughout the day until it stopped hurting. At 1 month post-op this is still a little sore and I'm still working on being able to walk normally again. Though it's been a month I'm technically at the halfway mark of healing since this recovery takes 8 weeks. Part of that 8 week restriction is not being allowed to bend down or squat down so if I drop something I either have to pick it up with my feet or wait until someone around me can get it. The 8 week restriction also applies to exercise in general, lifting more than 20 pounds, and sexual activity (including masturbation).
The reason you’re limited for 8 weeks is because this is when you’re at the highest risk of the implant detaching from the pelvic anchors holding it in place. You don’t necessarily feel pain when this detaches but you’ll notice that the implant doesn’t have the same level of rigidity/won’t stand up as well. For my own peace of mind I check the implant frequently throughout the day (less if I’m out and about) by pulling down my pants/underwear and seeing how well it can stand.
The outcome
Urination:
To both mine and Dr. Chen's surprise, having my erectile device placed fixed 99% of the urological issues I was having. I'd already undergone one urethral repair but a recurrent stricture meant I was looking at another one, this time using buccal tissue from my inner cheek, which I was kind of dreading. Going into these operations you have to accept the possibility of complications and how the subsequent repairs can impact your life but it's still disheartening when complications do occur. I'd say this is especially true when you're having more than one repair for the same issue. Though the issues weren't as bad as they were before my repair in September I was still having issues with pressure when peeing, a weaker urine stream, and having some urine leak out into my underwear after peeing. A compounding issue here is that my pee also had a strong and unpleasant smell. The first time I peed after stage 2 I almost couldn't believe the difference. You're warned beforehand that swelling can sometimes make it hard to pee, so with my previous issues I was expecting peeing to be a bit of an ordeal for awhile. Lo and behold, when I peed for the first time it was the strongest I'd seen my steam in almost a year, I peed in maybe 15 seconds, and there was almost no pressure. Like I said before, Dr. Chen was surprised (but very happy) to hear this. What we think happened is that there must've been folds or 'loose' areas in the urethra when it was flaccid that have now been straightened out by the ED, thus urine flows through the urethra easier. 1 month later and my stream is still strong, I have pressure every now and then when peeing but nothing substantial, I pee within an average time frame, I have almost no leakage afterwards, and the strong odor is completely gone.
Sensation:
I wanted to add a note here about how the ED has impacted my sensation. Going into this operation one complication you have to be aware of is the potential impact on your sensation due to compression of or damage to the nerves. Dr. Chen has never had a patient permanently lose all of their sensation but he has had one patient (a friend of mine) temporarily have this happen. Immediately after surgery his entire phallus was numb but he gained all of this back within a few months. In my case, I didn't lose sensation necessarily but some of it was dulled. Areas that were extremely sensitive became less so and a few areas where I had less sensation now had none. That said, this was/is also temporary for me and over the last month I've been gaining back that sensitivity. Dr. Chen said the fact that the sensation is dulled rather than gone is a pretty great sign that I should get all of it back. It’s likely that the dulled sensation was from inflammation/swelling since this can put pressure on the nerves.
Before I jump into the next section I want to make it abundantly clear, as always, that I in no way give anyone permission to save or distribute the pictures I post. No matter how well intentioned you are, even if it’s “just for you”, this still stands. I’m making a choice to share the details of a very personal step in my life and I’m not doing so lightly. If it ever comes to light that someone is sharing or saving my pictures that person will be blocked immediately and I will delete all of my posts without hesitation. Have some consideration and respect for others here - this is my body, not a dehumanized idea of “results” for people to look at.
Physical changes:
I’ve posted about this before but the difference in my package pre- and post-stage 2 is night and day. This stage inadvertently corrected a lot of small aesthetic issues I had with my results and finally gave me the ‘full’ look and feel that I was hoping for. I was ecstatic about my results after stage 1 but as the swelling and inflammation went down my phallus was, well, super flaccid. I could easily fold the shaft onto itself and the compression from underwear alone was enough to make everything look smaller because of how easily it could be squeezed. After stage 2 this is no longer an issue. The testicular implants fill out my scrotum perfectly and the erectile device increased both my length and girth by nearly an inch. The mons resection also helped with properly positioning the base of the shaft. Now I completely fill out my underwear and finally have that ‘full’ look I was hoping for. I’m hesitant about this but I added a picture as an example. (Left: 2 months post stage 1, Right: 1 month post stage 2)
Mental changes:
I'm adding this section because the mental changes that have come from this stage are too big to not talk about. Stage 2 completely changed my relationship to my body and has helped me feel a sense of peace, wholeness, and connectedness that had been missing. I was happy with my results after stage 1 but the urological issues I was having, aesthetic issues here and there, and not being capable of having penetrative sex prevented me from feeling fully connected to and appreciative of my body. The trans-related issues with my body are all but gone and the non-trans related issues are significantly easier to handle. I feel like I'm finally able to look into a future that doesn't need to revolve around surgery, recovery, money, and everything that comes with that. I've been processing through a lot of this in therapy and what keeps coming up is that I can finally live my life. I can see a future.
This will solely focus on the technique that Dr. Chen used for my operation in March of 2017 - this doesn’t reflect the techniques used by other surgeons or how the technique may change over time. Dr. Chen begins by making a small horizontal incision above the penis on the mons. The size of this incision can vary pretty widely depending on if you’re having a mons resection as well. If you’re just having implants placed then the incision is roughly 2-3 inches, with the resection the length will depend on how wide the mons is and how much underlying fat is present. If a resection is performed then Dr. Chen first dissects down to the lower rectus fascia and removes the underlying fat causing the prominent mons. He then dissects down to the connective tissue (periosteum) at the base of the pelvis where the left and right sides meet (pubic symphsis). I’ve included a picture below to show where this is. Here he places 4 anchor points that will hold the erectile device in place. As a side note, cis men have a suspensory ligament in their penis that attaches to the pubic symphysis, so in a way our erectile devices mirror this. After placing the anchor points they create a channel through the phallus for the implant to fit. The channel is made roughly through the middle of the phallus, avoiding the urethra which sits closer to the bottom. Next they measure the distance from the anchor points at the pelvis to the tip of the penis so they can choose the appropriate implant size. Once this is determined and verified they wrap the implant with Dacron graft (often used in aortic repairs). The implant is then placed into the phallus and secured to the anchor points in the pelvis. At this point Dr. Chen closes the wound with multiple layers of sutures and, if you’re having testicular implants placed, moves onto that procedure.
Throughout this surgical process the team is continuously cleaning every incision, channel, open wound, etc. using multiple antibiotic and antiseptic solutions as well as changing their gloves and gowns. These extra precautions are taken to reduce the potential risk of infection.
How long do you have to stay in SF this time around? And what would they do if they had someone with a longer phallus then you and they wanted to use the semi rigid device?
About 2.5 weeks. The stay could’ve been closer to 1.5 weeks but because Dr. Chen only holds office hours on Thursday I had to fly in almost a week early for my surgery on a Tuesday. Dr. Chen schedules all of his pre- and post-op appointments for Thursday because it’s the only day he isn’t in surgery (aside from emergency surgeries). I flew in on a Wednesday, had my pre-op that Thursday, had surgery the following Tuesday, and then my final post-op appointment was set for the Thursday of the following week. Ideally he would see you at least 1 week post-op, hence waiting until the week after surgery for my post-op appointment. If all goes well then you’re cleared to go home and can leave that day.Regarding the length of the semi-rigid implant, if the distance from your pubic bone to the tip of your penis is longer than their largest implant then Dr. Chen can use something called a snap-fit rear tip extender. These extenders are placed at the end of the implant (toward the pubic bone) to increase it’s length beyond the capacity of the implant itself.
hey, can you feel the rod inside you and does it hurt to move/use? thanks
The only time I’m aware of/can feel the rod is when I’m changing the position of my penis. As I put pressure on the rod to change the position I can feel small ‘clicks’ inside my shaft where the segments of the rod are moving but that’s about it. It’s fairly minor and I've been told over time/as the rod is used more the clicking stops. Aside from soreness from being so newly post-op I don’t feel any pain. Despite having the implant wired to my pelvic bone I’m not aware of it 99% of the time.
