Procrastination of medical decisions is over!

As a disclaimer I am very frank about things in my life, especially about mental health and about transitioning to a woman. Most people won’t talk about the grosser or more awkward things so there is a lack of information of not only negative things, but how people addressed them and if it worked.

This post is definitely TMI for some people, so you are warned if you want to read more.

Yesterday I went to the urologist to follow up on multiple issues. Because I talked about this in my old blog and not here I will give a brief recap.

Back in 2019 when I transitioned I underwent an orchiectomy, the process to remove testicles in order to stop producing testosterone. It was the only way to have my estrogen and testosterone numbers work out, and it did just that. However there were four drawbacks from it.

The first was Peyronie’s disease, basically the lack of testosterone causes penile atrophy and makes the penis curve in very painful directions, this normally is temporary, and while mine lasted way longer than normal, the pain is finally gone (and remarkably not as much atrophy as was assumed). This was a huge issue for years, and yes eventually I will probably chat here about it.

The second was a slight bit of dripping after urination, that is always a side effect anytime surgery in an area of your bladder system. The doc yesterday has a medication that may help with very little side effects, so here is hoping in three months it will work out.

The third is bloody seminal fluid when you orgasm. This sucks and is one of the two things that really bothered me (yes both things more than the pain in the penis due to Peyronie’s). This is caused by the prostrate and happens to older cis men and we can’t be sure if the timing is normal, or if the orchie did push it over the edge, either way it is the same. No pain, but it looks like a murder scene anytime I have an orgasm, so very uncomfortable mentally and socially if I want to seek out new partners (I am fortunate, the hubby doesn’t care about that).

Normally for most people this also passes, but for me for four years it has not and evidently even without the lack of testosterone my prostrate has not shrunk that much. The meds I am going to get for the urination may in fact help, but it’s only a possibility. So we are going to see how the meds work, if they don’t however there is a second, far more sure process as they have a surgical fix (low key surgery at that).

Basically they do a roto-rooter to the prostrate, and then do some laser cauterization and that should cover it. So the doctor cleared me if I want the surgery, which if by April my meds haven’t fixed it I will want the surgery, and preferably as soon as possible. Oh and its possible the meds might help with this as well, that is a double win!

The fourth is the remaining scrotal sack which turns out is significantly causing me dysphoria. The penis doesn’t, but the scrotal sack for whatever reason does. They don’t remove the scrotal sack on most transfem women initially, as normally it does tend to shrink a bit, plus it is the best option to use if I decided for a vaginoplasty and the rest of the surgeries to get rid of the penis and get a new surgical vulva and vagina (it is a key portion of the skin used for the vaginal wall). I have kept the sack for years now, mainly because I wanted to research the disadvantages and side effects of the surgery before committing either way.

If you gave me a magic wand to replace my AMAB equipment with a full cis-girl vagina I would take it in a heart beat. However surgical transition is very harsh including a major surgery with multiple procedures that not only remove your AMAB parts, but they have to replumb your urethrea and urinary track, move your sensitive portion of your penis and remake it into a vagina.

The positive, if it all goes well is a fully working vulva and vagina that can have penetrative sex. There are even variations of the surgery that it can lubricate itself (however the details of that immediately made me say no thank you for me). If everything is successful it is functionally the same for sexual interaction (with the bonus of no children, no cramps, no PMS, sorry sisters but we aren’t cis and we don’t have the same cycle because of it).

The negatives however are harsh and include the following:

  • A major surgery that has many weeks of recovery (usually at least 12 a lot of times more), weirdly enough though the surgery is not nearly as long as my facial as the normal penile inversion vaginoplasty is 2-5 hours and my facial surgery was 12-13, my recovery was much quicker.
  • Only an 80% (best case at this time, but always getting better) of retaining sexual feeling in your new clitoris (this is way to low a chance for me).
  • Many people have to have revision surgery, sometimes 2-3 times to get it fully right.
  • In order to use the vaginal part, you have to dilate the vagina with uncomfortable insertion devices four+ times a day for many weeks and even after years you still have to do it regularly monthly or so (if it all goes well).
  • Bladder and other internal organs are always at risk for injury from the surgery that may not fully go back to pre-surgery levels of use (I already have the urination issue, don’t need more possible urination issues).
  • No matter what the vaginal canal may close back up even with dilation because sometimes your body just says no, and I already had huge issues with hormones not wanting to work, this seems problematic at best for me.

On top of all this, I always found trans women with penises to be very attractive and just as much women as cisgender women, so my penis itself never bothered me (well it bothered me a lot when I was still a guy, but after transition my penis is fully functional and I actually like using it).

One of the biggest reasons though that I had kept the possibility of bottom surgery (other than I would like to have sex like a ciswoman if I could) was that it might fix the bleeding seminal fluid problems.

What I did find out was that my scrotal sack gives me dysphoria and I hate it. I had huge testicals and it turns out that my scrotal sack didn’t really shrink so it causes a huge bulge, I hate the way it looks, and I want it gone.

Well the doctor made it clear that vaginoplasty will not fix my issues. That was the largest reason I might have been willing to risk all the side effects and when he said that it made my decision easy. I won’t be getting a vaginoplasty so that means at the first opportunity I can have the scrotal sack removed. He comfirmed it is medically necessary if I want it, so its covered too.

This means I can move on from hovering over that decision and I feel good about it. Sadly I still get into fights with some trans-medicalists, but this means I can double down now that I am not waffling.

That means I got to walk out of my appointment yesterday with answers and options for all my issues. Two of them include surgery (both probably done this year if I can arrange it), one involves medicine and the fourth has already pretty much fixed itself.

I call that a good day.

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