Lee says:

If you want to have a vaginal canal (maybe you just want one!), you can get full-depth vaginoplasty even if you don't plan to use your new vagina for penetrative sex-- but you would need to use a dilator regularly to maintain the depth and width of the canal.

If you don't want to be vaginally penetrated, even if you do it yourself with a dilator in a non-sexual context, you might find that minimal-depth vulvoplasty is a better option for you than full-depth vaginoplasty.

Minimal-depth vulvoplasty (sometimes also called zero-depth vaginoplasty) creates an external 'female' vulva, so you'd be able to pass while changing in the locker room for example because you'd have labia majora, labia minora, and a clitoris, but you wouldn't have an internal vaginal canal that could receive penetration.

If you know know that your feelings on vaginal penetration will not change over time as your dysphoria lessens after surgery, minimal-depth vulvoplasty is a good option because it significantly reduces many of the risks of medical complications associated with full-depth vaginoplasty.

But it may not be ideal for folks who think that their feelings regarding penetration might change over time as their relationship to their body changes and they want to explore different activities as they grow to be more comfortable in their post-op bodies and have lessened dysphoria.

If there's a chance that someone even maybe might become interested in exploring vaginal penetration, they will need to consider very seriously whether minimal-depth vulvoplasty is the right choice for them because it requires either using or discarding a lot of the tissue that could have been used to create the vaginal canal for full-depth vaginoplasty.

That means that there's no easy path to create a vaginal canal after someone has had minimal-depth vulvoplasty, so they can't just change their minds a few years after surgery and decide that they want a vaginal canal after all.

All that being said, minimal-depth vulvoplasty is a great option for people who want to have a vulva instead of a penis and are certain that they never want to be vaginally penetrated. There are many people who have had minimal-depth vulvoplasty and are very pleased with the results.

Of course, every surgery has risks, and I'm not getting into the in-depth risks and benefits in this post-- this post is more about letting you know what your options are regarding vaginal canal depth and the ability to receive vaginal penetration.

If you are seriously considering this surgery, you should make a consultation to discuss the risks and benefits and expected outcomes with a gender-affirming genital surgery team. For this type of surgery, you'll likely see a urologist and a plastic surgeon who collaborate on creating the genitals you want to have.

Lee says:

Research on transgender health and wellness after gender affirming surgeries can be helpful for transgender people who want to learn more about what their options for medically transitioning are.

Knowing the potential outcome of these interventions can help inform and guide the decisions of people who are considering getting these surgeries— and it can also help inform cisgender healthcare providers too.

As someone who had bottom surgery myself (I had ALT phalloplasty) I took a deep dive into the current research on the procedure before making my decision, and while the research was helpful, talking to people who had the surgery I was planning to have equally important.

That being said, if anyone is considering getting peritoneal flap vaginoplasty, this new study should have interesting results and is worth reading!

There isn’t enough knowledge out there about this topic, especially given the relative newness of the peritoneal pull-through procedure as a vaginoplasty option.

-

Here is the primary author’s Twitter summary of the study:

“📊Retrospective review of 199 peritoneal flap vaginoplasty patients

⏲️Median time to orgasm = 6 months

🚭Any smoking history = correlated with less orgasm recovery

Among those with minimum one-year follow up (89%):

🔀Orgasm pre-op not significantly correlated with orgasm post-op

🎆Rate of post-op orgasm was 86%, however,

🌷Not all anorgasmic patients were attempting to orgasm

📈Patients continue to become newly orgasmic past one year

Interventions for anorgasmia post-surgery include:

🔧Pelvic floor physical therapy for scars, hypersensitivity, or dilation difficulty

🩺Testosterone rx (orchiectomy is hormone intervention!)

👂Sex therapist with 🏳️‍⚧️ competency

❤️‍🩹Trauma informed care

We examined a rudimentary outcome (orgasm: yes/no). There is so much more to learn about the sexual health of transgender women and nonbinary people after surgery! It is a privilege to work for this community under the mentorship of Dr. Zhao and Dr. Bluebond-Langner at NYU Langone”

Full publication here: https://doi.org/10.1016/j.jsxm.2022.02.015

(It costs $31.50 to purchase access to the full article, but if you are in school you can request that the research librarians help you gain access to a copy of the full text of the study)

Lee says:

I’m two weeks post-op today and continuing my post-phallo supplies post series! I’ll write about which items I got, which ones I used, and which ones I found helpful.

(For those who don’t know what ALT phalloplasty is, see this post!)

Today’s post-phallo item is a wedge pillow.

Even though I’m 2 weeks post-op now I’m still using mine because I’m still not allowed to sit up straight in a chair (which means I can’t drive yet either).

[Image one: A person is reclined at a 20 degree angle. Image two: A person is sitting at a 60 degree angle. /End ID]

I’m allowed to lie flat on my back, or lie at a 20 degree incline (depicted in the first image by the half purple figure). This is sometimes called the Semi-Fowler's position.

When I was discharged from the hospital, they said I was also allowed to start sitting at a 60 degree angle but only for 15 minutes at a time. This is sometimes called the High Fowler's position, and it’s shown by the blue figure with hair in the second image.

So most of the time I lie on my back on a wedge that brings me to a 20 degree angle, but when I eat in bed then I flip the wedge into a higher 60 degree angle so I’m able to eat more easily. Then I set a 15-minute timer on my phone so I don’t accidentally sit up for too long.

I’d order the wedge in advance of surgery so you have time to use a phone app to measure the angle yourself and return it if needed. However, I’d recommend discussing your surgeon’s specific requests regarding angles before you buy a wedge so you can be sure that you’re getting one that meets your particular surgeon’s instructions in case they want you to be at a higher or lower angle.

If you can find a wedge that’s a 2-in-one and flips between the two angles you need, that’s perfect! Most 2-in-1 wedges are at 30 degrees and 60 degrees though, so you should try to see if the two wedge angles are listed on the website. I’ve even tried comparing the product image to my protractor!

I’d personally rank a 2-in-1 wedge as your best option, but if you can’t find one that meet your angle needs, getting two different wedges and swapping them as needed is your next best bet.

An adjustable wedge that allows you to remove or insert material is going to be more work because you’ll be unzipping it and cramming in the foam and re-zipping multiple times a day, so the only reason I’d recommend getting one is if you have a small living space and can’t store 2 wedges at the same time in a corner or closet somewhere overnight (you should switch to a normal pillow to sleep). 

Medical wedge sites will list the angle (example) which takes the guesswork out of the equation.

[ID: Lee chilling, laying back minimally propped up at the very bottom of the twenty-degree wedge]

Pros:

Cons:

Where to buy:

You can find a ton of them on Amazon! 

Other reviews:

Lee says:

I’m 1 week and 5 days post-op and continuing my post-phallo supplies post series! I’ll write about which items I got, which ones I used, and which ones I found helpful.

(For those who don’t know what ALT phalloplasty is, see this post!)

Today’s post-phallo item is an eye mask.

[Image description: A black, red, and blue eye mask. /End ID]

While an eye mask isn’t a form of PPE, it’s still essential to have when you go to the hospital!

(Sidenote: Everyone has been talking about PPE-type face masks for the past year but that’s something different! I did have to wear a face mask until I went into the operating room. Then I had the face mask on again when I woke up in the post-anesthesia care unit. But when I was transferred to the hospital room I stayed in for the next 6 days I actually didn’t have to wear a face mask because I am fully vaccinated and was Covid tested before my surgery. I did have to put a face mask on to go into the hallway, but in my own room I could be maskless.)

When you’re in the hospital, it’s never going to be 100% dark. There is always light coming from somewhere-- even when they darken the hallway at 10 pm, it’s still lit up.

The machines that display vitals and the IV machines in the room have bright screens, and they start to beep often which makes a nurse come in and flip on all the lights to see if your vitals are weird or if your IV bag needs changing.

The nurses also will come in literally once every hour all through the night and flip on all the lights to check your vitals and use the Doppler to see the blood flow in your penis. That’s in addition to the times they come in to help you get something or to address the beeping.

After the first few days the nurses come every two hours, then every 4 hours, but unfortunately the nurses aren’t the only people waking you up.

The residents came by at 10 pm and 4 am to talk to me and check me out, occupational and physical therapists would stop by during the day, you’ll have meals delivered, people come to change the trash, and so on.

Basically, if you want to sleep for longer than 1 hour uninterrupted, you’ll need to get an eye mask so the light from the hallway, the light from the machines, and the lights turned on by all the people entering your room don’t fully wake you up.

One of the most important things in choosing an eye mask is the adjustability. If the band that goes around your head is too big or too small, it won’t fit comfortably and it’ll pinch your head or slide off so it doesn’t block the light. So that rules out all the eye masks that aren’t adjustable and just have stretchy cords in the back-- the cord is always too tight at first, and then it becomes stretched out and there’s no way to re-tighten it.

While eye masks with Velcro on the straps are adjustable, Velco is also something that I feel like should not be near your head because it can make a crunchy noise and if you have long hair (which I don’t, but I remember what it was like!) it will get stuck in there. It’s also a little difficult to adjust with one hand.

I like the kind that have the adjustable slider (like the image above) so you can just move it over. These can get long hair tangled in too, but it’s not as bad as Velcro, and there’s no extra strap hanging off the end because it just changes the loop size so it’s neater and feels more comfortable when your head is laying on the pillow because you don’t feel the tail of the strap going off who-know-where.

Another thing I find really important in choosing an eye mask is the feel of it because I have sensory issues. I don’t like materials that are too plastic-y, or have rough seams and tags, but this eye mask feels soft and slightly silky so I feel comfortable putting it on my face.

I like that the masks come in a pack of 3 because it means if one falls on the hospital floor you can just put on another one. This is also helpful for people who get really hot and sweaty in the Bair Hugger because they might get the eye mask all sweaty too and want to use another one because the first one got gross. 

These eye masks are hand-wash only, but I’ve thrown them in the washing machine anyway. If you send some home with a visitor to wash and bring back to you the next day, you should tell them to put them in a delicates bag and treat them as delicates if you want them to last longer. But if you’re washing them in the washing machine pretty frequently, you might have to buy a new set after a year even if you use the delicates bag and cycle. But that’s plenty long enough to get you through the hospital stay after stage 1!

If there’s any single item you can bring with you to the hospital to have as soon as possible, I’d recommend the eye mask. The ceiling lights were shining in my eyes when I was laying on my back in the post-anesthesia care unit immediately after surgery before I got transferred to my room and I kept thinking “Damn, I shoulda brought one mask in my pocket!” because they brought me my clothes and other items they had taken from me before surgery back before my family was allowed to bring me all my things that we had packed for the stay.

Pros:

Cons:

Where to buy:

Other reviews:

Lee says:

I’m 10 days post-op and continuing my post-phallo supplies post series! I’ll write about which items I got, which ones I used, and which ones I found helpful. 

(For those who don’t know what ALT phalloplasty is, see this post!)

Today’s item, resistance bands, might seem like it shouldn’t be on a post-phallo supply list, but I’ll explain it!

After stage 1 ALT phallo, you have to support your penis. You can’t just let it hang down in your underwear right away.

My post-op instructions from the surgeon said:

As you might guess, showering while constantly holding your penis in one hand is non-ideal. 

While it is fully doable to shower while holding your penis, it is inconvenient because it leaves you with only one free hand. So you have to use that single hand to hold the shampoo bottle while opening the top without dropping it because if it falls on the floor you’ll need to leave the shower to get your grabber/reacher device. And you’ll only have one hand to use to hold your towel and dry off afterwards, and only one hand to hold your toothbrush and put the toothpaste on it... and so on.

Wearing the disposable mesh underwear filled with Kerlix gauze is also not convenient because it does allow you to have two free hands but the gauze gets heavy and wet as you shower and then you need to hold your underwear up with one hand again so it doesn’t sag. That brings you back to the single-hand-free problem.

That’s where the resistance bands come in!

[Image description: A stock image of a person exercising with a resistance band. 3 folded bands are visible nearby. /End ID]

My family has helped me hire Justin from T4T Caregiving to stay with me and my partner to help with my recovery, and he suggested that I try resistance bands to free up both hands! 

How it works: 

Unlike pantyhose, which some people have converted to a similar sling, the resistance bands don’t sag when they get soaked. Plus, they’re made of plastic which can be dried by hanging from the shower rod or by drying with a face towel so you don’t have to worry about them taking forever to dry.

You can also wear the bands when you aren’t in the shower and that will free up both hands so you can open a peanut butter jar on your own or cut an apple for a snack. They aren’t useful for propping while you’re laying down, but as long as you’re up and about they’re pretty great.

I bought these particular resistance bands because they are six inches wide which is just long enough to support my penis. Ideally you want a band with a width that’s the same or longer than your penis’s length to allow enough room to create a shelf for the penis. If you use a band that’s more like a cord then it won’t work because your penis will hang off the end and be only partially supported.

The bands I bought were each 5 feet long and came in a package of three. Justin cut one of the bands in half and tied each half-band to one of the full-bands to create two slings.

Here’s an image of me wearing one of my makeshift resistance band slings:

[Image description: Lee standing with a sling around their neck. The sling is made out of a blue band tied to a green band. The image cuts off before their crotch area so you only see the band going over their clothing. Lee has light brown skin and a small beard and is wearing a t-shirt in the first image and a black bathrobe in the second image. /End ID]

Pros:

Cons:

Where to buy it:

Other reviews:

[Image description: A nurse brings a large blue plastic bag of various supplies to my hospital bed. Her face has been censored out by a large circle. /End ID]

Lee says:

This is going to be another entry in my series of post-phallo supplies posts, but tonight I’m breaking the usual format of writing about a specific individual item. Instead, I'll just list all the key wound care-related supplies I was provided with (or told to buy) as one big group!

Sometimes the hospital will provide supplies like they did for me, and sometimes you have to buy supplies yourself. On occasion, the surgeon will order supplies for you using a company like Edgepark or Byram, and they'll bill your insurance and mail the items to your home.

Unlike most of the items in my post phallo supplies reviews which you can (and probably should) buy while you're still pre-op to prepare for your surgery date, I wouldn't reccomend buying wound care related supplies before surgery without discussing it with your surgeon first.

Different surgeons have different supplies that they reccomend, and what you need and how many of of each item you need depends on what you've had done in that particular stage.

So while I am not necessarily reccommending that you buy these particular items right now without checking with your surgeon, I did include links to the items that I was given by the hospital so you can click and see a visual of what type of item I'm talking about if it sounds unfamiliar.

Supplies:

Antibacterial Soap [This is just soap because I should wash my hands before and after I touch my penis.]

Aquacel Ag Advantage [This one is made with real silver so it can run on the expensive side. I place it over the open tip of my penis while it heals]

Aquaphor Healing Ointment (14 oz jar) [A thick layer of Aquaphor is used to cover my split thickness graft site and applied twice daily]

Aquaphor Ointment Body Spray (3.7 oz can) [The Aquaphor spray is great for adding a little moisturization touch up during the day]

Bandage Roll Gauze (6-Ply 4-½” x 4-⅛yd sterile) [The Kerlix bandage rolls are used to prop up my penis too, and I go though a lot of these]

Disposable gloves [I use gloves when I touch any open wounds]

Disposable mesh underwear [I cut a hole in the mesh to stick my penis though to help prop it up]

Disposable underpads [The Chux pads go on my bed to catch any blood]

Flushable wipes [I still have a Lot of painful swelling in my original anatomy so isn't comfortable to wipe with toilet paper yet]

Gauze sponges (4x8" 12-ply sterile) [I use gauze squares to help prop up my penis]

Gentle Foaming Cleanser [This can be used to clean my thigh in my daily shower]

Medical tape [This helps secure the Adaptic and Aquacel]

Non-adhering Dressing (5x9") [The Adaptic goes over my donor site which has been covered by a split thickness skin graft]

Non-Adherent Dressing (8x3”) [I use Tefla to cover my leg when I need to put pants on to travel to my post-op apointments]

Petrolatum Dressing [Xeroform can be used like Adaptic or placed under the glans ridge, but I didn't have glansplasty in this stage]

Other reviews:

Reacher/grabber

Lap desk

Resistance bands

Lee says:

I’m 8 days post-op and continuing my post-phallo supplies post series! I’ll write about which items I got, which ones I used, and which ones I found helpful. Today I’m posting about an item that I didn’t actually buy for myself but have found invaluable.

After ALT phalloplasty you’re not supposed to bend at the waist until your surgeon clears you to do so.

(For those who don’t know what ALT phalloplasty is, see this post!)

This makes it very hard to pick up things that you’ve dropped. If you drop your phone on the floor, you can’t lean over and bend at the waist to grab it like you might normally do.

Yes, you might be able to very carefully bend at the knees without bending forward at the waist and lower yourself down close enough to the floor to reach your dropped item that way.

But the knee on my donor leg is a bit swollen and painful, and it isn’t possible for me to bend it enough to reach the floor. This is also a pretty common experience early post-op.

So if you drop something on the ground, whether it’s your AirPods, cough drops, or toilet paper, it’s going to stay there until you can get your caregiver to come and pick it up for you.

That’s where this cool thing comes in:

[ID: Silver "grabber" with blue handle to squeeze which closes two blue suction cups]

When I was in the hospital, the occupational therapy team brought me a reacher/grabber, which I was able to keep and take home with me.

I found the same one I got from NYU on Amazon, and if you ask your team during your pre-op and they think that you likely won’t be provided with a reacher/grabber by the hospital I’d 100% recommend buying one for yourself!

The model I have isn’t able to pick up heavy things; it has a weight limit of 5 lbs. While this may seem like a negative thing, it’s actually really helpful because after stage 1, you’re not supposed to do any heavy lifting (over 5-10lbs) for 6-8 weeks.

So when I try to pick something up and my grabber isn’t able to do it, it helps me realize “oh yeah, maybe that gallon of milk is too heavy for me to grab anyhow”. I keep forgetting my limitations and my sensory issues mean it’s a little too easy for me to push past or not notice pain, so this grabber is a convenient way for me to check whether I can and should be lifting an item.

It’s been a lot more convenient than you’d expect; not only can I not reach the floor, I essentially can’t reach anything that’s below hip-height, including the bottom shelves of the refrigerator and my cat’s food dish and water bowl in their stand. So even if you’re not as clumsy as I am and don’t drop as many items, it’s still going to be helpful to have.

[Relevant advice: In the week before your surgery date while you’re still pre-op, you should go around the home and move all the items that you use to places where you can reach them without bending!]

[ID: My hand holding the handle but not squeezing the grabber-trigger]

And of course the no-bending-at-the-waist thing usually means no sitting for around 2 weeks— you can only stand or lie on your back!

If you’re lying on your back, it can sometimes be hard to reach things that are just outside your grasp like a thermometer on the far end of the bedside table, for example, because you won’t be able to sit up and twist to grab it. You’d have to get up out of bed and walk over there to get them, and you may need assistance getting out of bed if you have blankets on over your lap desk.

I’ve also found the grabber useful for everyday tasks! I used to have to move my bedside table and scoot the bed a little bit away from the wall if something fell behind the headboard because I needed to have enough space to stand there and enough room for my arm to be able to reach behind the bed. Now, I can use the reacher/grabber and it saves me a lot of effort to pick up those miscellaneous sleep eye cover masks that like to collect behind my bed.

[Id: The two blue suction cups on the grabbing end]

Pros:

Cons:

Where to buy it:

Other reviews:

Lee says:

I’m 5 days post-op so I’m starting my post-phallo supplies posts! I’ll write about which items I bought, which ones I used, and which ones I found helpful.

This lap desk is one of the best purchases I’ve made for my ALT phalloplasty recovery!

(For those who don’t know what ALT phalloplasty is, see this post!)

I’m supposed to either stand or lie on my back. So I’m not supposed to sit at all, ever.

At best, I can get tilted at a 20 degree angle while I’m laying down.

Being on your back makes it hard to see your screen which is where the lap desk comes in. It has the option to tilt up at an angle so you can see your computer screen while you’re lying down.

[ID: Stock photo of lap desk tilted up at an angle with a computer on it. Part of the desk remains flat and has a cup holder.]

The other cool option is just keeping the desk flat. This doesn’t sound very useful, but it actually is! That’s because the desk has legs and can essentially act as a bridge.

[ID: Stock photo of lap desk sitting flat with a computer on it.]

If you have had ALT phalloplasty, your legs have been though A Lot™.

If you want to see what I mean, look at my 4 days and 5 days post-op pictures posted on @datgenderqueerboi. [TW: those images show my leg post-phallo which is essentially an open wound. If you’re squeamish, don’t click!]

Often, people are told to leave their split thickness graft site open to air to heal. So there’s no bandage on it, and uhhh you might be able to guess that it isn’t comfortable for you (or conducive to healing) to have your leg rub against the blankets.

So you can put the lap desk over the area of your leg where the donor site and split thickness graft is, and then put your blankets on top of the desk so you’re fully covered in blankets and the heat is kept in but the blankets aren’t directly on your leg.

Pros:

Cons:

Here are pictures of me using the lap desk to explain what I mean:

(TW: you can see my thigh which is still healing from surgery)

[ID in ALT text]

Other reviews:

Where I bought it:

Lee says:

Still in the hospital, had my first stage of phalloplasty on Friday. I might be getting out on Wednesday.

I can’t bend at the waist or it could compromise the blood flow, so I can only lay down fully flat on my back or stand upright, no sitting up at all.

That means multiple people have to help me out of bed because I have to do it while staying like a board so my leg doesn’t bend.

Today I’m going to try walking with the physical therapists.

I have a wound vac on my left thigh draining the blood over the donor site and skin graft, and I’ve got a Foley catheter in because I can’t get up to use the bathroom yet. I have these squeezey things on my legs and my penis is propped up on some gauze.

My penis is looking very post-op. Right now the top of the penis isn’t closed which is a bit scary to see but the surgeons promise it’ll heal on its own. It’s a bit swollen, so I’m not sure whether I’m going to stay at this girth or not in the long-term or whether it’ll get smaller as the swelling goes down.

Long & thicc is a good way to describe it, but I think I could be happy with it without reducing the girth with excision debulking, we’ll have to see. I could also reduce the length when I get glansplasty but I’m not thinking that far ahead yet.

It’s not very convenient to have a big penis, but it’s also not bigger than some of the prosthetics I’ve used before and it’s made of my own body so eventually I could tuck a little if needed like how transfeminine people sometimes do.

I haven’t been able to measure yet, but it looks to be similar in size to the Transthetic’s Joystick that I have somewhere in my closet at home.

Update: I’ve managed to stand for 14 minutes and walk a few feet with the help of the physical therapy team.

Send us all of your questions about AMAB genital surgery!

A few of our transfeminine mods have gotten the procedure and are going to make a FAQ for our transfeminine resources, so if anyone has any questions about amab lower surgery please send them to our inbox! 

We really want to encourage you to send us all your questions about transfeminine lower surgery (it can be on anon if you want) because without frequently asked questions we can’t have a FAQ, so don’t feel shy about sending them in!

Bottom Surgery blogs!

Kii says:

Hello followers! I have been trying to compile a list of blogs to direct bottom surgery questions to, because none of the mods have a lot of experience with bottom surgery stuff. If you have a blog that has helped you out, or you have a blog yourself, please send us an ask or reblog with:

1. Blog URL

2. Surgery/surgeries they blog about

3. Whether the blog posts photos of post-op genitals or not. (Both are fine, but some people want to see finished results and some might be triggered by the photos)

I am in extra-special need of any vaginoplasty blogs!