My GRS With Dr Toby Meltzer (2/2)

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On the ninth day after surgery (which is only six nights of VIP status, not seven as stated in Dr Meltzer's information pack), I was discharged from the hospital. We spent the next six nights in a motel in Portland, to give me more time to recover before the long flight back to New Zealand. I resumed my HRT, though without the anti-androgen, of course. We chose a motel relatively close to the hospital, but with hindsight that wasn't a particularly helpful idea. The trip to the hospital was a one-off journey, and staying somewhere close to plenty of good food outlets etc would have been more sensible.

It was a bit of a walk to the local restaurants, which was the most exercise I'd had since the operation. Sitting at the restaurant tables proved to be a bit uncomfortable, but I coped well enough, and the change from hospital food was welcome (though the hospital meals had been very nice, with a good selection of vegetarian options to choose from for each meal). Most of the time was spent on more dilation, reading, and television. After a couple of days we went out to the laundromat, and the following day I was taken out for a brief tour of Portland, and spent some time (and some of what little money I had left) at Powell's, one of the world's largest book shops. Both excursions tired me out a great deal.

We had another appointment with Dr Meltzer before we left, to check on my progress. He seemed perfectly happy with how things were going, and not at all concerned about my upcoming flight. Though it had been less than the one week specified in the documentation, he recommended reducing the frequency of douching to once a day. There were some large lumps under the skin of my labia, but these didn't concern him either, and they eventually disappeared.

The international plane trip was not as bad as I'd feared. The airplane seats weren't too uncomfortable to sit in, though visits to the bathroom were still a welcome relief. I don't think I slept, but I read, listened to music, and watched some of the inflight film program. We had an empty seat next to us, which was lucky. It wasn't practical to dilate at all on the trip, but skipping almost a day didn't seem to do any harm. The first dilation when I got home was a little more difficult and painful than usual, but no real problem, and everything was back to normal after that. I started including the second dilator size in my dilation after a few days, though I continued to start with the smallest each session. Over the course of a few weeks I moved up to the fourth and largest dilator, and stopped using the smallest at all. I got the hang of reading with one hand occupied holding the dilator, which solved the problem of boredom setting in.

The area at the base of the vagina looked the messiest. Several incisions came together there, and there were two places where the seams came apart slightly leaving miniature chasms. This was only a cosmetic issue, as the bulk of the healing had already occurred, but they still concerned me until they finally closed up. Several yellowish white sutures came loose over time, some with visible knots, which took at least a couple of months to disappear completely. I cut free the ones that dangled out the most with scissors. Sutures could also be felt inside the vagina, but by then douching was no longer washing out a significant amount of debris.

The drain holes and the abdominal suture sites didn't look too great. All four were deep indentations with yellow gunk at the bottom. But over a few weeks they gradually became smaller and less gunky, one side faster than the other. The clitoris was covered in black stuff for a long time. Yellow gunk gradually appeared beneath the black stuff, pushing it out and away from the clitoris. Maybe eight weeks after the operation, the black stuff (which had looked a bit like a scab, but felt soft and squishy) was hanging loosely enough from a thick trunk of yellow gunk that I was able to cut it off. The yellow gunk disappeared over the next few weeks.

I returned to work part time one month after the operation (once the recommended frequency of dilation went down from four times a day to twice a day). From the following week I worked almost full time, though I had shorter than normal days for a few weeks to make up for going back to work early and to fit in the time for dilation in the morning. My energy levels were a bit low for a while, but not enough to prevent me from working (a desk job).

Generally it looked and felt pretty good - most of the scars were barely visible. The sites of the abdominal sututes were just small faintly pink areas, covered by hair, and looked likely to eventually disappear altogether. The drain sites were somewhat larger, darker areas (one more so than the other), also covered by hair. One small incision scarred badly, but it wasn't in a highly visible location. The clitoris wasn't quite what I expected, being more of a pink region of skin over a lump than an actual structure on the surface, but was very sensitive and there was clearly a lot more to it underneath. The labiaplasty would make major changes to that area's appearance, so I wasn't too concerned. The whole genital region seemed to be nicely sensitive, though there was a patch between it and the navel that was still numb, where the skin was cut free from the flesh to allow it to be stretched down a bit. The hair in that region took longer to regrow than the rest, and was darker than it had been. My energy levels were back to normal, and dilation continued without incident.

The urethral opening was a bit of a problem. It was located too far back, almost inside the vagina during dilation, and it aimed consistently much too far forward - apparently a common complaint. It seemed to be following more or less the direction established by the catheter during the first eight days of recovery, so perhaps changing the way they deal with that would prevent the same problem occurring with future GRS patients. Hopefully mine will be fixed at the labiaplasty. I had some more electrolysis in preparation for the labiaplasty, though much less than was needed for the original vaginoplasty.

By the time the urethra healed fully, it was consistently pointing slightly upwards. It was impossible to use the bathroom without holding a big wad of toilet paper between my legs to prevent urine from going over the edge of the toilet on to the floor or my pants. This was not random spraying; the stream was quite steady and directed, it was simply impossible to aim it sufficiently downwards. While not a serious complication, it was decidedly irritating.

I was reasonably happy with Dr Meltzer's work. He did an excellent job of preserving sensitivity in the genital region, though the patch above the pubic hair was still rather numb. There was no problem with vaginal depth, and it could stretch to accommodate the widest dilator in the set. The cosmetic result was acceptable, considering that I hadn't had the labiaplasty yet. The least pleasing aspect of the surgery was the positioning and angling of the urethral opening, though at least it works. I was certainly glad I had the operation; it was a great relief to have something approximating a normal body at last.

The labiaplasty was even more vital than I'd expected, and not just for the cosmetic appearance when naked. The vaginoplasty on it's own wasn't enough to make it possible to wear a bathing suit in public, for example - because the labia did't join up at the top, the gap between them was very visible even through fabric. The urethra definitely needed correction, and the extra protection for the clitoris would be welcome.

I was not entirely convinced his work was worth the exorbitant fees he charges (approximately US$14,000 for the vaginoplasty and another US$3,000 for the labiaplasty, and rising (now $3,600 for the labiaplasty at last check)), but obviously I couldn't try out GRS with cheaper surgeons make a comparison. If you're willing to pay, he does a good job. And whichever surgeon you choose, having someone with you helps immensely.

I arrived back in Portland two days before the surgery, to give me time to get over the jet lag. It was almost a year since my last visit. Although I was travelling on my own this time (an extra airfare would have been prohibitively expensive for such a relatively minor operation), I was staying with friends rather than in a hotel. On my second morning in the city, I went with out breakfast and was dropped off at Dr Meltzer's office.

I didn't get an opportunity to speak to Dr Meltzer before the operation. I changed into the hospital gown and foot coverings (I can't think of a better word to describe them), then a nurse shaved the surgical site, applied a generous dollop of Emla anaesthetic cream, and I think gave me some kind of sedative. After waiting around for a while, I was taken in to the operating theatre. I was able to have a personal stereo and the soft toy I'd brought with me on the operating table. Once I was on the table, my feet were put up in stirrups, and a cloth was put up to block my view, with the base around my waist and the top tilted forward towards my head, so I couldn't even see the ceiling on Dr Meltzer's side of the room.

The surgery began with a series of anaesthetic injections. One in particular was very painful, despite the Emla. However, they did their job well, and the surgery itself was painless. I could feel that something was going on down there, presumably from tugging on the surrounding area outside the effect of the anaesthetic, but it didn't bother me unduly. After a while I started listening to the tape I'd brought with me. My left leg got quite uncomfortable after a while, and adjusting the position of the stirrup didn't help much. This was probably the worst aspect of the surgery. Also, despite my best efforts to prevent it, my bladder got up to it's usual tricks and started to bother me half way through. I asked when the catheter was going in, and was told not till the end, but it could be put in early if necessary. Fortunately I was able to hold out to the end without too much difficulty. The insertion of the catheter was not pleasant, but not as bad as the injections at the start.

The surgery took somewhat over an hour, before I was released from the stirrups and allowed to get up. There were dressings on the surgery site, with the catheter tube emerging from the side and attached to my leg. I was able to shuffle back to the examination room easily enough, took my antibiotics, and got dressed. After that, I was taken outside in a wheelchair, but had to walk down the steps outside to the car. Dr Meltzer's driver took me to the Eastmoreland hospital admissions desk and left me there. I had to sit and wait for several minutes before the admissions clerk could deal with me, and then started walking to my room. I got about half way there before starting to feel seriously nauseous, and leant against the wall while the nurses got me a basin to puke in (just barely didn't need it on this occasion), and a wheelchair to take me the rest of the way.

The room itself had three beds, which I wasn't happy about. If I'd been staying more than one night I would have insisted on a private room, but under the circumstances it didn't seem worth making that much fuss. As it turned out, nobody else was brought in, though another Meltzer patient had been expected; I didn't find out what happened to her. After collapsing on the bed for a while, completely drained by the exertion, I changed back into a hospital gown and got in to bed properly. I had been extremely displeased with this whole rigmarole. Dr Meltzer requires "bedrest, lying as flat as possible until the moring after surgery." That is not at all consistent with performing the surgery at his office instead of at the hospital, and the only reason for it I can think of is so he can make a bigger profit by not paying hospital fees. The hospital's performance was appalling as well.

I spent the time in hospital watching TV and dozing; I didn't feel up to reading. Nightfall didn't change this, as I was unable to sleep properly due to a stomache ache and uncomfortable legs from lying flat. I was able to eat very little. At around 10am the next morning, the catheter and drains (much shorter than the ones used for the vaginoplasty, and not attached to bottles) were removed. This was fairly quick and painless. I got my first look at my new labia, which were black at this stage, but meeting at the top. They were stuck together, and I was a bit nervous about pulling them apart to apply the antibiotic ointment, but it wasn't a problem and the flesh inside was unexpectedly pink and healthy looking. There was a line of stitches above the labia.

After this, I tried taking a shower. I'd requested a shower chair, but there was some furniture in front of the bathroom door preventing it from opening enough to get the chair inside, and I had to wait for someone to come to shift it (I was far too weak to attempt such a thing). Even sitting down most of the time, the short shower exhausted me, and I vomited when I got out. A while later, I was picked up by my friends and taken back to their place, where I slept. That evening, I was well enough to eat, and watch a video. The next day, I was feeling noticeably better, and went out shopping for a little while, but had to sleep again afterwards. The day after that, I flew back to New Zealand. I found the seats on the plane remarkably comfortable, and survived the long flight well. Over the next few days, I steadily got my strength back.

The blackness along the edges of the labia seemed to be the same stuff that had covered the clitoris after the vaginoplasty, with the yellow gunk underneath. It shrank over a few weeks, with two largish bits breaking off. There were large numbers of sutures along the inner edges, and the pieces that came loose seemed to be so riddled with sutures that the flesh just didn't have enough connection to my body to remain viable. The rest of the sutures gradually came loose one by one over a period of two or three months. The attractive pinkness between the labia unfortunately faded as the swelling and blackness receeded, with the whole area returning to the appearance of more or less normal skin, and the labia became less clearly defined.

The surgery was pretty thoroughly healed within a couple of months. There were still pink lumps along the line above the clitoris, which might have been bad scarring, or a result of buried "dissolving" sutures that hadn't dissolved. The visible sutures along that line were the last to disappear. This and the other scarring were well hidden by the pubic hair, which grew back normally, and the folds of the labia. The inner labia were noticeably smaller in the two places where the black stuff had come away, but healed nicely. The clitoris looked a bit better than it had before the labiaplasty, but more exposed than I'd have liked; the labia did not come together at the top as much as they should, due to the sutures pulling apart somewhat at this high stress point. I'm not sure how much of this was due to being forced to move around so much immediately after the surgery.

The labiaplasty did not make as much difference as I'd hoped. The gap between the the labia is still more visible than I'm comfortable with, and the urethra is only marginally better. The aim of the urine stream is now generally downwards, but still farther forward than I would like; on one occasion it has gone over the top of the seat, but that appears to have been an isolated incident. The urethral opening is now if anything located slightly further back than it was, so there was no cosmetic improvement.

Dr Meltzer was widely regarded as performing state of the art surgery, and being one of the best of the field. That may well have been true, but if so the state of the art left a bit to be desired, and either way his main concern was profit. Admittedly I had had little opportunity to compare with natural female genitalia, but I couldn't imagine anyone seeing my vulva and not thinking it looked odd. Still, it was a vast improvement on my pre-surgical state, and I certainly didn't regret it.

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