I saw Hans last Tuesday (7th May) for what was due to be my final appointment with him.
He checked over all of my surgical sites, asked how everything was going with the pump and after the hernia repair, and said he was really happy with my outcome.
We talked a bit about the tip of my phallus – the scarring from the glansplasty hasn’t healed as well as I’d have liked. My options are either to have another glansplasty surgery, or to look into medical tattooing. I’m probably going to look at the latter of the two – but not for a while.
All in all – it was a really good appointment. I’ve been signed off from Hans completely for work purposes, but I will be seeing him again at the end of the year just to make sure everything is still going well.
If you’d told me three years ago that I would be post Phalloplasty now, I would’ve laughed at you. But here I am, and although it has been one of the most mentally challenging things I’ve ever done, I don’t think I’d do anything differently.
I will be doing an overall update soon with pictures of how things are going, but I need to get a few things in order before I can take the time to sit down and do the post justice.
***Please be aware that I have placed some pictures of my arm in the arm section. If you’re a bit squeamish or don’t want to see them – just scroll past***
It’s been a pretty intense last couple of weeks. I ended up being on antibiotics for the infection in my arm for two weeks. Thankfully, this time I didn’t have a reaction to the medication, and it cleared up nicely.
I started back at work this week. Originally the plan was to start back on half days, but my usual GP wasn’t back at work when I had my review – so the doctor I saw just put me back on full days. Its tiring, but at the same time it’s nice to be back doing something other than sitting around home.
I saw Hans and Scott on Tuesday, and those appointments went really well. I’ll go into it in more detail below, but I see Hans again in December; and Scott in November.
Arm
Now that it isn’t green anymore, things are moving forward again really well. There were some areas of the graft that started to deteriorate because of the infection, but they’ve come back well. The graft has a good supply of blood to it, and the majority of the slough has gone now. The big sloughy area – that you can see in the pictures – took the longest to come off, and in the end it needed to be removed with a stitch-cutter. Judging by the smell when it finally came off, it was holding the last of the infection – so getting it removed was a priority. Had we left it there, it would’ve taken a significant period of time to come off itself.
I have pressure sensation all over, and more and more areas are getting full feeling back to them. Once I’m out of dressings and the arm is exposed to more things again – it’ll get even better.
I’m still getting dressed in the Mepilex AG for the moment. My OT says my body responds well to it – so why not? We’re no longer putting the Mepitel under the Mepilex, because it appeared to be holding a bit too much moisture in the wounds. I’m down to tewo dressing changes a week, and hopefully it’ll heal over completely in the next week or two. We’ve discussed moving into a compression sleeve soon, but want to wait a bit longer first.
I’m now allowed to drive! At this stage it’s only as required, and I can only drive an automatic. I’m no longer in my full arm splint at night – just the yellow cast. I’m also allowed to start wrist movement exercises – just moving forwards and backwards for ten reps, 3-5 times a day. My backwards range is currently at 30 degrees and forwards is at about 50.
Scott was really happy with how it was looking, and my appointment with him is mainly just as a final appointment.
Pictures are below, and are weekly. They show the main area of infection for comparison reasons, and some of them are pretty gnarly – you’ve been warned.
Week 5 Week 6, Day 1 (Pre-infection) Week 6, Day 4 (During infection) Week 7 (Slough removed) Week 8
Phallus
At this stage, the phallus is healed and I’m at the point of scar management. I don’t like placing the tape on the underside because I find it constricts the skin, and I react quite easily to it – so I just use vitamin E oil instead.
I found a short time after the urethral opening healed, that there was some skin poking out the bottom. This freaked me out slightly, because I thought the urethra had somehow managed to come loose and was falling out. It isn’t. I sent pictures to Hans, and he advised that he thought it was a granulation issue. This was confirmed when I saw him on Monday.
Basically, the skin hadn’t healed to the point where it had created a barrier (epithelialised), and the granulation tissue underneath has created an excess of tissue to fill the hole. It’s easily fixed in most cases, and mine will be resolved during the second stage when Hans removes it surgically. I actually have some hyper-granulation tissue on my arm too – but the pressure from the dressings are keeping it in place.
Hans was very happy with how everything was healing. He advised that the London team are now getting guys to flush the urethra. He doesn’t know whether it’ll make a whole load of difference at this stage in my healing, but he’s told me I can flush it through with some saline once a day.
I’m quite pleased about this, because it has already had a marked impact on the amount I was draining from the phallus. Hopefully this continues.
OOOO!!! I nearly forgot! I have more sensation! If I lean the phall us to the side, I have sensation on the right hand side. It’s disjointed at this stage (I can’t feel the phallus, but can feel it in my leg), but hopefully over time it’ll get better. Still very exciting 🙂
Bum
I can now sit for extended periods of time without getting up. I still need to get up and walk around, or rest for a bit at times – but it’s much better than it was.
Hard surfaces and chairs are still an issue… I forget that there isn’t as much cushioning there anymore, and sit down too hard sometimes. The scar is looking good, but I’m placing tape over it to try to stop the keloiding.
Post-op Appointment
I thought it’d be easier to do this here rather than dedicate a whole post to it. During my appointment with Hans, we discussed stage 2. Depending on a couple of personal factors, I should be looking at early to mid February for surgery.
We went through the surgery itself and what it’ll entail. I told Hans that I’d prefer to have the clitoris buried, rather than exposed – he’s advised to do some research on both and make sure that’s still what I want when I see him in December. Basically if it’s exposed, I can get it hidden down the track if I want. If it’s hidden, it’s much harder to try to expose it, if I change my mind down the track.
There are also two ways to do the scrotoplasty. One way is to create the scrotum and place spacers in, ready for stage three. The other is to create the scrotum, but leave it empty until stage three. He said he’d prefer to put the spacers in, but ultimately he’ll decide on the day of surgery. To be honest, it doesn’t bother me either way.
Everything went well, and he’s very happy with how everything is healing.
He had a look, and confirmed that things at this stage should continue to heal well. I do have an area at the bottom of the new urethra that looks a little unwell and white. Hans said that it looked superficial, and that hopefully it wasn’t the whole way through. Ideally the white part will die eventually and be replaced by healthy skin. If that doesn’t happen though, or that part of the graft is lost, then he may need to take some skin from the inside of my mouth during stage two.
I no longer need my donut! Very pleased. It was great for support and mobility; but because the swelling is going down, it was starting to irritate the stitches and the skin in the area. I’m much more comfortable now.
He also advised I could remove the dressings on my groin/inner thigh, and that there should be no issue at this stage with sleeping with my arm on a pillow rather than fully upright in a sling. I have no feeling in the area with the dressings at the moment, so there was no pain (even though I pulled out almost every hair follicle in the area); and I’ll probably continue to sleep with the arm upright until I get the go ahead from Scott as well as Hans to sleep otherwise. It’s not going to hurt it if I sleep that way for a bit longer.
I’m sending Hans weekly pictures of everything so he can keep tabs on things, but I don’t need to see him again until mid-September. Woot 🙂 hopefully by then it’ll be a fly-in-fly-out visit.
My Transition FtM 