Post-Op: Day 33/34 (September 3/4)
This whole post concerns orgasms and pumping, so if this is TMI, read no further.
Post-op orgasm #1 was on day 33. Since I had no evidence of urethral fistula for three days and was technically cleared for pumping, I figured it would be safe. I kept stimulation to the head only because I wanted to avoid disturbing any lingering stitches on the shaft. Compared to pre-op, everything felt a lot more localized to the penis. Before and despite not touching those areas, I would get a lot of peripheral stimulation to areas I didn't like feeling. So this was an improvement. Oddly, I felt burning in the former vaginal area, so perhaps trying things this early was a bit premature. I felt no pain, however.
I pumped for the first time on day 34 post-op. I can get a seal with the cylinder I used pre-op (1"ID, 1.5"D flared base, 3.875" long) but can't pump out nearly as far. Pre-op, I measured 2" when pumped in the cylinder. I didn't measure this time, but I would be surprised if I even reached 1". I couldn't apply much pressure because I felt pulling at the stitches that are still at the base of my penis. On the up side, no stitches ripped and there was no bleeding or pain.
My penis doesn't fill the diameter of the cylinder like it used to, leaving room for the swollen underside to expand. I think this cylinder may be good once the swelling goes away and my penis heals into a normal shape, but for now I think I would benefit from a smaller cylinder. I'm getting one that is 0.75"ID, 0.875"D flared base, 3.125" long; hopefully that will keep the swollen tissue from enlarging further. The next size down is 0.5"ID, 0.625"D flared base, 3" long; I think that would be too constricting, since the head of my penis measures slightly larger than 0.5" in diameter.
BELOW LINKS ARE NSFW:
I purchased the cylinders here:
http://www.extremerestraints.com/nipple-and-pussy-pumps_221/clitoral-enlargement-cylinder_1247.htmlAnd I purchased my pump here:
http://www.extremerestraints.com/penis-pump-accessories_220/deluxe-metal-penis-pump_407.htmlThere's also a kit with all three cylinder sizes plus a pump but I wanted an all-metal, not plastic, pump:
http://www.extremerestraints.com/nipple-and-pussy-pumps_221/clitoris-enhancer-clit-pump-kit_1248.htmlI've had both the metal pump and large cylinder for 2 years and can attest to the build quality of both. The cylinders are Vac-u-Loc, so the pump can be detached and the cylinder will still keep pressure (useful for extended pumping sessions). I use a water-based lubricant inside the cylinder to reduce friction while pumping out.
Despite the penile 'workout' of the past two days, I still have no evidence of urethral fistulas.
Post-Op: Day 35/36 (September 5/6)
It is evident that I no longer need the suprapubic catheter and I have an appointment on September 7th to have it removed by a local urologist.
For now, I have been pumping with the simple syringe pump that Marta gave me. I am able to pump a little more out compared to the first time and it is also easier to pump. The penis seems less tight/shriveled and more willing to stretch; I suppose that would be the scar tissue softening. However, it's still nowhere near as much as I used to be able to pump out and it doesn't pump out as easily, either. Hopefully with time comes improvement.
Miro sent an e-mail inquiring about how voiding went. I said it was very good, all things considered, and I told him about the appointment for the suprapubic catheter removal and asked how long I was to take the antibiotics (Augmentin) after catheter removal. He replied with 3 days and again reminded me to pump regularly (oh I am, believe me... obsessively, almost).
Post-Op: Day 37 (September 7): No More Catheter
Today I got the suprapubic catheter taken out (yes!). So overall it was a very good day but also kind of upsetting. Nothing bad actually happened, but it was a day of 'outing,' getting half-naked, and general awkwardness for me. Throw in my anxiety about my penis appearance--not due to its actual size so much as the fact that, right now, it looks like I have no shaft--and it made for an unsettling day.
My P.A. called the urologist before surgery to make sure that he would not have an ideological problem with treating me after metoidioplasty. I found out that while he is directly across from the local Catholic hospital, he is not affiliated with them and would have no problem seeing me.
I went to the urologist's office and everybody was really very nice and respectful. The doctor (who is both a urologist and a urological surgeon) and his P.A. did seem somewhat curious about my case, but were professional. I had the papers from Dr. Miro describing what was done during surgery as well as the photo CD of surgery, which helped. Here's why: when the doctor came in, one of his first questions was if I had the erectile device implanted yet. Clearly, he was expecting a phalloplasty. He looked at the photos on the CD first and commented that the final post-op photo looked like very neat work (maybe in regards to placement and how cleanly the incisions were stitched--how do surgeons judge these things?). He also commented on the surgical 'drape,' saying that it looked like cloth and that disposable paper is used in the U.S. He inquired about the hospital quality in Serbia and seemed surprised to hear that the facility I went to was recently built, very clean and modern-looking. He recognized Dr. Djordjevic's name and said that he knew about Miro's contribution to hypospadias repair--something about a conference in Philadelphia. So that was cool that he had heard of my surgeon, but I don't think he was familiar with metoidioplasty. One of his questions, in looking at the photos, was 'why did they leave just the glans? Didn't they lengthen it?' Ouch. Honest question, but I winced at it. I said that the length was entirely dependent on one's own anatomy. He asked why phalloplasty was not performed to which I said that, while the surgeon performs both, it was my preference to have metoidioplasty. He seemed curious as to why, so I explained that I needed to get a job and get on with my life--a shortened version of my reasons, but he understood it and acknowledged that phalloplasty can be a difficult surgery with lengthy recovery times.
He and the P.A. first took a look at the suprapubic catheter site and then looked at my genitals. I awkwardly pointed out that my shaft was still very swollen and retracted. He put a gloved hand under the testicle implants and commented that they were in good position. Then I zipped up and we talked about what would be done. He said he wanted to do a VCUG before removing the suprapubic catheter--standard procedure in the U.S., I gather--and seemed shocked when I said that I had already been urinating out of my urethra for several days with no issues. Personally, I liked the 'try the urethra yourself before removing the catheter' method; it let me know that everything was indeed working while still having a 'backup system' installed. It also let me get used to the new urethra before trying to urinate contrast dye into a portable urinal in front of an X-ray technician. Anyways, despite it working fine as far as I could tell, I agreed that it would be good to get an inside view of the constructed urethra.
I was sent over to the aforementioned Catholic hospital to have the test done. There was significant awkwardness over the fact that I was still 'F' in their system (I was born there and basically my entire history was on file, minus transition-related stuff), but the nurse who was getting me ready for the test was really very nice about it. l ended up needing to tell her what surgery I had done and why, to which she said 'oh, thank God!' as though I had cleared up a great confusion. My appearance is clearly male at this point, and I guess she was having a quandary over the 'F' on my lab order sheet (I didn't even know that was on there, but I should have guessed). It's her job to get the portable urinal (male or female style) and notify the appropriate X-ray tech (male or female), so I can understand the problem. She was awesome about it, though, and brought in the male technician who was also nice about everything.
I was led to a huge machine and laid on a horizontal table. At this point, I was in a hospital gown that opened in the front. A drip of the contrast dye was set up and connected to my suprapubic catheter. As soon as the second tech who would be running the machine came in, the drip was started. The second tech seemed a bit curious about the surgery and asked where it was done. He seemed slightly off-put, but remained professional. Anyways, he was operating the computer behind glass. The first tech that was actually touching me was better about things.
When my bladder felt full (the drip took an especially long time, perhaps due to the small diameter suprapubic catheter), the table I was lying on rotated into the vertical position. Standing, I was given the portable urinal, which I put very close to my genitals so it was touching the underside of my penis to catch any runoff. The imaging device was attached to a movable arm and the tech with the computer adjusted its position and gave me the go-ahead. Peeing in front of people is not my forte, but I concentrated on a fire sprinkler in the ceiling and got the stream started. After several stops and starts, I finally emptied my bladder. The test was done; the tech said he had a good image, which he sent to the urologist (presumably electronically because by the time I went back, it was already on the computer). I re-dressed and headed to the urologist's office.
The P.A. met me and relayed that the doctor said it looked good and that she would be taking the suprapubic catheter out. She found the stitch and clipped it (small sting), then started to pull the catheter. It was slightly adhered at the entry point, but it came undone easily. It felt weird and burned a bit as it was pulled, but it was out quickly. She asked what I had been doing to clean the site (sterile saline solution, Bacitracin, change dressing 1-2x/day) and she said that it looked like I was having a reaction to the Bacitracin. Oops. Apparently it can actually promote the growth of yeast--really should have taken Miro's advice of 'you don't really need this' more to heart. It had worked really well on my drain sites after top surgery, but then I wasn't also on a broad-spectrum antibiotic. Anyways, she said it didn't look serious. I kept pressure on the site for a while with a gauze pad, then she taped it up. She said the wound might drain and there could possibly be a little urine (?!), but not to worry--it would heal over within a few days.
The doctor came in and basically went over the findings. No fistulas, apparently, but he actually seemed more hung-up on other visual findings--as he put it, "this is still a very female structure." I really didn't know what to say to that (was thinking: well, yes... the surgeon isn't going to start messing with internals for a urethral lengthening), so I kind of just gave a blank stare. He then said something about tubularization and that my urine was coming down into 'the V between the legs', as in the female manner. I wish I would have asked for more clarification. I was just a bit taken aback. Another thing I wish I would have asked for clarification on is that the X-ray was taken from the front only; it showed the original urethra very clearly, but the neo-urethra was obscured and a side view probably would have shown it more clearly. He gave some advice on the implants (if the skin feels especially warm to the touch, it's probably infected) and I was led back to the waiting room.
I am no doctor--maybe he could tell that all was well with the neo-urethra by just the front view--but after I left his office, I got the feeling that maybe we weren't entirely on the same page after all. I gave him Dr. Miro's surgical report and the photos from surgery, but I could have perhaps spent more time talking about what was done. Thing is, he didn't ask or give the immediate impression of being confused and I have reservations about telling doctors (especially the only urologist within a couple hundred miles) 'how to do their jobs.' In retrospect, though, I think I would have felt better about this doctor visit had I spoken up more. But after the length and 'female structure' comments, along with questions (which seemed more like doubts) about the quality of care in Serbia, all I really felt like doing was bolting out of there.
Post-Op: Day 38 (September 8 ): Improvement
Today I am feeling much better. I still have some lingering concerns about the VCUG: was the image sufficient to really check out the neo-urethra? My bladder looked like it was obscuring the former vaginal cavity--what if that didn't seal correctly and I am now urinating into the cavity, impeding healing? Maybe I'll ask the urologist for a copy of the X-ray so I can send it to Dr. Miro and ask his opinion on the matter.
But functionally, urinating seems fine, and I'm thankful for that. Emptying my bladder is much, much more comfortable without the suprapubic catheter (I was surprised by how quickly things started feeling 'normal' in that regard). I am still peeing frequently (and drinking plenty of water), but it is approaching the normal-for-me rate that I had pre-op. The urgency that I had with the catheter isn't there so much and holding it seems easier.
Yesterday, I noticed some pus-like fluid coming from the catheter site, so I changed the dressing several times. Later today, the drainage stopped and the site looked like it was scabbed over, so I switched to a breathable band-aid. I am noticing that my lower abdominals feel very sore and tight. It's sort of like going overboard on sit-ups isolating the lower abs and then finding that you can't easily stand up straight the next day. I notice this upon moving from sitting to standing. After I've been standing for a while, it stops feeling so tight.
Another thing I am thankful for is pumping and Cialis. I've already talked about pumping and I am making slow (very, very slow) gains. It pumps out easier now, but I don't think I'll be able to hit my former length for a long time. Prior to surgery, it took a year or so to get to that point and only the last 6 months could really be called daily pumping. Also, as soon as the pressure is released from the pump, most length disappears (same as before surgery), but a small gain remains--for a short while. I could literally watch as my penis moved and retracted inwards until it was more of an 'innie' than an 'outie.' So last night, feeling rather bummed about my results and about the whole day, I took my first 10mg of Cialis. Wow, that works fast. I took it, continued with pumping, and when I was done, I found that my penis was not returning to the 'innie' position. Further coaxing resulted in it sticking straight out from my body with more length than I have ever seen and it was honestly the best thing I could have seen at that point.
I woke up today to a penis that was, for the first time since being wrapped at St. Medica, external. The effects of the Cialis remained throughout today, though not as strong as initially. Additionally, the swelling on the underside of my penis has been going down (I'm noticing a clear, sticky substance exiting the stitches). With the penis protruding more as a result of Cialis, the extra skin from the swelling is stretching out and looks better. I can't wait for the 10th, which is my next Cialis dose.
Wow--just realized that my mood is now linked to my penis. Oh, and the Packers just won the first game of the regular season
