Susan's Place Transgender Resources

Hi everyone.  :) I just returned from Bangkok to Istanbul, 2 weeks after having my SRS and tracheal shave with Dr. Sutin. I thought I would write my experiences because there are relatively less posts of this type about PAI. I was well enough to start writing this as soon as 1 or 2 day post op but I wanted to write on my keyboard so I just took some notes there. I don't know how detailed this will be, but you can ask me anything.

So after I was sure that I wanted to get this surgery within the first half of this year, I did some weeks of extensive research in this forum and other places. Thailand and PAI seemed like the best option for my circumstances. I first contacted them in February, asked my questions and soon had my surgery scheduled for 18th of May. So I will start from May 11.

They had said it is okay if I stop HRT 5 days before surgery and it made sense to me. I really didn't want to stop 2 or 3 weeks earlier anyway.(but I would if the doctor said so) So instead of stopping completely cold turkey I took half the dosage for two days, and stopped altogether at May 13.

My mother and I had our flight at May 14, evening Istanbul time. It was about a 9 hour flight so not that bad but it was still kinda uncomfortable, I wasn't sure if it was stopping HRT or maybe that I was sick.

May 15: early morning we landed in Bangkok, we had to wait maybe an hour for PAI driver to pick us up, who then explained that students were returning to school after their 3 month vacation and traffic was very bad. He took us to Salil hotel in Thonglor and informed me about my appointment next day. We checked in with mom to our adjacent single rooms. I was feeling really tired and jetlagged (although it is just 4 hours difference) and kinda sick. I was nauseous and had some throat pain and probably had fever too. I was worried I wouldn't be fit for surgery on 18th.

May 16: Thankfully I was better this day. We saw Dr. Sutin in the morning, he first explained us the surgery, and took his time answering our questions. I also mentioned my sickness from yesterday and he gave me antibiotics to be safe, and told if I am in good condition on the surgery day it is ok. Overall we had a really good impression from Dr. Sutin. We also talked with PAI assistant/manager a lot about details, who is a nice cheerful person. And there was an interpreter who had formerly lived in Turkey, he helped us all day, also a very kind guy. He works part time with PAI and I was surprised to learn they get about 1 or 2 transgender patients from Turkey each month. So after our appointment in the clinic we went to Piyavate hospital for bloodtests and a chest x-ray. I had also filled some medical forms. Because I had my birth sex on my passport (you can change your legal name but not your gender without having surgery in Turkey)they registered me as Mr. *feminine name* which I would see in a lot of papers (even in food trays). That was kinda annoying they take a lot of transgender patients afterall. But nurses gendered me correctly all the time so its ok I guess. Then in another hospital two psychiatrists evaluated me and wrote my letters.

May 17: I was told to eat lightly and avoid stuff that is hard to digest. I took the swiff solution in the evening, it was disgusting but ok. A driver took me to the hospital at midnight where I would spend the night before surgery.

May 18(surgery day): Early morning nurses woke me, prepared me, measured my fever and blood pressure etc. At about 9 they took me to a big operation room. There were maybe 10 person, they did some preparations and Dr. Sutin entered and said hello. In a bit a nurse said ok you sleep now and I was out in maybe 10 seconds. When they woke me I was very conscious, able to think clearly. A nurse informed me that surgery went fine. I had an oxygen mask for a short while, whichy they removed soon as I was breathing fine. The surgery took 4-5 hours I think. They gave me a morphine drip after and there was no pain. I spoke to my mother, rested etc. I was surprised that there were no food restrictions immediately after surgery. They brought me a full meal with soup, spaghetti and chicken/shrimp, fruits etc. I ate a little of everything.

Day 1 post op: Dr. Sutin visited me, answered my questions. This day was ok too. Morphine drip was finished in the evening I think and they gave me pills instead. Painkillers and antibiotics after meals. They regularly checked my fever, blood pressure and oxygen level I think, a little device on my finger. Nurses were very kind, some speak good English some less but at least know the relevant words not much problem there. My mom mostly stayed with me too.

Day 2: I could slowly walk around this day, also sit with the ring pillow.

Day 3: Dr. Sutin saw me this day, removed the dressing. A nurse taught me how to clean myself with a betadine solution. they were giving me a sponge bath everyday too.

Day 4: I think it was on this day they stopped painkilller pills too. But I had no pain. I never had much pain actually, maybe I am lucky.

Day 5: On this day I was allowed to shower. I also checked out from the hospital and was taken back to the hotel. Now there was a problem here. On PAI's advice I had checked out from one of the rooms for five days, and I specifically said to the reception it was for five days and which day I would return and need the room again. But appearently they didn't take any notes and gave the room to someone else. They had no other room to give me for 2 or 3 days so I had to stay in the same room with my mom. Thankfully there were two beds at least.

Not much happened on day 6.

Day 7: This day I had an appointment with PAI. Dr. Sutin saw me, he removed the catheter, it was kinda painful but not that bad, showed me how to dilate. A little more than 5 inches if anyone is curious. I had to pee in the clinic otherwise they would have to put back the catheter so I was kinda nervous. I drank a lot of water and coffee and walked around etc and eventually I was able to pee. It just goes to weird directions because of the swelling but that is getting better. They also gave me anti swelling meds. and more antibiotics. I still take antibiotics btw but almost finished. Oh also Dr. Sutin said I could restart E now.

Day 8: we were given new rooms, this time a little nicer with balconies.
Ok so I don't have much to say about these days, I would dilate two times a day for 30 minutes as Dr. Sutin instructed, not fun but ok, easier than what most surgeons recommend I think, mostly rest, sometimes go to hotel restaurant or a very near Italian restaurant. Hotel wifi was kinda bad. (it was ok in the hospital) maybe buy a local sim. I read on my Kindle, listened to music etc. A few times I had a little fever but was ok after taking a pill, that went away quickly too.

Day 14: Dr. Sutin saw me in the clinic for the last time before leaving. Again he spent a lot of time, checked if I have sensation too. I do but it is painful on the clitoris, appearently it is oversensitive now but it will normalize in 3-6 months. He says in about 6 months swelling will go down and then it's the final look. I feel like it's going to look good but I really don't know too much about aesthetics of this area. :)  As long as things look and function normally I will be happy. Tracheal shave result looking good too, there is a small incision mark we will see when that heals. Anyway I was very relieved that everything was recovering good.
They gave me a medical paper about my surgery, which might come in handy for correcting my legal gender, also another paper to get help in the airport. I was feeling well so I didn't ask for a wheelchair but said it would be great if they can arrange me a comfortable seat and they did. 2 seats next to me were empty so I could lie down when I wanted.  8) Return flight was actually easier, I didn't need to take any painkiller too.

And that is the end for now, I will probably post updates if anything happens. This was my second to last step of my transition and it was possibly the biggest. I am very happy it is behind now. Oh I also asked Dr. Sutin whether he thought I should have any FFS, he said I just have slight brow bossing and nose surgery but it is optional. Exactly what I was thinking, maybe eventually I will have those but I see it a cosmetic thing as I seem to pass fine. I will try to concentrate on healing now and let my lawyer handle most of my legal gender correction process. I hope this wasn't too hard to read and as I said you can ask me anything. :)

Thank you very much for that very detailed review.  I found it very helpful. 

Great review, I'm sure there's going to be many people very interested in reading it.

Glad you found it useful. :)

Hello Freya,
I'm from Istanbul, too. And I want to go Pai for my Srs. I really want to listen to your experience in a detailed way. If you are ok to answer my questions, please contact me.

Quote from: newgirlin_town on July 05, 2017, 04:46:53 AM
Hello Freya,
I'm from Istanbul, too. And I want to go Pai for my Srs. I really want to listen to your experience in a detailed way. If you are ok to answer my questions, please contact me.

of course, you can't pm here yet I think, I can send you an email address or something

i will be glad to get your email address for conversation :)

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Ok now that I think I know a little more about correct anatomy, I will post an update. (I'm almost 8 weeks post-op)

I've been recovering well, dilation is boring but painless. I have three issues maybe I'll ask PAI later but there's not much to do this early post op.

1-Lack of fourchette/posterior commisure of labia minora. Here suzifrommd explains it better than I could https://www.susans.org/forums/index.php/topic,171501.0.html I heard this is very common in this surgery because they don't usually make these details in one step. Because it may not stand frequent dilation early post op I think. I understand it but I was wondering if:
a cis vulva can ever be that way?
And is it easy to connect the labia minora in the right place this with a revision?

2-my clitoris seems fused with skin above it in a weird way. I read this can happen to cis women but they mean clitoris is under the hood. In my case, clitoris is not hooded and seems fused with the skin above. I don't know if it was that way early post op or it healed weirdly. Maybe I should make a seperate thread about these things.

3-I found some hair the first 2-4 cm inside, just on the side that near perineum. I don't know if this is the place they can't scrape during surgery. I know I was taking a risk by not doing electrolysis before(it would be very inconvenient in my circumstances) so I don't blame anyone but still upset. I don't know if laser/electro can work here. Like I said it is not too deep inside but still an awkward place to work. I heard depilating creams can help but I won't try it this early post op.

I had surgery with Dr. Burin at PAI.  He said there would be some hair post-op, and there is. It can be seen at the opening of the vagina.  Im waiting for my OB doctor to examine me to see if its deep inside too. OB is researching to see if there is any good methods for hair removal.  I will post again if he has any insight.

This is normal as you cannot scrape the skin in that location. PAI's Dr Sutin did my srs and I was advised before hand. With the roots only 1 to 2 cm deep you can easily remove by electrolysis or laser. I just finished off any hair issue with laser. I know I may have to do another series again in a year but for now its great. Dont be embarrassed about asking to have it done.

I examined more and it goes at least 2 inches deep in my case, on the bottom side only. I am not sure if there are more hairs any deeper but probably few if any. I can't exactly see/feel myself.

I think laser can handle the 1st inch but not much deeper. Electrolysis may work for 2 inches from what I read but that's difficult and not everyone will try. I will ask some places after I'm healed some more.

Some say they pluck theirs and hairs get fewer in time.  ???

And there are depilatory creams but it may be risky to use there and it's a temporary solution.

Gamergirl please let me know if you find any better solutions. This issue depresses me a lot sometimes.  :(

On the plus side PAI says clitoris shape will get a little better in time and Dr. Sutin can do revision for labia minora later.

Other than these I've had a very easy recovery so far.  :)