Hello there,

I'm more than 3 months post op and pain free for several weeks, back to running and going out yippee. Still often not passing despite the breast aug, less yippee. :/

Anyways, I'm having to do very long dilations to maintain the depth I've achieved, despite, I think, having my granulation lessened by now. I think I've noticed a pattern that it is much harder to dilate on a full stomach. I like to eat a lot of food, and it has lots of fiber, so my belly inflates quite a bit after food. Is it possible that on a full belly that the stomach and intestines are pushing so that it is hard to get the dialator all the way in? I might be wrong here, but it subjectively feels easier for me to dilate after waking up from a full night's sleep and evacuating.

Also, still no sexual sensation. What is the range of normal times it can take to get sexual sensation? Also, might be psychological since I'm bummed a bit I still don't pass a lot and it makes it hard for me hard to take myself seriously which makes it hard for me to feel sexual. I do feel touch in the area and it does feel like a different kind of touch sensation, but I just can't seem to get aroused at all.

All in all glad I did it. Much more enjoyable to do every day things like pee, shower, wear clothes and I love the new clothes I can wear without needing to tuck.

Also I have developed an overall body itching sensation in the last month, I think it's since using the steroid cream to reduce granulation but I'm not sure. I also had my estrogel dose increasted at the same time due to low estradiol blood test results. I don't get it outside, so it is something in my apartment but then again I have lived here for years before surgery without itching.

Gas, needing a movement and a full bladder will all make it more difficult to dilate. A bathroom stop before dilating is always advisable. It also helps if you can totally relax everything below the waist as any tension will make it more difficult to insert the dilator.

As for the itching skin, a doctor might be able to tell you more but living in the dry climate that you are in, your skin may be dry as the result of surgery and you may need a skin moisturizer after a shower or bath. Another possible problem is you skin could be more sensitive and soap remaining in your clothes after you wash them causing irritation. If you can, you might run a double rinse the next time you do your laundry and see if that helps.

To be sexually responsive, you will need to be sexually excited and need the equivalent of foreplay or an active imagination. If you are unable to be comfortable with yourself, it would make it more difficult to obtain this state. You are now like a CIS woman and as the result, you need to be ready for sex before attempting to have sex.

Regarding the itching, if it was my clothes wouldn't I feel it outside as well?

Regarding sexual response, do you think from what I described that my clit nerves are correctly connected and working by now or did you simply iterate how the emotional state is a prerequisite to sexual response?

Hi Ruth,

It took me 5.5  months to figure out how to masturbate. I thought I had nerve damage. I purchased 4 didoes of different shapes, lengths and sizes. I eventually figured out I needed to be very warmed up with the dildo in me. I would alternate nipple play and vaginal/clitoral play. I was enjoying the play when things started to click. I realized I needed to apply a little more force than before. My prostrate and clitoris needed attention and active driving. No automatic anymore

I am offering guesses on the itching as I don't know the cause. My roommate was having issues as the result of the laundry soap so I offer that as one possible solution. It's possible that sweating is blocking the effect of the soap or helping with the dry skin issues. If my simple suggestions don't work, a doctor would be advisable as it's possible the skin issues are being caused by something not related to surgery.

The clit nerves should have never been cut however there was a bunch of trauma as the result of surgery so it may take 3 months or more to get over it. You are now nearly completely free of testosterone so sexually things function a bit differently. You have to be in the correct mood however sometimes that isn't enough. A few of our member use very low dose testosterone to raise their levels into the proper feminine range. For some, progesterone can aid in the sexual response. If you think you are doing everything right and it's still not working, have your testosterone levels check in your  next blood draw.

The testosterone is normally delivered by patch and it's a product developed for CIS women who are having sexual issues. It's not enough to produce masculine effects but if your levels have zeroed out after surgery, it will enhance the sexual experience. By the way, my body still produces testosterone but I am in the mid feminine range so I don't require additional testosterone.

Ruth, if I had any expectations of passing, then yes, not passing would be rough for my already fragile post-op libido.

I'm just 12 weeks post-op and just 2 weeks ago my clitoris was far too ouchy to enjoy direct stimulation, even if I was already aroused. Now I'm past that hurdle and my most recent exploration really wasn't looking for orgasm -- I had too many other things in mind to seek that out but also felt the pressure of not having engaged my aroused in a while.

So yes things are coming along for me and I did have some arousal feeling very soon after surgery. Then recovery got harder and I got fatigued and most of month two was pretty well devoid of any capacity for sensual pleasure or even iideation.

Yes dilation for me is affected by contents of stomach or bowels, that was a weird revelation.

How do I know where my testosterone should be? In my blood tests, before surgery too, it was always below 1.5 nmol/L. The test doesn't show results below that. I was able to reach orgasm pre-op with those levels if I tried, but with my post-op body I don't know how to do that now.

As I said, my estrogen levels are low as well. Since I am now listed as female in the system, it only shows I am somewhere below 100 pmol/L and the test doesn't bother with lower levels (pre-op was 160+). As I said, we raised the estrogel dose significantly, but some days I only take one of the two doses because I am afraid maybe the estrogel is causing the itching... I really don't know what's doing it because both the dose change and the use of the steroid cream happened at about the same time.

I do remember having some weak arousal sensations actually in the first month of recovery, when I was still "up in the clouds" from my change, and now I am more used to it. So there was a different emotional state, but is it possible I also somehow had more testosterone in my system? I stopped estrogel two weeks before surgery, stopped androcur one day before surgery and resumed estrogel one week after surgery when they let me get up.

Another idea, could the higher dose of estrogel be chocking out the little testosterone that I have?

I didn't need an anti androgen, my E injection alone suppressed testosterone into the 12-18 range, probably what's made by the adrenals. I believe androcur can completely eliminate T. Post op you should have the T produced by the adrenal glands and a normal female measure in the range of 10-70 ng/ml.

I also take progesterone which definitely helps with my libido, some women report testosterone works for them. Studies are not clear that either has an effect, however it's for sure that hormones have different effects on different people so what works for you may not for others.

I also know in the absence of all hormones, my sex drive really plummets so I'd think sorting out your levels to whatever target you want seems like a good idea.

Beyond the mechanics I think your mind could be more important. I know what turned me on before HRT and those same things still work for me. How I approach them changed a lot on HRT. Before estrogen I could nearly always count on just stroking myself to get things rolling, after I began hormones, I really needed to be mentally desiring sex and to tease out arousal by paying attention to the rest of my body (breasts in particular) in ways that would have done absolutely nothing for me in my testosterone days.

So the old fantasies (mostly) worked, the old ways of being physical, not so much.

QuotePost op you should have the T produced by the adrenal glands and a normal female measure in the range of 10-70 ng/ml.

I think the units should be ng/dl.

I inject and about 4 days after injection I start feeling frisky at times.

I need to have my T checked. When I was post op 3 months I was placed on T cream. I used about 1/2 the amount prescribed and my T was 80 ng/dl . Papillion wanted 30 to 40 ng/dl. Low female range. The reason was for bone health and libido. My PCP and I agreed to stop T and have another blood test in 6 months and see how my T level was with my adrenals making  T.

Keep in mind you just had a major hormonal shift from no hormones to low dose hormones to a higher level of hormones. It takes time for you body to recover from surgery and the changing hormones.

Itchy, talk to your doctor and read the side effects for the steroid you are taking. I never heard of being itchy from E.

ESTRADIOL LEVELS
SEX                     pg/ml
Women (> 18 years old)   
      Follicular Phase  30-120
      Ovulatory Peak   130-370
      Luteal Phase      70-250
      Post-Menopausal   15-60
Male                    15-60

TOTAL TESTOSTERONE LEVELS
SEX      ng/dl        ng/ml
Females  6 - 86     0.1 - 1.2
Males  270 - 1100   2.4 - 12
Conversion factor: 1 ng/ml = 3.47 nmol/l

I'm a little confused what you mean by "sexual sensation"? Surgeons have some variation in their techniques and I'm completely speculating by saying this. From a purely physical standpoint, the glans nerves are separated but never cut unlike many of the nerves that get cut while creating the vagina canal. As far as penile inversion goes, the clit should be sensate out of the box. I know mine was.

My experience doesn't really constitute data on the issue. Maybe other people will chime in. Now I'm curious about this too.

In a couple weeks I will be 3 months postop.  Still no sensation at all anywhere outside the vagina, so I have similar concern.  Aesthetically, it did not turn out good.. so at this point I'm happy to just put clothes on and forget about it.  Least I can better enjoy yoga pants. 

I was curious about this issue of not being sensate so I emailed my GCS surgeon and asked her about the issue. This was her response this morning.

QuoteThe nerves to the clitoris or the dorsal nerves have to be dissected a long distance. They are very small and fragile - so it's common for them to get "neuropraxia" or they go to sleep on one or both sides for a while after surgery. Haven't had that problem yet, but nerves can be very tricky.

Sounds like you just have to wait it out, but it's not hopeless.

Quote from: Gamergirl on July 19, 2017, 02:38:06 AM
In a couple weeks I will be 3 months postop.  Still no sensation at all anywhere outside the vagina, so I have similar concern.  Aesthetically, it did not turn out good.. so at this point I'm happy to just put clothes on and forget about it.  Least I can better enjoy yoga pants.

Being numb like that is completely normal. You just had the nerves cut for the creation of the Vaginal Canal. Renerving is a slow process just like healing from this surgery. It can take longer than 6 months to start feeling anything in the area.

The worst thing you need to worry about is being normal.

Quote from: Ruth Ruthless on July 18, 2017, 04:46:33 AM
How do I know where my testosterone should be? In my blood tests, before surgery too, it was always below 1.5 nmol/L. The test doesn't show results below that. I was able to reach orgasm pre-op with those levels if I tried, but with my post-op body I don't know how to do that now.

As I said, my estrogen levels are low as well. Since I am now listed as female in the system, it only shows I am somewhere below 100 pmol/L and the test doesn't bother with lower levels (pre-op was 160+).

That is very low. You are close to the top of the female range for testosterone (1.8 nmol/L in Australia) and at the low end of the female estrogen reference range.

I find I get the best feminisation effects when my testosterone is below 0.5 nmol/L and my estrogen levels are above 1000 pmol/L.  My endo uses crystalised implants- I'm not sure if they are available in the USA, but they have the added benefit of not needing to take any medication, and also keeping the E levels very stable throughout the day which is good for my mood.

Have you had higher levels in the past?  Have you always used the patches?