On Pain, Joy, and Bottom Surgery
Note: What follows is a personal and at times graphic account of my experience getting a penile inversion vaginoplasty, otherwise known as gender confirmation surgery, sexual reassignment surgery, or simply, bottom surgery. I go into detail about what I went through physically and emotionally. If you’re experiencing feelings of dysphoria, internalized transphobia, etc., it may not be the best time to read this. As always, I suggest keeping in mind the number of the all-trans staffed Trans Lifeline at 877–565–8860 (U.S.)/877–330–6366 (Canada).
My therapist told me that in the weeks leading up to my surgery, perhaps the overwhelming anxiety and depression I was feeling stemmed from grief. This struck me when I realized how accurate it was. The intensity of my emotions before surgery was overwhelming; I felt like my mind was trapped inside a tiny room, unable to escape.
My body, meanwhile, was in the room with my therapist. In one corner was me, somewhat stymied by my recent higher-than-normal dose of injected estrogen and normal probably too-high dose of caffeine. I spilled my proverbial dysphoria onto the floor like it was my job. In the other corner, my feelings were being reflected back at me in ways that were expected, mundane even. But also profound.
No one can really explain to you what it means to be given a vagina from loose change. Those coins that have been sitting around on your desk for over two decades, seemingly without a clear purpose. You can’t remember who gave them to you. They function as currency, yes, but inconsistently—like how they only sometimes accept U.S. dollars in Canada. These coins are thrifted trinkets and hand-me-down doodads from the store you never knew had a return policy, the great-uncle you never really connected with, the body you realized wasn’t yours.
Maybe you took these coins into town. You tried to use them to buy things, and it worked! But in the back of your mind, you’ve always had this strange feeling that the store clerk slipped up in accepting them. These coins are normally only worth something in another country. And then you ask yourself, Did I even go into town? Or was that someone else? Soon, the question becomes not just about the coins and the trip to the store, but about who it was who made that trip, whose body it was, whose mind… who are you?
Grief can stem from never truly knowing what or who has been lost. Division, disorientation, disassociation, dysphoria—or is it deletion?
From my first, awkward, alien orgasm as a teenager going through my first puberty in a staccato, clinging to the remnants of an emo band-infused androgyny until the reality of testosterone forced its grasp over my body, to the serene feelings of peace disseminated across my mind as I slipped my first tablet of estrogen under my tongue. For most of my life, I didn’t know my body as my own. I didn’t connect with my body; it was a vessel for my mind to live through, encumbered by strange chemicals at odds with my heart.
In other words, no one truly explains what it means to be “given” a vagina, period. But is the surgery something that gives, gifts, takes away, remolds, or rebirths? It probably does all of those things. To varying degrees, I understand my experience cast through a number of different lenses, including a celebratory renewing, a selfish reinforcement of the gender binary, a gaping wound that will always be trying its best to close shut, and a generous jettisoning of the symptoms of dysphoria. Mixed messages, to be sure.
The morning of my surgery, I stir from sleep shortly before 5 a.m., though “sleep” is a generous term for the fumbled tosses and turns over the past night. Checking my phone, I see that the temperature outside is minus 5 degrees, which seems obvious, appropriate even. Throughout my hospital stay, the city will experience a burst of temperatures inspired by the recent polar vortex, falling to minus 30 degrees with wind chills as low as minus 60. It’s dangerous to be outside for even moments. Dangerous to be a human with a body, harmful, scorning, sinful.
When the patient waiting room opens at 5:30 a.m., I sit calmly, watching the wandering eyes of others preparing for their surgeries. All eyes seemingly question what the others are there for. Feeling exposed with moments left before my procedure, I assume my reasons for being there must be painfully obvious. (I later realize this was probably unlikely.)
I almost pass out from the initial insertion of the IV. This is embarrassing; I thought I had the fortitude to watch someone put a needle in my hand after having given myself estrogen injections for so long. My surgeon is calm and stoic, making me feel immensely more at ease. Tears start to flow silently and profusely as I am wheeled into the operating room. I shift my body from my hospital gurney onto a colder, harder surface, surrounded by what appears to my frenzied mind to be hundreds of medical professionals with varying types of medical equipment in hand.
Steel, sterile, soundless, sleep.
Then I am awake, and in pain. Pain will be a frequent requiem during recovery from surgery, but the first time I feel it is certainly the worst. My relationship with pain during recovery is interesting. Past the actual logic of it all, and burrowing deep inside my mind, I realize that I almost feel the pain to be deserved in some way. Why do I think this?
I think part of me—the part of me that still occasionally pipes up to question not simply whether I am a woman, but whether I am even transgender, or anything other than a monster—asks for the pain as an inherent requirement for womanhood. Asks for the heavy bleeding in the weeks of recovery, the uncomfortable wearing and changing of multitudes of pads per day, the pain of penetration by what amounts to a plastic dildo, the cleaning of said dildo, the vaginal douching, the washing, the drying, day in and day out, morning, afternoon, and evening.
I think this stems from feelings of loss, feelings of yearning for pains I will never experience. No (true) menstruation, no childbirth, no seemingly sourceless pains from the “natural” fluctuation of estrogen, progesterone, and luteinizing hormones within my ovaries, uterus, fallopian tubes, and other organs foreign to my body.
Do I feel this out of a sense of misplaced duty to run through some predetermined, prerequisite “hurdles” to womanhood?
In the process of recovery, I looked within myself to find a lot of hard truths. In some of the circles I frequent—namely, those that deem themselves progressive, anti-capitalist, or leftist — there is a collective yearning for a future ideal of gender. A world where a presented diaphanous femininity is not necessarily a requirement for being treated as a woman or, perhaps, where pronouns, choice, and self-determination reign supreme.
In some ways, I strive for that world. I want a world where that can happen. Do I think we’ll get there in my lifetime? Absolutely not. But that doesn’t mean I can’t try to take steps forward. Having bottom surgery, in some ways, may appear to some as taking a step backward. It’s as if I’m admitting to myself that yes, I am subscribing to this need for a vagina and, in a way, perhaps permitting myself some level of weakness. I am a supposedly politically “woke” transgender woman. I am supposed to believe that it is transphobic to think that I need a vagina to be a woman. And I do believe that.
But then where does that leave me as a “postoperative” binary trans woman who feels comfortable living squarely within the confines of queer femininity? Have I, in some way, capitulated to the desires of a patriarchal society, a cis-sexist society, or even a capitalist one? I feel strange undertones of guilt beneath my newfound sense of empowerment.
I also faced myself in other ways, especially in the weeks and months leading up to the surgery, before I even found myself steps away from the surgery center. I faced my own expectations, how they were likely to be overblown and let down; I faced my feelings about my past relationships, all of them with cis women, nonbinary AFAB people, and trans men; I faced my own internalized transphobia, my fear that suggested I was a monster for “cutting myself up,” rearranging my anatomy in a Frankenstein-esque manner; and importantly, I also faced my millennial (post-)capitalist-induced state of not “being enough,” of not making enough difference in the world, of asking too much in return, and of being a burden on my friends and family.
Feeling like a burden is a state not unfamiliar to most trans folks. Before getting bottom surgery, I shifted my career path to match my passion for reducing global suffering. How could I reconcile this desire to minimize suffering with the need to put myself through the pain of surgery and recovery? How could I justify putting others through a small taste of the same as I relied on them for care and support?
As an activist and advocate for some of the most oppressed and least-acknowledged beings on the planet (namely, farmed animals like chickens, pigs, and cows), I felt uncomfortable realizing that to be most effective at what I do—and to live out my remaining decades of life in my body with any shred of comfort—I would perhaps have to burden the people around me.
But after all of it, above all else, I also had to face the reality that, no matter how I spun it, I was going forward with myself and myself alone. My mostly well-meaning cis friends and family had little to no knowledge of what I was about to undergo. And even among progressive circles, there is of course this notion that the ordeal was largely unnecessary anyhow, as plenty of women don’t have vaginas. I was stepping into the unknown.
I was constantly asked, “Do you have support? Do you have people you can go to?” “Sure! Of course I have plenty of support,” I’d respond. The truth was I had support in the form of people who were willing, but somewhat unable, to connect with me on my need for this massive change.
In a way, this lack of connection was strangely comforting. As a truly solitary experience, excusing my perhaps overdramatization, I went into it thinking it could be tantamount to what death might feel like. And in some small way, I found solace in that. Solace in the knowledge that I and I alone was strong enough to overcome every obstacle, everything society was telling me, to proclaim that this was my body and I would make it mine.
And make it mine I did. Just as my first puberty ensconced its hold on my body in a seemingly rigid staccato, recovery from this surgery in the middle of a characteristically Minnesotan winter into the first signs of spring seemed particularly appropriate.
As I returned back home, at around three weeks post-op, the focal points of my recovery made a dramatic shift. No longer was I concerned with simply managing my pain and getting through each day. Now I was starting to notice the small things that signaled why exactly I had gone through the procedure in the first place.
In the worst moments of recovery, the internal questions became deep, personal, and prying. Why did I even do this? Why did I put myself through so much pain, and others alike? Is this all even worth anything? Won’t I still be clocked and ostracized as a trans woman anyhow? Won’t partnership, intimacy, and even love still be out of reach? Aren’t I still a monster? Aren’t I still a “man in a dress”? Aren’t I still faking all of this? Am I even really a woman? Maybe what the government is saying about me is right. I don’t actually exist.
But regardless, we shoulder on ahead. It’s hard to describe the feelings of starting to understand what being at home in your body feels like, after having not experienced it for most of the two-and-a-half previous decades of life. I imagine it might be akin to having lost access to one of your primary senses (like hearing, sight, or touch) early in life, and to have it returned back to you through some medical procedure over 20 years later.
I will admit, it is an absolutely fantastic feeling. I feel alive in ways I never thought possible. As perilous as it may seem going into the surgery with no idea how it will feel on the other end, I have some sense that our bodies and minds must really know what is right for them, all things considered.
Spring’s first bloom brings new beginnings for all of us, this one being particularly special for me. In the first major thaw of spring, several feet of snow finally beginning to melt under a daylong onslaught of pouring rain, I came to in more ways than one.
My first experience with strenuous physical activity went better than expected. I thought my body would be all out of odds with itself, forgetting the movements that used to be commonplace, like hands over holds covered in chalk, climbing up bouldering walls, or legs moving quickly, one after the other along icy, slushy paths. Instead, it was better even than before.
Pain had become minimal, and while there was certainly pain associated with running and other activities, the feeling of being at home with my body was most apparent when it was in motion. Knowing that running has always been the activity that makes me feel most alive, it’s unsurprising that this is the context in which I now feel doubly so.
This first thaw also brought my sexual (re)awakening. While the goal of getting bottom surgery for most is not solely to feel sexually at home in one’s body (see: all the words I’ve written so far), it’s certainly a major piece of the overall experience. Unfortunately, I think there is an unstated assumption about trans women getting bottom surgery: The only reason we have the surgery is to have “normal” sex with (cis) men. For me and many others, this is really not the whole story. In reality, the feeling of existential oneness with my body, and ownership of what it is and who I am, is the summation of my reasoning for seeking bottom surgery.
In this process, inevitably sexual feelings play a role, as they likely would for any human who is not asexual. And I think it would be wrong to omit any mention of this, in some attempt to cover up or conceal aspects of my sexuality. As Natalie Wynn most quotably said, “Can I confess something kind of dark to you? I have this really fucked-up fetish where I want a boy to put his penis in my vagina. Crazy, right?” Saying it any other way would erase part of my experience, and I think also would contribute to the general silence surrounding female sexuality, the female orgasm, and other such conversations. I think leaving this part out of the story would be contributing to misogyny. However, of course I don’t want to in turn erase another aspect of my experience: A lot of my romantic and sexual attraction is still directed at women and femmes, just as it has been for as long as I can remember.
Context aside, to the say the least, everything just feels right now. For one, there is something very, very different about orgasms with testosterone-dominant hormones versus estrogen-dominant hormones. This is an experience any transfeminine person with time on hormone replacement therapy can attest to. Waves versus straight lines, to say the least. Also, I think there is an additional, significant difference on top of this from just having a vulva, complete with all the associated parts. To be honest, I’m not entirely sure why this is the case, simply that it is. It is, and it feels to me like it should, and that’s all I ever really wanted.
On this year’s Transgender Day of Visibility, I thought about the nine weeks of recovery I’d just gone through, the past couple of years of transition, and the rest of my life. A theme that I have frequently come to in the past weeks and months is one of trans joy. All too often, the stories of transgender people are framed as onerous, difficult, trying, sad, or otherwise displeasing.
It’s true that many of us struggle, some more than others. I also think it is important to frame my narrative with context: I am a queer (read: bisexual), white, transgender woman with no known visible or invisible disabilities. I had a Catholic, suburban, middle-class upbringing in southwestern Virginia after being born in South Carolina. The majority of my adult life has been spent in the Midwest, from Ohio to Wisconsin to Minnesota, and this includes the privilege of having accessed seven years of postsecondary education, including a liberal arts undergraduate experience at Oberlin College and a master’s degree in geochemistry at the University of Wisconsin in Madison.
My purpose in sharing this narrative is not to highlight my experience as unique or deserving of any particular attention. It is partly educational: for trans people interested in the surgery, for cis people who would like a better understanding of what it’s like for a trans woman to undergo this procedure, etc. It is also partly therapeutic. Throughout my transition, I’ve found it helpful to journal as a form of therapy to better my emotional and mental health. The experience is certainly fraught with difficulties, both expected and unexpected. This piece is a public journaling because while many have gone through this procedure, not enough understand it, understand trans people’s experiences, our lives, our truth. I only wish to humbly submit my narrative account to the collective experiences of transgender people, which together are incredibly varied, vast, and complex.
I feel so incredibly privileged to have access to what I have had access to, to live in the body that is truly my own, and to have my mind in a place I never thought it could reach. I hope that everyone is able to have this experience with their body, their mind, and their entire being. I am euphoric about my gender. I am full of joy, full of confidence, full of pride. I am me.
On Pain, Joy, and Bottom Surgery
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