I am a trans woman, meaning that while I was assigned male at birth, I am now living happily as a woman. I’ve been on hormones for a few years, I’ve had surgery to reduce the size of my Adam’s apple, and I also had surgery on my genitals to go from having a penis and testicles to a vagina.
There is however a real lack of information out there about life following lower surgery, both for trans women wanting an idea of what to expect, and for non trans people looking to understand more about what lower surgery entails.
So, I thought I’d do a bit of a Q&A post. This post looks to talk about surgery, daily life, sex, dysphoria and a whole bunch more.
But Laura, you do know right that you have a mutilated penis and not a vagina, right?
Yes, there’s a bunch of you out there who are going to stumble across this and inform me that my vagina is a mutilated penis and not a vagina blah, blah, blah. Yep, heard those thoughts already, you’re not going to be telling me anything new by firing that ol’ chestnut at me. We got that out the way now? Good.
To try and address this a bit more seriously, my genitals as they currently exist are recognised as being a vagina by the wider medical community in most areas of the world. Here in the UK the term Neo Vagina will sometimes be used, which makes me sound like some kind of crazy cyber hacker woman, but it’s still considered a vagina and not a penis.
I’m happy with my genitals, and I really do not care if you consider my vagina a penis.
So, like, would people having penetrative, vaginal sex with you be able to tell?
Cis women’s crotches generally have some variation in appearance from person to person, but most of them follow the same sort of physical appearance structure. You’ve got the vulva as the term for the parts of the vagina externally visible on the body, the labia (lips) which when separated reveal a clitoris and clitoral hood up the top, a second smaller set of labia minora, the urethral opening and the vaginal opening.
Let’s talk a little bit about my vagina. From the exterior, you’d be very hard pressed to tell my vagina was that of a trans woman and not a cis woman. My vulva’s appearance falls well within the curve of cis woman vagina appearances, when my labia are separated you see a clitoris and clitoral hood up the top, with the urethra and vaginal opening where you could expect them.
There is however, one key difference between my vagina and that of a cis woman. The depth of my vaginal canal is determined by the length of the penis I had prior to surgery. There is a very set depth at which something inserted into my vagina will stop dead in its tracks. For me this is pretty close to six inches, but it is a limit that exists. For some trans women this will be considerably shorter. Someone with a longer penis than my vagina may be able to tell there is a point beyond which they cannot go. Someone with a shorter penis will not be able to tell this fact.
A doctor performing a pelvic example may be able to tell this.
Can you enjoy penetrative vaginal sex?
Yes, very much so. My vagina was made using tissue from my old penis, with the nerves kept intact wherever possible, meaning that I still have practically full sexual sensation in my genitals.
It is important to note that nerve damage is a potential risk of lower surgery. While I didn’t lose any sensation in my crotch, I did for over six months lose sensation in a large patch of my left leg. While this did eventually return, it did act as a reminder that when doing such complex surgery, damage to nerves is a possibility.
My clitoris was made using the most sensitive tissue from the head of my penis, and as such is the most sensitive part of my genitals. This is the same for a vast number of cis women. While I get sexual pleasure from the interior of the vagina too, it is the clitoris that is most sensitive to sensations.
Also of note, due to the clitoris being hidden behind the Labia and clitoral hood, that area of tissue has become much more sensitive to sensations for me post surgery than when it was penile tissue.
My vagina is very much capable of enjoying penetrative sex, as well as other types of sexual contact.
Are orgasms different now?
Yes, very much so.
When I had a penis, orgasms were very much a build up to the orgasm, a brief but intense moment of sexual pleasure, and a sudden crash. It was built up to, happened very suddenly and was very definitively over.
Since lower surgery, my orgasms are now much more of a wave I ride. Where I previously would have had a sudden intense moment of sexual please I now experience waves of pleasurable sexual sensation that last considerably longer and are much easier to chain together. I can orgasm, continue to enjoy sexual activity mid orgasm, and then proceed to orgasm again while the first orgasm is still ending.
Even setting aside the element dysphoria used to play in sexual activity, I can’t deny that my orgasms are far more enjoyable now. I don’t know any explanation for why my orgasms are so different now, I only know that they are.
How quickly did getting lower surgery clear you of genital dysphoria?
Instantly… Kind Of…..
So, waking up from lower surgery I straight away felt a lack of dysphoria regarding my genitals. An uncomfortable weight on my mind that had previously been a near constant part of my life was gone in an instant.
I did at a couple of points during my week in hospital experience dysphoria regarding the loss of my penis. My new genitals were painful, bloodied, rearranged and my brain at a couple of points didn’t know how to process that sensations were not coming from new places in my body. When paired with exhaustion and paranoia from what was easily the most difficult hospital stay of my life, I did experience a couple of weird moments of passing dysphoria. These did not return once I was out of hospital and back to my life.
Do you ever forget you don’t have a penis any more?
There have been a couple of occasions I’ve sat down to pee, and instinctively gone to point down a penis that’s no longer there. This has happened maybe 2-3 times in six months. It makes me chuckle more than anything. Old habits die hard.
Is it true you have to insert a solid rod into your vagina three times daily FOREVER or your vagina closes up or falls out or something?
There’s some truth and some myth out there about dilation, so I’ll try and clear that up if I can.
When you are first recovering from lower surgery, yes, you do have to perform dilation, the insertion of a solid perspex rod into the vagina, three times per day with the aim of preventing the vagina closing up. The body suddenly has a new opening deep inside it, it assumes this is an injury or a wound, and at first tries to close it up. Dilation is a vitally important part of post surgery recovery.
The myth comes in when we talk about it being something you have to do three times daily forever.
Over time, the number of dilations can be reduced dramatically, which helps considerably with returning to a normal life that doesn’t revolve around needing to lie down and stick a thing in your vagina.
A few months post surgery I went down to twice daily, cutting out my middle of the day dilation. A few months later I went down to once daily. Now, nearly ten months on, I’ve moved down to dilating once every two days. I know people who’ve moved down to dilating once a week or even more infrequently than that.
Also, over time, you can begin to replace perspex rod dilations with sexual activity, be it sex toys or penatrative sex with a penis. If you’re engaging in penetrative sexual activity at least once a week you may not have to worry about dilation at all.
Basically, I’m going to need to make sure I pull out a dildo and have some me time once per week for the rest of my life, which I am super okay with committing to.
How long was it before you were recovered through that you could have had sex?
For me, it was around six months before I felt confident that my vagina was healed up enough that I would have been comfortable engaging in gentle penetrative sex. Ten months on I’m not worried about it in the slightest.
How hard was recovery?
It was easily the most difficult time in my life.
I spent months in constant pain, leaking fluids, exhausted all the time, unable to move properly, unable to sit properly, and having to spend 90 mins, three times per day, putting my day on hold to dilate.
I spent months unable to focus enough to work, falling asleep early and waking early. I couldn’t lie on my side for several weeks.
The week I spent in hospital I felt incredibly scared, alone, and paranoid that I might have done the wrong thing by having surgery. I got so constipated that for almost two weeks I couldn’t eat food without vomiting. I was incredibly dependant on others looking after me for a while. It was very difficult.
I’ve heard of people’s sexuality changing after hormones and surgery, did this happen to you?
Sort of. Prior to surgery I very much identified as lesbian. I was a woman purely interested in women romantically and sexually. This has been a fair amount more fluid since surgery.
I still lean heavily towards attraction to women, but I now have a romantic and sexual interest in some men. I am definitely heavily female leaning, but there’s now a few guys I find interesting in that regard too. I’ve not yet settled on how to label my sexuality. I still often use gay or lesbian based on my heavily female leaning bias, but it’s probably not accurate any more.
The best explanation I’ve seen for this is post lower surgery and the removal of the testicles, there’s no longer anything standing in the way of my body and oestrogen, which may play a part in the subtle shift in my sexuality.
What was the biggest practical positive about having lower surgery?
I can now wear leotard style swimming costumes and leggings without being concerned about my genitalia. It may seem silly, but it really did make a huge difference to my confidence. I now wear leggings without wearing a skirt over them, I can go swimming again, and just knowing my genitals are what they should be makes me feel far more confident re-engaging with life.
I recently joined a female roller derby league. While I would have been more than welcome pre surgery, I personally would never have had the confidence to join until now.
What things did you not properly expect about lower surgery?
I braced myself for the worst pain of my life. I still underestimated how painful I would find surgery recovery.
I didn’t prepare mentally for the fact I would worry and panic at first about if I did the right thing.
When the surgeon told me to bring sanitary pads to the hospital for post surgical bleeding, I later learned that standard pads were woefully insubstantial for the bleeding I would experience. Big thick incontinence pads were much more appropriate to the amount of bleeding I was dealing with for the first few weeks.
I didn’t prepare for the fact that shortening the urethra in order to reposition it would lead to needing to relearn a degree of bladder control. At first I found myself needing to pee more suddenly and with less warning. While this improved over time it was an unexpected initial shock.
I didn’t prepare for what now seems obvious in hindsight, peeing with a vagina needs much more care and attention to proper hygene. Where a penis leaves the urethra completely uncovered to pee, with maybe a drop or two needing dabbing at the end, with a vagina the urethra is buried under a trench of flesh that the pee must pass. Pee will get in your vagina. You can’t rush cleaning that up. Moist toilet wipes are a godsend.
And there you have it, a bunch of stuff people have been asking about lower surgery for trans women that’s not super well documented online. Hope you all feel educated about a set of genitals that the internet helped fund.