My Forthcoming Gender Affirmation Surgery...
and the number one thing cis people get wrong about it
Next month I am slated for bottom surgery. It’s obviously an important part of my transition and I am so excited that it will move me one step closer to being a more authentic version of myself. It’s going to be an intense process with a difficult recovery. I am being advised that I won’t be able to sit for more than thirty minutes at a time for the first six weeks after surgery. For me, bottom surgery is absolutely a requirement for me to be myself.
A quick note: as this article talks about bottom surgery, there are some medical details and body parts talked about. If that’s not your cup of tea, this article might not be for you.
When this comes up as I’m talking to cis folks, there is something that they equate to bottom surgery that does not ring true for me. It’s completion. The thought they have is that bottom surgery completes the transition process. For me, nothing could be further from the truth. Bottom surgery will be a monumental step, but it is not completion. I don’t want to undercut the importance of this surgery, because I’m in daily distress from having my body like this and this surgery will alleviate so much of this distress. But there is no way that this surgery will complete my transition.
Transition is very much a journey that involves being a work in progress. I’ll sometimes use the past tense when I talk about transition and state that I transitioned in November 2023. That’s because November of 2023 is when I socially transitioned and started living as Veronica everywhere. That period will always be symbolic of when I stepped into myself. Most trans folks don’t state it like this, but most trans folks also don’t socially transition everywhere on the same day. Each of us has control about our transition journeys and where we will go.
So, why is this thought of completion the most common misconception of my bottom surgery? I wrote about earlier standards for transition in January (Why Did I Think Transitioning Was Impossible) and a quarter century ago the medical community’s view of transition was very binary. This was an imposition of society onto trans people that they could only be authentically trans if they followed certain steps in an exact order that culminated in bottom surgery. Some places still require this to update your gender marker. It’s as if trans people had to prove their transness to society by “completing their transition” by getting bottom surgery. It’s really gross that society put this type of imposition on trans people.
When I was telling people that I would be transitioning in 2023, I got asked if I’d be getting the surgery. I’d always answer it by talking about where I would be starting - electrolysis. When I began my transition, I didn’t have bottom surgery in mind. I started transitioning because I am a woman, fully and authentically, no matter what my body looks like. I focused on where to start, HRT, being Veronica, and then electrolysis and legal updates to my name.
There’s a dichotomy for trans people. We do not need to access any medical interventions to be fully and authentically who we are, while at the same time medical interventions are often medically necessary and life saving. Those two things sound contradictory but they are both absolutely true.
There are multiple reasons that I am having surgery, and of course there is a component of pleasure behind it. With that said, sexual intercourse is NOT the primary motivator toward bottom surgery for me. The primary motivator is that I am in daily distress from having these incorrect parts on me. I need them removed to stop the discordance. Let me get into what that looks like for me and why I chose the surgery that I am having.
When trans women have bottom surgery, there are actually multiple options that they can pick from (same for trans men and nonbinary people, but I’ll just be discussing options only for trans women here). The option that I mentioned above, vaginoplasty, is what is typically thought of when bottom surgery is mentioned for trans women. This involves removing the penis and testicles and forming a vulva with outer and inner lips, a vagina with a full canal, moving the urethra, and forming a clitoris with a clitoral hood. The most common way to form the canal is with a penile inversion, where they take a penis, turn it inside out, and that becomes the basis for the new canal. This recovery process is intense, it involves frequent dealation for the first year, and the results are affirming for those who choose this route.
There is another option called an orchiectomy. This option removes the testicles. As the testicles are what produce testosterone, this procedure is very effective for trans women who want to stop fighting the hormones that their body produces.
Then there is a third option, and this is what I am pursuing. It’s a vulvoplasty, which is sometimes referred to as a zero depth vaginoplasty. It’s everything that a vaginoplasty is, but there isn’t a canal that is formed. I’ll have, essentially, a dimple instead of a canal. There are a number of reasons why I’m choosing this path over the other two options outlined above. I’m picking this surgery over an orchiectomy because I want all this tissue gone and because I want to look and feel at home in my body and have it fully reflect the authentic me.
There’s a list of reasons why I’m picking this procedure over a full depth vaginoplasty. This first is dilation. Most trans women who get a full depth vaginoplasty need to dilate for the rest of their life, and many times a day during the first year. Not doing this can cause the canal to shrink or close. That’s a lot of work and it isn’t work I’d like to do. The second reason that I’m picking this path is that I don’t need to be on the receiving end of vaginal sex to feel complete. Isn’t that really a patriarchal view? No, my existence doesn’t need me to be fucked by a man so that I’ll be complete. 0% of my transition is for men and 100% of it is for me. As I mentioned above, this surgery is about bringing me closer to who I’ve always been. I’ve been married to a woman for 26+ years and we are monogamous. I don’t need to have a canal.
The third reason is that this surgery still provides many avenues to pursue pleasure. I’ll have the only organ on a human body who’s only purpose is sexual pleasure - the clitoris. They will be taking tissue from the tip of my penis and repurposing this to form the clitoris. It will take months for the nerve endings to regenerate, but I cannot wait for this. While a canal is not important for me, the ability to derive pleasure is extremely important. My erogenous zones shifted after starting HRT and I cannot wait for my body to be in even more alignment with that shift. There’s are fourth and fifth reasons that I’m choosing this path. Reason number four is time. To undergo a full depth vaginoplasty, most people need to undergo electrolysis hair removal on the surgical site. Because hair growth cycles, this process takes time. It typically takes 90 to 100 hours to clear the area over a period of up to a year. The fifth reason is related to this, and I just don’t think I would be able to take the pain of hair removal in the area of the future surgical site. This is because this is a part of my body that I’ve had past trauma to. The trauma was so severe that when the doctor examined the area of my surgical site at my bottom surgery consultation, my reactions to her examination caused her to send me for an ultrasound to confirm the structural integrity of my surgical site wasn’t going to yield any surprises at the surgery. The ultrasound was thirty minutes. While I wasn’t in any physical pain, I cried the entire time. It was horrible and that’s such a clear representation of the physical distress that I’m in on a daily basis. I can’t imagine the trauma that I would endure by sending an electronic charge into each individual hair follicle to permanently stop its ability to grow hair in that area.
When you add all five of these reasons up, it’s obvious that I’m choosing the right option for me. The analogy I’ve used for this surgery is that maybe I could go through a cumbersome process and eventually I might be able to get a sports car. But I could get a Corolla right now. I’ll absolutely take the much more sure Corolla over a delayed process to potentially get a sports car. There has been a lot of interruption in transgender care across the country, both for trans youth and adults. Being able to get this surgery in less than two years from when I started HRT and socially transitioned is an incredibly fast timeline. I’ve had both focus and fortune to bring me on this path without a slew of lengthy delays.
This surgery isn’t completion, I’m starting with the surgery that’s most important to me. Some trans women don’t have any surgeries. Others might start with facial feminization surgery (ffs) or top surgery. I am fortunate that I will not need top surgery as I’m already satisfied with where I am at there. I’m in the lucky minority of trans women who are satisfied through HRT for breast growth. As for ffs, it scares the hell out of me - much more than bottom surgery. Maybe that’s me being naive about bottom surgery, but I don’t think so. There’s really no reason for me not to get bottom surgery. Whereas with ffs, there are so many potential options that it’s really hard to think through all of the possibilities. I’ve seen trans women in the community talk about what they go through after ffs surgery and it really seems like they are going through hell. I don’t know if I’ll get any of these procedures.
However, lately when I’ve been seeing trans women who have had multiple ffs components done, their results are incredible and overwhelm me. I can’t stop crying. That’s both because I’m so happy for them and the relief they must feel and because I am reminded of my own dysphoria every time I look in the mirror. There are multiple women that I know online who have had ffs, so I won’t mention them by name. Their procedures have produce breathtaking results. There is also a public figure that causes me to cry every time I see her results. That public figure is the drag queen Bosco. She was on RuPaul’s drag race a few years ago, came out as trans on the show, then transitioned after the show. She had facial feminization surgery, and I just can’t get over how she looks today.
Looking at her today both completely breaks me and gives me hope that I too could see something different in the mirror some day. I have no idea if facial feminization surgery is something that I’ll also pursue at some point. I can tell you that any time I’m in public and outside with the wind blowing, I feel significant anxiety. I have areas of my hairline that make me feel really dysphoric if they are exposed. This is why my hair always has either bangs or a center part with hair framing my face, as that covers my dysphoric spot. With that said, I have had some hair start to regrow and reclaim hair growth on my scalp in areas that haven’t grown anything in over two decades. If I’m starting to have hair regrow in areas that it hadn’t been growing in, is it smart to disrupt this regrowth and look at surgical methods for hair restoration?
It’s not just hair, as I feel dysphoria in other parts of my face as well, especially in my nose and chin. Now add my brow ridge, adam’s apple, and having an angular face, and that’s already an almost overwhelming number of options. I have a dichotomy when I look in the mirror. What I see is so much better than it used to be. At the same time when I look in the mirror sometimes the dysphoria wins. Part of that is that my rosacea was so bad that my nose changed shape and I have this WC Field bulb on the end of my nose. It’s also just due to undergoing the wrong puberty. Today, I have absolutely no idea if I’ll ever address any of this through surgical methods. The good news is that I don’t have to make a decision today, tomorrow, or at any point in the near future. After all, I’m on a journey. I’m not seeking completion.
May all go well.
Thank you for this article, you confirmed many reasons why I’m choosing this option as well. Can’t wait for a surgery date soon.