Body positivity, calm pragmatism, I'll take whatever!
August 28, 2017 9:49 AM   Subscribe

Last December, I had a much-needed surgery and am fortunate that so many things went right. How can I be more forgiving and body-positive about the things that didn't go great and still don't look 100% right?

(details about vaginoplasty/gender affirming surgery follow)

After years of planning, hair removal, waitlist-floundering, saving, and getting better insurance, I'm super fortunate to have finally had gender affirming surgery (vaginoplasty) last December. This is the only surgery I wanted to pursue as a trans woman -- I've wanted to have an inside in this sense so badly. I went out to California and had the surgery, had a couple of wonderful friends and my mom help me recover, got back to my town and stumbled my way through the second semester of grad school (somehow). I just passed eight months since surgery, and have just started to regain my full energy (getting on Welbutrin helped a lot).

Things that went very well: the surgery was generally a success! I'm healthy, sensitive in the places that matter (and this is slowly increasing even!), adequate depth, etc. Things no longer hurt for the most part. And I've even been able to have (very different feeling, also much more elusive) orgasms! So like, so many things went right, and I'm very happy about these things.

Things that didn't go as well: Early on I had some wound separation on one side of my vulva. As a result, I have a huge lopsided amount of swelling and scar tissue. This has gradually gone down, but the whole region overall is still very swollen up, and I can feel some of the scar tissue having hardened. Also, in general, my vulva looks different than the vast majority of other vulva I've seen -- very little clitoral hood, shapes of things, etc.

I know that some of this is due to swelling which, for me, seems to still be working itself out (most people only experience a few/several months of swelling, but others seem to experience this level of swelling for a year or more). But it seems there's a good chance that the wound separation really just kind of warped the whole shape and that's what I have to work with.

What I can do about it: My surgeon DOES offer free revisions if I'm unsatisfied at the year mark (early December). I e-mailed him about how things are going and he gave me some suggestions of things I can do to help with the scar tissue, cortisol shots etc, and also to keep waiting and reach out in a few months if I'm unsatisfied with any aspect of things. So, on paper, I have a good situation where I can just keep waiting and then take action and pursue a revision if needed.

But I'm really worried I won't be able to pull this off. He'll likely schedule my revision in the middle of another grad school semester. I'm under a lot of pressure to graduate on time to keep my funding and soon after find full-time employment (to pay off my maxed-out credit cards due to medical debt) and so I'm worried about pulling everything off again. Revision labiaplasty generally has a much shorter recovery time, only a week or two, but still. Also, given how much sensitivity I have and other positive things, I don't want to just mess things up because of some apparently internalized idea about how things "should" look -- I didn't pursue surgery to achieve a specific (and unrealistic) ideal yknow, I just wanted to have the vagina that was right for my body as it is.

In general, I still have so much residual anxiety related to going through surgery. I have a lot of anxiety about medical stuff, and even going through with one surgery was a big deal. I mean, I know I could do it again if I need to. But I think some part of me is still just kind of reeling from everything that happened especially in those early few weeks. I really don't want to go through any aspect of that again, but I will if I need to.

My problem right now: Every few weeks, I fall into an anxiety hole where I take some photos to compare myself to earlier progress, as well as compare myself to other cis and trans vulvas online (I know, this is not smart). I just start to feel really inadequate, that nobody is ever going to want to be with me, and then I obsessively try to research my plan of attack and just read the same old forum posts about swelling and revision surgeries and cis men's perceptions of neovaginas. Again and again and again. I also hate doing this because, generally speaking, I'm a person who believes in nourishing a positive relationship with my body as it is and having compassion and self-love about these things.

Having surgery in general has made me feel comfortable with myself and relaxed and at peace in this profound and lovely way. Having an interiority in this way is meaningful to me on a deeply personal, even spiritual level. I'm so grateful I took the actions I did, and I think my surgeon did a good job, and I think my body is just healing in the way my body does.

I also can't resist the temptation to berate the fuck out of myself for these inadequate aesthetics and use them as evidence that I won't find love in the way I want to so badly, and to just endlessly spiral over the same options, the same plans. It's just pure uncut despair, and it's not good for me. I want to feel good, and about half the time I feel very good about things. But the other half I just feel all this worry and self-criticism, and then shame about those feelings (I hate answering the question "how are you feeling after surgery?")

Do you have any guidance for avoiding these despair holes, practical tips about recovery, reassuring tips about swelling or the spectrum of vulva types, anything? I need to protect myself from these feelings because they are all consuming and very scary. Or maybe I just need to feel them. Thank you thank you.

(PS. On the chance other trans folks considering surgery read this, let me just emphasize that I have zero regrets about pursuing this surgery. It absolutely sucks it's so difficult to make surgery a reality for many of us, but the complicated logistics and financial aspects before surgery and these healing complications and anxious thoughts afterwards pale in comparison to the easy affirmation of waking up with my body as it is now. Keep going, if this is something that matters to you <3 )
posted by anonymous to Health & Fitness (12 answers total) 3 users marked this as a favorite
I'm really sorry you're going through this. I'm a cis male so I have no direct experience with your specific situation, but I do have experience with depression, anxiety, despair, loneliness, and body image issues. Please forgive me if I get a little off-base here, I'm doing my best.

First, let me say that you sound like you have a really healthy, grounded outlook on this whole thing at least on what I think of as an "intellectual" level. That is, you know how you want to feel about all this, and you are coming at this with a goal of finding self-love and self-acceptance. You're having trouble making your emotions go along with what your head says is right, though. That's super understandable and super normal.

So, are you in therapy? You sound like someone who not only needs to have a compassionate, trained, expert professional to talk to about this stuff, but someone who would probably stand to actually get a lot of benefit out of it. Maybe you already have that, but you don't mention it in your post. If you do, great. If not, that is probably something to look into. Possibly it might help to work on finding a better medication regime as well, one that can smooth out those highs and lows and stop you from cycling down into despair.

Also, let me reassure you from the persoective of a cis male that having an unusual-looking vulva is not going to be a problem in terms of finding love. Any guy who is worth actually having as a partner is going to be interested in you as a person, not as a vulva. Yes, possibly you may meet some guys who have a problem (their problem, not your problem!) with your vulva. However, those are not the types of guys who you want to spend your life with. You've probably heard people say that before, but dammit it's true.

Anybody who you are going to end up with long-term is going to know all about you and they're going to be in love with the whole package, not just your genitals. Lots of people of all genders and sexes, cis and trans, have genitals that differ from the norm. You're going to want to be with a guy who understands that. Not only is it kind of directly relevant for you, it's also just a sign of the kind of empathetic, understanding, broad-minded person that everyone should want as a partner. Someone who can't wrap his head around the idea that not everybody's body looks like the ones he sees in magazines is not going to be a good partner, probably for anyone.

Now, talking about revision labiaplasty. Is there any reason you can't wait on this? Do you have to make a decision in December, or is this something you could decide on later and schedule for a time that worked better with the rest of your life? Maybe just knowing that you have the option, even if you're choosing not to exercise it at present, would help you feel more relaxed about things. Perhaps in another year or two you'll be in that place of acceptance and you'll decide you don't need to pursue it. Perhaps you'll decide that a revision is something that you really just want to do for yourself. Either way, things will be less emotionally raw if you can table the decision for a while. No need to impose artificial deadlines on yourself.

It sounds like some of your distress centers around your feelings from your last surgery and the recovery from it, and maybe you're not able to make your best decision here because of that. It does sound like the recovery for a revision is likely to be way easier than from your original vaginoplasty, but (understandably) you're feeling like it's going to be just as difficult to deal with as the first time was. If you can give yourself some time to recover more emotionally as well as physically, you might find yourself in a place where revision doesn't seem like such a big deal. Or maybe you just won't feel like you need it. Either way, it sounds like maybe you need to wait for the emotional swelling to go down, so to speak, which may take longer than the physical.

Finally, you probably need to cut yourself off from those forums and photos that you're circling around with. It sounds like they're feeding an unhealthy dynamic in your psyche. Do whatever you have to do to totally block that stuff out of your life, at least for a good couple of months. That kind of dynamic is one that I am familiar with (albeit for other subjects than the appearance of my genitals) and getting rid of whatever the object of my online fixation is has always helped me break the cycle.

Well. That doesn't address everything in your post, but hopefully at least some of what I just said is useful. If I blundered, please forgive me if you can. I wish you peace, acceptance, and love. You'll get through this.
posted by Anticipation Of A New Lover's Arrival, The at 11:21 AM on August 28, 2017 [8 favorites]

I'm a cis female. The only thing I wanted to say to you is that even among those of us born with vulvas there is a huge amount of variability, and to date, I have not heard firsthand of a situation where someone has been found wanting because their lady bits don't conform to an ideal.

I have read that there are women who undergo minor surgery because they want their bits to look "pretty", but, at least to my knowledge, they are a very small minority. Lord knows things don't look perfect down there for those of us that have undergone childbirth and other traumas to our nether regions, and there are plenty of wonderful individuals that have chosen to love us despite those imperfections, because those imperfections are largely irrelevant to someone who loves the rest of you.
posted by Everydayville at 1:52 PM on August 28, 2017 [9 favorites]

Echoing Everydayville but from the other side, never have I heard of a man getting into bed with a woman and then aborting because her genitals didn't look right. Granted I don't tend to hang out with people who would have that sort of conversation in the first place, but still. It's not even something that's come up as a friend-of-a-friend thing, or an abstract idea. In my experience, that scenario is totally unheard-of.

So maybe that line up above about the possibility of someone "having a problem with your vulva" was unnecessarily pessimistic. I wasn't too sure about it even as I was writing it, to be honest.
posted by Anticipation Of A New Lover's Arrival, The at 3:06 PM on August 28, 2017 [1 favorite]

I don't know if this will work for you, but for me, the ways that my body is not socially approved have turned out to be excellent asshole filters. Quality people will love and appreciate you -- and your body -- in full.

This is sometimes painful! It's disappointing to be turned down about a physical characteristic about which I feel insecure. But as I look back, I can see that I dodged a lot of bullshit by being out of the mainstream, and discovered a lot of unusually excellent people by having a "this is me: human, imperfect, and all; love me or leave" kind of attitude.

And for learning self compassion, what helped me most is this question, "What would I say to to a friend having this experience?"

Good luck! This is tough stuff.
posted by spindrifter at 3:32 PM on August 28, 2017 [3 favorites]

The VAST VAST VAST majority if people don't have photos of their genitals on the internet.

There's a HUGE variety of vulvas and bodies out there. (I personally like the cute illustrations from The Vulva Gallery. They have included topics about all types of vulvas, not just cis vulvas.)

In addition, most people have some body thing that is outside of "average" but that doesn't mean it's not NORMAL or that it's not BEAUTIFUL.

Our bodies change. They do weird things as we age. We get scars and bumps and wrinkles.

I personally, would see how healing goes for a while. Don't rush it. Scar tissue can take a looong time (years) to settle down. See how things physically feel. Personally I'd be cautious about the possibility of adding more scar tissue to such a sensitive area as it can be painful or affect feeling just for how something may look.

It seems honestly like a VERY short amount of time to get used to and accept a new part of your body. Hell, I'm in my 4th month of my 3rd belly button (slightly changed each time after two surgeries) and I'm STILL not used to how my own belly button looks in the mirror or look down.

I'm cis, but deal with body issues and chronic illness. I've also has scar tissue do funny things like be super painful or tight or lumpy. I'm not in line to want to add more scar tissue.
posted by Crystalinne at 4:04 PM on August 28, 2017 [2 favorites]

I think everyone else covered the many aspects of this question, so I'll add another vote in the "we all have different bodies and they're all fantastic in their own way" column. I'm also going to second the recommended therapy, not only because therapy can be hugely beneficial to Everyone but because you're going through a lot of things all at one time. You may even find that some of your anxieties about school are getting mixed up with your anxiety about your body changing, since anxiety and those sorts of feelings have the lovely effect of infiltrating unrelated things. Having someone else that's not involved directly in your stuff can be hugely helpful. If you're not in therapy, see if your university can help you access that resource.

You've also undergone some major changes to your body and have new physical aspects. Have you created any sort of relationship with your new bits? You mention orgasms and that is awesome. Are you indulging in a healthy bit of self-love? As woowoo as it sounds, masturbation in a loving way can really help with the emotional self-love, too. You can start with even just giving yourself a nice massage in that area. How does it feel when you rub/stroke/massage different areas? Ground yourself in those pleasurable feelings. Don't neglect the areas that you're not too keen on, either. Do you have a name for your genitals? Does it have an identify? These things aren't required of course, but the more you can associate positive feelings with the less-desired aspects the more you may find them to be fine after all. There are plenty of resources for those who don't find their bodies to be their ideal versions, but you may find that those that are for survivors of sexual assaults can be helpful simply because they are focused on that sexual aspect that's almost impossible to separate out of the genitals. The Body Keeps the Score is an excellent book, as is Healing Sex. Research Emotional Freedom Techniches- they sound a little out there, but it can be a useful tool to add to your arsenal.

Don't be too hard on yourself, you're creating a new relationship here. Many people take years to be comfortable with their preinstalled hardware, without the additional steps and complications that you've had. I'd give it time to see how you feel.
posted by shesaysgo at 4:43 PM on August 28, 2017

Surgery is hard on the body, and we all recover at different rates. I worked with a PT who's knowledgeable about scar massage to reduce swelling years later.
posted by Jesse the K at 5:33 PM on August 28, 2017

Since no one's mentioned it here yet - Wellbutrin is also known to increase anxiety. I decided this was an acceptable side effect for me since otherwise it was working well, but it's also a fine reason to try a different med if you want to.

N-thing that it is way outside the norm to criticize any aspect of a partner's body, and I think it's unlikely to happen with anyone who hasn't revealed themselves to be a cad pretty quickly after meeting.

cw: four-letter word for female genitalia...

If you find coloring books pleasing/relaxing, you might check out the Cunt Coloring Book by Tee Corinne. It was drawn to assist a sex education class, there is a ton of variety (including lopsidedness), and the fact that it's black and white outlines vs. photos might help reduce the tendency to compare?
posted by momus_window at 6:10 PM on August 28, 2017

Bodies are all *so* different. And recovering from a signifiant surgery takes time - not just physically but emotionally. I cannot even imagine the kind of asshole who would get into bed with a woman and then call a halt because her bits didn't look "right." (As far as I know, not a whole lot of direct staring at bits goes on during sexytimes anyway, for most folks).

Is it worthwhile to email your surgeon again and tell him you're concerned that if you do need a revision surgery, it will be scheduled during the middle of the semester and hamper your ability to graduate on time. And ask him if - if it comes down to it - he will have some flexibility. Might be good to explain that you're hoping it will all be moot but it would help your peace of mind in the meantime.

Do you have support? Maybe a friend you can call when you're getting into anxiety-space to go and see a silly movie or eat fro-yo?

Seconding therapy and discussing your meds with your doc.

Good luck to you!
posted by bunderful at 6:20 PM on August 28, 2017

".... never have I heard of a man getting into bed with a woman and then aborting because her genitals didn't look right." Quoting Anticipation Of A New Lover's Arrival, The

I have, but her genitals were perfectly normal, it was their wedding night and he never attempted to have sex with anyone ever again. So I think that was on him.

Have you tried comparing your new vulva to cis vulvas that have had surgery, or which are older?

The thing is, you could always get the surgery, but the only fair comparision is to a post surgery vulva. And in ten years you are going to have an older vulva, and in another thirty five years you are going to have a much older vulva. So going to a lot of effort to get a perfect vulva new is a very short term strategy. You might end up with a vulva that looked really pretty, a perfect pink heart shape, and keep it for five years, but then what with the inevitable fact that life involves wear and tear sooner or later you pubic hair will go grey and you will get cellulite and stretch marks on your thighs, and at that point, the fact that your vulva looked portrait perfect for five years will count less against how much you and your potential future partner(s) are enjoying the one you have then. So scar tissue and lack of sensation to me would count a lot more than lopsided. Especially when you haven't yet finished the swollen stage so you don't really know how much lopsided you are looking at.

And there is the story of the cis woman who from early adolescence masturbated by gently and repeatedly tugging on one side of her labia minora. With the result that in her twenties she noticed that that side was noticable larger that the other side! So she trained herself to switch sides, and some years later the previously short side had evened up. But I suspect you are talking much more lopsided that that story.

What I would concentrate on right now is healing, school, and self care, along with staying in touch with your surgeon. Then when school is finished and the healing is stable and as far along as it will get you might still want to go ahead and get some more work done. But at that point, having finished graduate school you will be in a better position to have a good job with a good income with a good medical plan, and a good relationship with your surgeon, who might just still be willing to charge low because you are a repeat patient. It's not like going with this surgeon now is your only ever option to get your vulva looking a little more tidy. And if I understand correctly - go over this with your surgeon and get him to advise, there is probably an optimal time to do new surgeries, which might not be the within-one-year mark. And THAT is when you should be aiming for if you decide to go for it, when ever the surgery would have the best chance of improving form without losing sensation and tissue softness.
posted by Jane the Brown at 7:55 PM on August 28, 2017 [2 favorites]

first, congratulations. huge life changing deal there. i'm so happy for you!

second: stop comparing yourself to other bodies. stop. if you are doing this please imagine me hovering over your shoulder like a public access TV dickensian doom ghost saying: STOP. CUT IT OUT. THIS IS TANGLED UP WITH WHAT THE CIS PUSH ON US AND FEEDS INTO OUR TERROR THAT WE WILL NEVER BE "NORMAL". this does not sound healthy or productive for you, so take a break from it.

second-part-two: yeah you have to feel some of those feelings. but please pay attention to the difference between processing the major reality that you made the choice to remake your body in a way that brings you peace and getting sucked into a despair bucket. the first is difficult for sure but i bet it has a different tone and flavor than the second. so pay close attention and don't be afraid to bat away the despair bucket.

third: are you able to talk to other trans people about your concerns? the cis, even the most well-meaning, in my experience do not get certain aspects of dysphoria/body comparison/angst that seem like they are attending you at this moment. i would prioritize finding others who have had this SPECIFIC experience so you can compare notes. if at all possible. NOT FORUM POSTS. COMMUNICATING IN REAL TIME WITH ALIVE HUMANS possibly computer assist

in my exceeding limited and anecdotal experience it seems very, very normal to have a complicated series of relief/anxiety/body comparison/frustration/shame feelings around gender affirming surgeries. i know that doesn't make having a bunch of weird feelings any easier, but the "omg am I Normal, are these feelings Normal" concern signifies, and sometimes it's been helpful for me to know in my marrows that it's ok that, for example, i am not 100% thrilled about every aspect of medical transition, it doesn't fucking fix everything, and also it's super great in a lot of other ways. i feel like we still are not allowed to have a lot of nuance around such matters in many a space because the national conversation is still stuck on whether we are permitted to exist and have rights and crap.

idk comrade, hmu if you feel inclined. i'm AFAB NB so not exact same experiences but you know the drill

let us know how it works out.
posted by nixon's meatloaf at 10:33 AM on August 29, 2017 [2 favorites]

I went through a lot of this stuff after my vaginoplasty too. I'm now a year and a few months out, and I still get caught up in sadness and shame about the whole thing sometimes.

Part of it, I think, is that we're under a lot of pressure to see our surgery results in very black-and-white terms that I don't think reflect the reality of anyone's relationship with their body. The culture around us wants to sell us the idea that we have two options: either we're 100% blissfully happy with our new bits, or we are A Tragic Case Of Sex-Change Regret, someone who Didn't Think It Through and Made The Wrong Choice. Even within trans community people talk about it like those are the only options. And so we end up hypervigilantly monitoring our own feelings, keeping careful watch for any signs of The Regret.

(It's a little like the stage a lot of us go through of obsessing asking ourselves "Do I feel like a woman now? How about now? Or now? Oh shit, that last time I wasn't sure. Probably that means I'm not really trans. Fuck." )

I've been telling myself that the right attitude to take towards post-op genitals is the attitude most people take towards, I don't know, their left elbow. I am absolutely not 100% blissfully happy with my left elbow. Probably if I spent the next eight months obsessively monitoring my feelings about my left elbow, convinced that the validity of my choices depended on those feelings, I'd find all sorts of weird ambivalence and Elbow Negativity to stress over. But, like, whatever. My left elbow does what it needs to do. Once I fell off my bike and had a gross scab on it for a few months and I didn't like that, but it got better. Sometimes it hurts and sometimes I knock something over with it and sometimes it gets all dry and ashy but most of the time it's fine. I'm getting to where some of the time I can take that same attitude towards my vagina, and I try to remember that that's good enough.

Sex is tricky. Like people are saying, nobody's kicked me out of their bed for having a funny-looking vagina. But there are a few things about it that are nonstandard enough that I actually do kind of need to have a little orientation session with new partners. (TMI, but my urethral opening is a lot wider than on most other people, and so if I don't point out what's what people sometimes try to stick things in it, which is not a satisfying experience for anyone ಠ_ಠ) I'm still trying to figure out how to negotiate this. It's a bit awkward. But, like, it hasn't been the end of the world. Nobody's been insulted or reacted badly, and if someone did react badly then they wouldn't be the right person for me to be sleeping with. And it's pushed me to get better in general at telling partners about my body and asking for what I want, which I've ultimately gotten some really positive stuff out of.

So, I dunno. Bodies are messy. People's relationships with bodies are messy. Being trans and preop can give you a 100% negative relationship with your junk, but being cis or postop or whatever doesn't give anyone a 100% positive relationship with their junk. It's okay to be irritated about this.
posted by nebulawindphone at 12:19 PM on September 25, 2017 [1 favorite]

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