I'm about three weeks past my penile-inversion, full-depth vaginoplasty, and I wanted to document some of the problems I have run into and how I have managed to cope or solve them.

Dilating with Wound Separation

Douching

Bleeding from Toilet Use

Diet: Protein & Calories

Boredom

As usual, let me know if you have any questions or concerns - I want to learn from you, but also to be a resource for the community.

Thank you for reading. 💕

this loaf was made with 100% freshly milled wheat berries as the flour!

loaf of white bread I baked in April 2025

the chapter on the history of Western philosophy's view on women was particularly disturbing - in summary, women aren't people.

e.g. Aristotle thought women were naturally mutilated, deformed versions of men. Hegel compared women to plants.

The idea of women being worthy of literacy and education, let alone being a professional like a lawyer, are all shockingly recent changes.

Are there ways that you are able to signal queerness?

People keep assuming my partner and I are two straight women, and it's just awkward sometimes. I know my partner would like if people saw us as a visibly queer couple, so I was hoping for tips.

Usually I try to engage in "PDA" like holding hands or kissing in public, but even that doesn't seem to always work (I have done this and had a waiter still assume we're relatives rather than partners).

Preface

Hi everyone!

I am really scared of needles. When I was a child, I was scared of getting vaccinated. I was a very anxious child, and the idea of a needle going into me was terrifying, not just because of the pain but also because of the foreign object going into me. I felt overwhelmed, and so I bolted - I ran out of the pediatrician's office and into the hallway and tried to flee. Staff captured me and held me down and forcefully injected, which was extremely painful and traumatizing.

Since then, I have always had really difficult experiences with needles. They unnerve me, it's hard to think about them going into me, and it's easy for me to feel anxious anticipating any blood draws or vaccines. I have never fully fainted around needles (I have always tried my best to cope), but I have nearly fainted several times despite my best attempts.

For these reasons, it has been a life-long fear of mine that I would become dependent on a medication I have to inject.

Yet of all the options, I still chose to inject my sex hormones. There are lots of reasons why I believe this is the best method (esp. compared to oral or sublingual routes), but I wanted to share some tips and tricks for other trans folks who have fear of needles like I do so that they can be empowered to inject hormones too.

Tips and Tricks for Injecting Hormones

Location: do the injection somewhere that you will be safe if you pass out (somewhere soft and flat, for example). It helps if the place is comforting as well - free from noise, distractions, stress, etc. Do what you can to create a safe and comforting environment.

Position: when you are injecting, keep your legs propped up (when you start to faint, blood can rush to the legs and keeping them level with your heart can slow or prevent fainting). I like to sit on a couch with my back supported, and use a firm pillow under my knees so that my legs can completely relax while remaining elevated and my legs level with my heart.

Blood Pressure: to help avoid fainting, do what you can to increase your blood pressure:

• be as cold as you can tolerate (it shunts blood to your core from your extremities and increases blood pressure)
• drink lots of water and "overhydrate" before injecting (this also helps reduce pain)
• if you've recently woken up or have been lying down for a long time, move around a little first and get the blood flowing - go up and down some stairs, etc.

Subq: to help with needle phobia I choose to inject subcutaneously (into fat) rather than intramuscularly. This is because subq injections can be done with a smaller gauge (not as thick) and shorter needle, so there is less pain and less anticipation of a big needle going into the body; I use 27G 1/2" needles (the grey ones) to inject and I barely feel any pain, sometimes there is literally no pain.

Draping: drape blankets over the parts of your body you're not injecting into to make it easier to forget you're injecting into your body (instead, make the injection site a foreign object, essentially dissociate from it and treat it as if it's all just mechanical, don't identify with the part you're injecting into).

Body part: inject into body parts that you don't find as disturbing to inject into; I find injecting into my belly much more distressing than injecting into my thigh (note: where you inject is constrained by the method you use, you can't just inject anywhere - I'm relying on you knowing where you can or can't inject, but figure out among those options which places are easier or harder for you mentally, if there is any difference at all).

Short break: especially when I first started injections I found it helpful to take a short break between drawing medication into the syringe and injecting; essentially this is about titrating exposure and minimizing built-up fear and anticipation. Over time I have found the need to do this has gone down, but I suggest it anyway - do something else, think about something else, don't look at needles or think about injecting at all for a few minutes after drawing up medication and before injection. (Note: don't take too long of a break, there are concerns about sterility and generally this advice would go against medical practice, but I think given the context a short break is acceptable and a helpful way to cope when you first start injecting.)

Quick jab, not slow push: when injecting subq (I don't do IM, so I can't say if this applies), pinching the fat and injecting quickly in a forceful and committed way helps avoid pain. Slowly pushing the needle in is not only more painful but much harder psychologically (it gives you time to think about it and panic), so it's better to almost surprise yourself and let your hands do the motion without having to think about it too much, and doing it quickly means you can't hype up the fear as its happening

Look away: I prefer not to look as the needle is going in, or out, and I like to keep a finger in the way of being able to see where the syringe meets the body while pushing the plunger down. Thinking about the needle in my body is part of what freaks me out and not seeing it helps reduce exposure - this may or may not apply to your needle phobia, and obviously you want to know you're injecting in the right place - so I look and orient where I want to jab first, and sometimes I try to look at more neutral parts of the syringe (i.e. not the needle) to help coordinate the injection.

Don't aspirate: subq injections of small volumes don't require aspiration (that's where you pull back a little on the plunger to see if there's blood which indicates you've accidentally hit a vein), so don't fret about whether you have hit anything.

Mental Simplicity: keep the injection mentally simple. I find it best to keep my mind elsewhere while the needle is in me, and to only think about the injection as little as is necessary to do it. Make it procedural and stay narrow-minded. Keep yourself from thinking anything beyond that simple procedure (like: OK, thrust needle in; good, now slowly increase pressure on plunger; good now slowly remove needle). Fill the gaps between steps in your mind with a distraction - I like to look out a window and take in a view, others might find music helpful. Don't think about what you shouldn't be thinking about, instead actively distract yourself with something else.

Contextualize the pain: This tip is a bit weird, but sometimes my anxiety builds up such fear around injecting I almost cannot physically do it, and in those moments I find it helpful to take a deep breath and then think about other times I have experienced much worse pain or physical trauma. Remembering those instances, and in particular how those sensations were not as bad as I would have thought and how I survived those helps put the injection into perspective: this barely registers as painful, and is causing almost no physical damage to me. Don't do this for a physical trauma that you are still disturbed by, it works best for cases where you're not distressed by the example. Most people have stubbed their toe and that hurts so much more than the injection, but you may have a better example - experiment and find what's helpful.

Reframe the needle: this mental trick might be too specific to me, there have been times where I have had things impale me by accident (like when gardening a dry reed of grass once shunted into my hand, or one time a stray sewing needle left on a bed ended up poking into my leg, etc.) - in my experience these events were not traumatizing or fainting type episodes, there was something just matter of fact and not fear-inducing about these experiences for me, so sometimes I like to pretend that I'm not pushing a needle into me, but instead I think of it like that reed of grass - a benign object, nothing to be scared of. Somehow this bypasses some of my needle phobia. I suspect it's because my needle phobia is based on medical trauma and by taking it out of the medical context in my mind I find it much easier to cope with. Depending on where your needle phobia comes from or what you are sensitive to this may or may not help (it may even make it worse, so be sensitive to your needs).

Control: finally, I would just say that my needle phobia is minimal when injecting myself now and I realized having control over the injection was important to managing and overcoming that fear. I have more needle phobia when others draw blood now than when I inject myself, and at first the relationship was inverse: injecting myself seemed so much worse than having my blood drawn. Also each injection seems easier than the last for me, and if you can successfully inject without panicking or experiencing fear or other negative emotions, having those "positive" or at least neutral injection experiences helps build a little bit of mental safety, and you want to protect that sense of safety. You may not have control over this, but for me that has meant to whatever extent I could, I try to reduce exposure to negative experiences with needles and emphasize positive experiences (and when I've had a negative experience, I try to give myself time to recover before re-exposing myself, so I didn't "spoil" the next experience as much).

Positive Associations: eat something sweet right after your injection as a way to build positive association with injections (there is actually research showing this helps, that's part of the reasoning behind having candy at pediatrician's offices). Likewise you can use fun bandaids (I use Welly bandaids) as a way to build some positive associations into your injections.

Prologue

All I can say is that injections were literally mentally impossible for me when I first started.

There were times I broke down sobbing after a particularly difficult injection.

There were times due to dissociation and distraction that I jabbed the needle in too quickly and the needle bounced in and out of me and I had to redo the injection.

There were times I sat there with the needle in hand and it took 20 - 30 minutes of mental struggle before I could get my hand to do the action of pushing the needle into me.

So I won't lie, there were some difficult moments - but overall, injecting was so much easier than I had built it up to be in my head. So many injections were easy, and shockingly I found more and more of them were pain-free.

These days I barely have to think about my injections at all - I practice none of these accommodations (except sometimes making sure I've had a little food and water if I'm injecting first thing in the morning and I'm a little woozy, just as a safety precaution). Injections are easy, and they get so much easier over time.

If you are worried about injections, I get it - but this is something you can learn to do, even with a needle phobia.

Lastly, I want to allow this to be a space for others to give their own stories and suggestions, and I want to encourage anyone who is confused or who is curious to feel free to ask me any questions they have. I'm an open book and wish to be helpful.

Thanks so much!

So I wanted to just disclose some of the struggles I have had with my vaginoplasty, framing it subjectively as the information I wish I had been armed with before surgery, because I haven't done the work to account for how my experiences compare to others to know whether my experiences are worth generalizing or not.

Things I wish I knew

If I could write a letter to my pre-op self before surgery, here are some tips and information I would pass along:

More Pads & Wet Wipes

I will need more pads than I realized, I packed maybe 30 - 40 overnight maxi pads because I figured for a single week that was a lot and other posts on Reddit and elsewhere mentioned that they didn't use many supplies - I needed more like 40 - 60 pads so I ended up buying a couple extra packs of 10 while at the hotel.

I also had to buy some extra wipes, I think I went through 2 - 3 containers in a week, so I had to buy 1 - 2 extra. (It has been less messy over time, but in the beginning it's a lot.)

Redundant equipment

Having a second hand mirror would have been really useful - having a mirror dedicated to the toilet station would have been nice so I could leave the other mirror as dedicated to my dilation station; I needed a mirror at the toilet to help me evaluate bleeding, help me navigate cleaning better, to observe my urine stream and so on.

Inserting the douche nozzle

Treat the douche like the dilator: use lube and a mirror to guide the douche nozzle into the vaginal canal. I did some damage and had some bleeding and made wound separation worse by trying to just guide it into me by touch alone in the shower.

Hospital staff's ignorance can be harmful

The hospital staff did not seem aware of the restrictions that come with a vaginoplasty surgery, e.g. they were unaware that after a vaginoplasty you should not sit or apply pressure to the sutures, as a result nurses put me at 90 degrees to use the bedpan, which likely contributed to wound separation later.

You have to advocate for yourself more strongly than is comfortable, and you are on your own to come up with solutions to avoid these complications caused by the hospital's negligence or ignorance.

A floating nurse from another floor won't know anything about your surgery or its details, I was variously asked to sit on the bed, to sit on a bedpan, to sit on a toilet all when my wounds were vulnerable and susceptible to wound separation - and I did have wound dehiscence as a result of complying with the hospital staff, so I wish I had known I needed to be more prepared to push back: don't sit on the bedpan, lie flat or at a 30 degree angle and try to use it that way.

Once you are not on bed rest and able to get out of bed, don't sit on the bed to get up, find your own way even if it makes the nurses uncomfortable. I had a nurse demand I sit on the bed before standing, but instead I found rolling onto my right hip bone and dangling my legs partially of the bed and then propping my upper body up slowly while sliding out of the bed avoided putting pressure on my sutures was better. This made nurses very uncomfortable because they see someone sliding out of bed like that as a liability - but don't prioritize the comfort of the nurses, do what you need to do.

Don't pee on the toilet if it's painful and difficult, I forced myself to at great cost. The nurses need to know how much you have urinated after the catheter is removed, and you are under a deadline to pee sufficiently after the catheter has been removed. They demand you measure the urine by capturing it in a little plastic insert into the toilet they want you to sit on to pee.

After my experiences of complying with this which caused bruising, inflammation, and wound separation - I recommend instead advocating for yourself and taking seriously the requirement to not sit, and opt to pee while standing, e.g. in the shower. I wished I had refused to comply, I prioritized the nurses preferences for following procedure over my own well-being and now I am in a precarious situation with regards to my wound separation, which is worsening every day and seems to be working its way deeper from the frenulum into the canal's skin graft.

Gas

I wish I had known about the post-op gas.

Before surgery, I had a balanced healthy diet with lots of vegetables and fiber and no meat. after surgery, they fed me a diet primarily of red meat, refined carbs, and sugar (think: a piece of roast, mashed potatoes, and ice cream or a juice concentrate).

Antibiotics, a mandatory fiber-restricted diet, and a diet with lots of sugars resulted in huge imbalances in my gut bacteria and I had extremely painful gas esp. starting day 2.

I don't know how to emphasize how much suffering this caused me - not only was it extremely awkward, but the had no way to escape and was more painful than any of my surgery pain was at any point to date.

I was unable to pass gas because strict bed rest meant I was lying on my back all day (usually walking around helps patients recover from post-op gas), and because of the lack of fiber and the daily dose of laxatives, every time I tried to pass gas there was diarrhea that came with it, so I had to be put on a bedpan every time I needed to pass gas. This was an exhausting affair - lifting my body onto the bedpan and then holding myself on it for 30 - 60 minutes while I tried to convince my body to actually release the gas and diarrhea was a serious physical trial.

In one day, I had to use the bedpan over 5 times, and each time was painful and put immense pressure on my surgical site, risked contaminating my wound vac, and was extremely painful.

They expect anaesthesia and the opiates to make you constipated, so they compensate by feeding you laxatives and refusing to give you fiber to try to get you to have bowel movements ASAP.

Unfortunately I am an unusual pationt: I had no problem with bowel movements, the resumed immediately and had a bowel movement within 24 hours after my surgery, so constipation was not a side effect of anaesthesia I experienced.

Furthermore, I did not have much pain so I did not take any opiates after the surgery, so I was basically given lots of laxatives for little reason and had a predictably awful time.

So I wish I had known to:

• stop the laxatives earlier,
• demand gas-x (simethicone) from the beginning, and
• maybe don't go along with their food and change my diet (e.g. eating yogurt instead of ice cream and juice concentrates, and maybe incorporating some fiber against their orders, to balance the bowel movements and avoid constant diarrhea).

Sleep

When people tell you that you won't sleep in the hospital, it's not for the reasons I thought, like the hospital has lights or is noisy or is a foreign environment.

No, you're exhausted and every moment you close your eyes you will find yourself slipping into dreams - it's not hard at all to sleep in the hospital!

But you won't sleep anyway, because nurses will wake you up every few hours.

A week of being kept from sleeeping was basically like being tortured, and enduring this aspect of the hospital was maybe a little traumatizing - you are unable to heal or rest because you aren't permitted to sleep longer than 1 - 2 hours. Even when a nurse would say they would let you sleep from midnight to 4am, it was more common that the nurse schedules would get disrupted and they would come in early at 3am or come in late at 1am instead of midnight. Because my blood pressure was low (from laying in bed all day from strict bed rest), my nurses panicked and interrupted my sleep more frequently to check blood pressure more frequently on the first few nights.

Blood Pressure

I wish I had known my blood pressure will be shot from laying in bed immobile all day every day - as mentioned, the nurses will panic and fret over this, but the solution is simple - sit up when they take your blood pressure. Elevating suddenly "fixed" my blood pressure readings. The only downside is that this did apply some pressure to the sutures, since you aren't supposed to sit - but even just elevating to a 45 - 60 degree angle helps avoid the blood pressure reading too low, the pressure from the bedpan and toilet use were what caused complications, not sitting at 45 degrees - go based on how you feel, but some elevation can help the nurses leave you alone. I have never had problems with my blood pressure, and I had no symptoms or reasons to be concerned from the low blood pressure readings the nurses were getting, but the nurses think in terms of standarized procedures and are not necessarily the most rooted in reality (so it's more important to check my vitals every hour than to let me sleep, even though my blood pressure was not dangerously low and I had no symptoms and it was just from lying in bed). Basically: learn what the nurses need to check their boxes, and learn to juke those stats. Elevate to get the blood pressure reading normal, don't drink any water right before they take your temperature, etc.

Dilation education

When they teach you to dilate, do not let the doctor leave until you are able to lay eyes on your vaginal canal opening directly with a mirror and you have demonstrated you can successfully get the dilator into the canal on your own without guidance or help - you need to know exactly where to put that dilator so you can be confident when pushing it in, if you apply the pressure in the wrong place you will cause complications like wound separation. My doctor helped me successfully dilate the first time and it seemed so easy, I knew roughly where to go and how to do it, but when I went to dilate on my own a few hours later, pressing where I thought was the right place suddenly caused a lot of pain and blood to gush out. Long story short, I was probably pushing in the wrong place (too high up, to avoid the "W" stitches below that I was explictly told to avoid, but which ironically was right where the opening was), and it was hard to tell where the right place was because of the inflammation. I had to problem solve the inflammation by using ice to reduce the swelling (something at discharge I was told explicitly not to do, I have heard this undermines nerve growth?) and getting a doctor to come back and help me dilate. It took them over 24 hours to get a doctor to help me dilate, and in the meantime I attempted to dilate three times and each time caused more bleeding and physical trauma. When a doctor finally saw me, they ordered me not to dilate and packed some gauze where the bleeding was. This was one of the most distressing parts of the hospital stay, and admittedly I completely broke down from the experience. It all could have been avoided with a little more education up-front, and even after I got help with dilation again, the new doctor made the same pedagogical mistakes as the first one: they helped ease the dilator in and then I didn't know how to do it myself. They had to come back later after a second, failed dilation attempt on my own (under their supervision so they saw I was doing it all "right" but still not able to dilate), and finally I explicitly asked them to show me the vaginal canal so I knew exactly where to go. Once I laid eyes on it, I knew exactly where to go and it has been trivially easy to dilate since. Force them to show you, make sure you see it and grok it before they leave.

Things that went really well

Just to not focus too much on the negative, here were some things I wanted to highlight as going better than expected:

Lube Syringe

The lube syringe was an amazing idea - it was less messy to suck lube into a syringe and then insert it and deposit it than to try to awkwardly squeeze KY jelly onto the tip of the dilator, the syringe is a smaller diameter and was helpful for identifying the vaginal canal before committing the girth of the dilator to pressing in, and the lube on the tip of the dilator was worse at distributing the lube and lubricating the dilator than the lube deposited directly into the canal (more lube was lost from the tip when first inserting)

Support person

Having someone in the hospital with you is absolutely necessary - during strict bed rest you are extremely vulnerable. If you drop something on the floor, you cannot get it back. You might wait a while before a nurse is able to come help you. Having someone there to help is essential. I was very lucky to have someone there for me, but I'm thinking this was far more necessary than I ever realized. At one point the psychology of spending a week in strict bed rest really got to me - my bodily autonomy had shrunk to the confines of a single bed. You are at the mercy of the people around you to ensure you have water, food, and access to information or anything else you need (like sanitary wipes).

Dilation is easy!

If you ignore the extremely difficult experience of learning to dilate, once I knew how to dilate I was surprised by how easy it was - people describe dilation as painful, difficult, the worst part of the whole experience. Some people describe feeling like they spend all day on dilation: dilating itself, and preparing for it before, and cleaning up after ... but in the first week out of the hospital, I actually found dilation was easier, less painful, and took less time than I expected. I even enjoyed dilating, stragely (not like sexually, but the process of deeply relaxing my body and mind to get the dilator in me was a nice forced break in some sense, a guaranteed zen moment in my day).

Equipment lists

I can come back with more, but this is what I have for now.

Also, feel free to ask me anything!

Here are some basic facts:

• method was penile inversion
• I opted for full-depth rather than a vulvoplasty
• surgery took 3 hours, though recovery took another hour
• I went under general anaesthesia and had to be intubated and put on a ventilator
• I'm currently admitted in the hospital and bed bound, discharge is scheduled for Friday
• so far pain is between 1 and 3 for me, most of the time it's between a 0 and 1.

Ask me anything!

Things I should bring, or shouldn't bring?

What I should do before and after, or not do?

What are your experiences and sage advice (or just gripes or personal experiences you want to share)?

EDIT:

Related previous posts:

• Home after bottom surgery
• Week and a half post op. The realization still hasn't kicked in.

cross-posted from: https://lemmy.world/post/29789039

Theresa Garnett (1888 - 1966)

Thu May 17, 1888

Theresa Garnett, born on this day in 1888, was a militant British suffragette whose acts of feminist rebellion included assaulting Winston Churchill with a whip, shouting "Take that in the name of the insulted women of England!"

Garnett was born in Leeds on May 17th, 1888. In 1907, she joined the Women's Social and Political Union (WSPU) after being inspired by a speech given by the feminist and later co-founder of the Australian Communist Party Adela Pankhurst.

The WSPU fought for women's suffrage in the United Kingdom and was noted for its use of direct action. Its members heckled politicians, held demonstrations and marches, broke the law to force arrests, broke windows in prominent buildings, set fire to post boxes, committed night-time arson of unoccupied houses and churches, and, when imprisoned, went on hunger strike and endured physically traumatizing force-feeding.

Garnett participated in several of these actions as a young adult, chaining herself in 1909, along with four other activists, to a statue in Parliament in protest of a law meant to prohibit disorderly conduct while Parliament was in session.

On November 14th, 1909, Garnett assaulted Winston Churchill, who instituted policies of force feeding suffragettes in prison, with a whip, striking him several times while shouting "Take that in the name of the insulted women of England!"

• Date: 1888-05-17
• Learn More: en.wikipedia.org, spartacus-educational.com.
• Tags: #Labor, #Feminism, #Birthdays, #Protests.
• Source: www.apeoplescalendar.org

If my account is on Blahaj and the community I moderate is on another instance like lemmy.world, and the user is from an instance we defederate from like hexbear, I won't see the hexbear user's comments (or even their user if I search for it) from my Blahaj instance, and so I don't see a way I can moderate their comments on the lemmy.world instance I moderate.

Does this seem right? Is there any workaround?

(I guess I could make an account on the same instance as the community I moderate just for moderating that instance?)

cross-posted from: https://lemmy.world/post/29144500