This week I took the first step towards gender affirmation surgery or “Bottom Surgery,” which is the process of changing the genitals of one sex to another. It’s a procedure some, certainly not all, trans people want and the reasons are deeply personal.
For me it boils down to these six reasons:
- Safety in women’s only spaces,
- Limiting medication,
- Addressing my Gender Dysphoria,
- Improved sex life,
- Improving overall quality of life.
This post will expand on those reasons, it’s also going explain some of the processes involved, which is why I included the short answer at the top. However, there are explicit descriptions of surgery-related things, genital-related things, and sex-related things in the post below so if you read on, you have been warned.
I always wanted a vagina, like from the moment I was aware of the differences between human genitals I was 100 percent convinced I shouldn’t have been born with a penis. Maybe that sounds weird for someone to decide at age four or five but there I was. Long before I knew what ‘transgender’ meant, or was aware that gender and reproductive organs were separate things, long before I was able to say, “I’m a girl,” I wished I was born with a vagina. However I was born with a penis and having lived with it for almost three decades now I can safely say, I don’t want to have it anymore, I never needed it, and I never wanted it – really all it has been, is a source of pain, strife, and confusion in my life.
Most trans women I know struggle with body image to some degree and for different reasons. For me it’s my penis, it’s always been that. Otherwise, I’m pretty cool with the rest of my body.
What is ‘Bottom Surgery’?
A Vaginoplasty is not having your penis cut-off, more like folded inside you.
There is an excellent explanation of the procedure on British Columbia’s Trans Health Page and here’s a link to an animation (very NSFW also ignore the dumb video title) of the whole process.
In lay terms, the surgeon begins by removing the testicles. Then they separate the head of the penis from the skin on the shaft. An incision right below the scrotum becomes the future opening of the vagina. The head of the penis, complete with nerve endings, is reshaped and attached above the incision, becoming a clitoris. The skin from the shaft is pushed inside and is attached to the opening forming a vaginal canal into the body and the leftover skin from the scrotum is attached to the outside of the new vulva. Once it’s all done the resulting product looks and acts like a vagina.
Safety in Women’s Only Spaces
Shared change rooms, or anywhere I might be nude or in a swimsuit, are predominately off limits to me right now. The reason for this self-imposed exile from those spaces is that I don’t feel safe there with a penis.
I’ll be the first to argue it shouldn’t matter, people should mind their own fucking business and get changed but people don’t. The cost of someone not minding their own business could be huge. They could make a scene, they could choose to deal with me themselves, they could go so far as to call the police. The implications are all shitty and uncomfortable and they’re not ones I want to ever deal with. I would die of embarrassment if someone ever complained about my genitals while I was trying to change for a swim. To avoid that I avoid any of those circumstances, and mostly it’s fine but sometimes it sucks, for example, I won’t go to a pool, won’t consider joining a gym etc. until surgery is done.
It would be nice to wear a swimsuit without the fear of outing myself as trans.
Gender Dysphoria, the clinical term used to describe trans people. It refers to a disconnection between your physical sex characteristics and the gender you are, this disconnection causes stress, anxiety, depression and a number of other related mental health problems. Not all trans people have Gender Dysphoria and even those with it see it manifest in different ways.
Literally, the only part of me that causes me to feel the feelings associated with Gender Dysphoria, is my penis.
I hate it, I always have. I first learned how to ‘tuck’ in my early teens, although I didn’t do it all the time. It was as an adult when I started buying women’s clothing that tucking became important it allowed me to fully cross my legs while sitting, I can wear leggings, skirts, or skinny pants. Tucking has been one of the things that help me manage the feelings that come with Gender Dysphoria, however, it only works while I’m wearing clothes. Anytime I have to take my pants off, the negative feelings come barreling back in, even just being in my underwear has the ability to trigger deep feelings of depression and anxiety for me.
The complete Vaginoplasty surgery typically includes an Orchiectomy (removal of the testicles), which would have substantial benefits for me. For one thing, I would have to pee less.
I’m on HRT and I love it. I love what estrogen is doing to my body. However, because I still have testicles a big part of HRT is about suppressing and overcoming the testosterone my body naturally produces. To do that I take a pill twice daily called Spironolactone, usually referred to as “Spiro.”
Spiro kills testosterone, it’s called an anti-androgen, Testosterone is an androgen. While that’s great, Spiro also is a diuretic and makes you crave salts while also needing to pee much more. Shortly after starting HRT I noticed I was using the bathroom at least twice as much as before. With an Orchiectomy, I wouldn’t need Spiro anymore.
Also, Estrogen doses can often be kept lower for longer if there has been an Orchiectomy, which would help reduce my lifetime breast cancer and blood clotting risks.
Finally, there is a cost. Currently, I have a drug plan through work, if anything ever changed I would have to pay out of pocket for the hormones I take. One less prescription is one less prescription to pay.
Improve my sex life
Sex is one of those things that always caused me great distress. When I was a closeted trans woman there was a period where I took on the role of ‘straight cis guy.’ Sex during that time felt performative, occasionally enjoyable but mostly like I was doing it to prove a point, the point being that I could somehow ‘overcome’ my transness (hint: you can’t).
In reality, it was only a year or so after I first lost my virginity penetrating that I lost my virginity being penetrated. I was raised my whole life to think anal sex was debasing, disgusting, or un-natural but when I tried it the first time it felt like the opposite of those things, even though the first time was over pretty quickly. As time wore on and I bounced between a performative world where I was a straight cis guy and a closeted world where I was a bi trans girl, I came to realize that I much preferred being the bottom rather than the top.
I don’t need my penis, I don’t intend on using it for penetrative sex ever again (at this point it’s already been many years anyway). However, there are a lot of great nerve endings there and if those nerves could be repurposed into a vagina, well that would be great for me.
Maybe this one doesn’t sound as significant as some of the other reasons, however, clothing has a powerful role to play in our presentation and confidence as people.
Because of the penis I was born with, there are limitations on the clothes that I feel comfortable wearing. I feel like I need to find stuff that will support and mask everything. While it’s just clothing, it’s a daily thing, it’s a wall I run into frequently none of it would be an issue if I had a vagina.
Improved Quality of Life
I don’t know if it is fair to expect that changing my genitalia will result in an improved quality of life. However, it is something that is often reported by those who have had the surgery. When I think about all the reasons I have (see above) for wanting surgery I see how those things would contribute to improving my quality of life.