Talkin' About My Crotch
Jan. 20th, 2012 12:54 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
timI have an announcement to make that some people may consider TMI and which may be NSFW if text can be NS F your W. In 3 1/2 weeks, I'm having genital reconstructive surgery. I'm a person who doesn't mind sharing details about my body that many would consider rather personal. The concept of TMI has never rang very true for me (in general, I want to know everything about everybody, and it's hard to imagine being squicked by somebody else knowing something about me). However, I also believe in consent, and part of that means not foisting details about my sexuality on anybody before they have the chance to opt out. So if you are someone who plays a role in my life such that knowing very intimate details about me would make you uncomfortable -- or if you just don't care what's going on in and around my crotch -- here's your chance to opt out. Don't follow the link.
Specifically, I'm having metoidioplasty (abbreviated "meta" since whoa that's a lot of letters) and scrotoplasty, with Dr. Toby Meltzer in Scottsdale, Arizona. To understand how meta works, it's useful to know that what are often called "male" and "female" genitals are actually much more similar than most people think they are. (Go ahead, read that post, it's really good.) So, even though I was assigned female at birth, I have a phallus, and so does almost everyone else who was assigned female at birth -- it's just smaller than the phalluses of most people who were assigned male at birth, and is held to my body by a ligament that prevents it from protruding outward the way the androtypical model does. Also, in case you're not aware, introducing exogeneous testosterone into a body that hasn't been producing it causes your phallus to grow -- pretty dramatically. (I've been taking testosterone for 4 1/2 years now.) Some guys say "about the size of my thumb" but either they're exaggerating or they have larger thumbs than mine. So anyway, meta is a procedure that involves cutting that ligament so that the phallus can stand out, allowing the owner (or other people, you know, hopefully) to handle it in a way more akin to the way in which one handles an androtypical penis. In addition, the surgeon will use various bits and pieces of extra tissue that's currently hanging around that area to lend more girth to my penis, because as you know if you've seen "Happiness", it's all about girth.
The scrotoplasty, which is a separate procedure, involves constructing a scrotum (as you'd guess) from what's currently my labia majora. This is also a pretty natural thing to do, since in fetuses, it's the same anatomical structure that develops into either a scrotum in androtypical fetuses or a set of labia in gynotypical fetuses. Currently there's no way to implant functioning testicles in a guy who was born without them, so instead I'll get saline expanders at first, and in a second procedure in a couple of months, silicone testicular implants. (Yes, like Neuticles, but you're not allowed to say that.) In the meantime, I'll have to inject saline solution into my scrotum every week, which sounds a bit scary but then, I never thought I'd be able to handle injections of any kind and now I inject myself with testosterone every week. It sounds like the expansion process is, um, interesting; the surgeon's instructions include some comment like "you may have to modify your clothing style." Because I'll be walking around with a nutsack the size of a volleyball, I guess? It's all part of the journey. Finally, I'll be getting a mons resection, which basically involves tightening everything up so that my penis can be moved up front and center rather than hanging down from where it's currently positioned.
Some guys get a procedure called urethral lengthening (UL) which relocates the end of the urethra to the tip of your penis. This generally means you can pee standing up easily, without using a stand-to-pee device, after surgery, though not always. I'm not getting UL right now since it's the source of most complications resulting from meta. I've read about what some guys end up having to go through with strictures or fissures, and for me being able to stand to pee more easily, while nice, isn't worth that. I can always get it done later if I choose to. The other reason I'm not getting UL is that with most surgeons (including the surgeon I'm going to), getting UL requires a vaginectomy. I'm pretty deeply ambivalent about having a bonus hole; there are things I like about it and things I don't. For now, I'm too ambivalent to give it up. So, after surgery, I'll have both a penis and a vagina, which is pretty fucking badass. I'm not sure what having a vagina with no labia will be like, but I know it'll be good to not have labia preventing access to the good stuff. My penis won't be very big, but it will be within the range, size-wise, of what's possible for male-assigned-at-birth people. It'll be obvious from looking at me naked that I'm someone who has a penis and scrotum, and not someone who has a vulva. (This is important mostly for me, in the mirror.) I knew for sure I wanted to have meta when I looked at this link (NSFW images), of a guy who had surgery with Meltzer as well. Meltzer has done a ton of these surgeries and I trust him when he says that meta without UL has very few potential complications. He was the only surgeon I considered -- of the others in North America who would do the same procedure, many of them would have turned me away because I'm too fat, and I didn't feel up for leaving the US for surgery right now (oddly enough if you don't know the backstory, one of the best surgeons for all-things-trans-guy is in Serbia).
I'm hoping that surgery will lower my high (probably higher than I'm often aware of) level of background anxiety (the theory is that when your brain is screaming at you every minute "wtf am I doing with this vulva, I'm a dude" it all starts to sound like white noise pretty quickly, but loud white noise) as well as enabling me to do the kinds of sexual things I'd like to do. I probably won't be able to penetrate anyone's ass or vagina with my penis, but I'll be able to get blowjobs in a way that's not fundamentally different from how any other guy who has a cock gets blowjobs, and jerking off will feel like jerking off. Beyond the particular in-bedroom details, I feel like more broadly, I don't approach people for sex or dating as much as I would if I had the kind of body I need to have. My subconscious looks ahead, imagines a scenario where disappointing or frustrating sex happens (for me, because I still don't have a penis at the end of it, no matter how attracted I am to the person), and says "no thanks". I've been in gay male cruising spaces a few times, and even had the nerve to remove my clothes, but in the end I always felt like my body was saying something that wasn't accurate about me, and that hooking up with anyone would involve so much explanatory labor to compensate for that that in the end, it wouldn't be worth it. It's a lot easier to have someone look at your crotch and be able to guess accurately at what you're interested in doing than to spend half an hour explaining it. I have a hard time articulating this even though it makes perfect sense inside my head, but basically, my brain is wired to need to have a penis and there's just no way around it. I've tried using a strap-on to fuck a partner (with more than one different partner) and I was super-conscious of having a strap-on on, and it basically had the opposite effect it's supposed to, of making me more aware of the way my body isn't where my brain needs it to be. For me, I think I just really need to have a phallus that's part of my body and wired into my nervous system. I'm aware of how ridiculous it is for me to type these words when we all take it for granted that this is true for every cis man. But for some reason, when you're a trans man, you have to say that explicitly because otherwise most people seem to just assume that you don't need a dick.
The other main type of genital reconstructive surgery that trans guys get is phalloplasty. Phalloplasty involves taking a flap of skin from elsewhere on the body (forearm, hip, or abdomen, usually) and constructing a tube that has the same dimensions as an average penis owned by a guy with a cissexual body. Actually, it sounds like a fair number of guys end up with above-average-sized results (but I would reckon that most of them would be happy to be average!) The technology doesn't exist yet to construct an adult-sized penis that can get erect spontaneously, so usually, guys who get phallo get a pump-like device put in that allows them to get an erection by squeezing a bulb or pressing a button. In contrast, guys who get a meta get spontaneous erections, since the underlying tissue already had the ability to get spontaneously erect (fun fax: clitorises get erect, too!) Generally, phalloplasty constructs the new phallus around the old one, so that the small phallus gets buried inside the larger one and gets stimulated indirectly when someone squeezes the penis. There are only a few surgeons who do microsurgery (possibly only one) so that the larger phallus has erotic sensation all the way down to the tip. Those were all reasons for me not to get phallo, as well as the higher cost and the fact that because I form hypertrophic scars, I'd probably end up with a very bad scar resembling a large burn scar on the part of my body that the skin graft was taken from (if that was the forearm, it would be hard to explain to people). However, it's possible to get a phallo on top of a meta, so there's always room for me to change my mind in the future, especially if the technology improves. I should point out that lots of guys get phallo and are happy with the results, and there's no need for me or anyone else to tell them they shouldn't be satisfied with their bodies. It's just not for me right now.
Unfortunately, I happen to live in a country where health care isn't considered a universal human right, and where it's standard for insurance companies to deny coverage for procedures that only trans people have even though these procedures are medically necessary for trans people (if an organization as conservative as the American Medical Association has admitted it, which it has, it's probably true). Due to some peculiarities of my job, I don't even have any health insurance coverage through my employer, and I only have a minimal individual plan for catastrophes. So I'm stuck paying $25,000 out of pocket. For me, the only way to finance surgery anytime soon was to go into debt; of the costs I've had to pay so far, I paid the majority from CareCredit (a medical loan service) and the rest from a credit card. It's definitely less than ideal to take on that much debt, but I didn't see other options. I could wait until I saved up the money, but that would mean waiting several years and honestly, I'm not sure I can make it that far. I figure it's better to take on the debt now in exchange for having an extra couple years of my life that are happier and more productive than they'd be otherwise. I also consider myself extremely lucky for having access to credit and for having the educational privilege to work in a field where I can fairly easily get a high-salary job that will allow me to pay back large amounts of debt in less than 90 years.
Oh, and I probably won't be able to ride my bike for a while, so that blows.
Anyway. There's a lot of politics and drama among trans men about genital reconstruction surgery, which is part of why I wanted to write this post. Everybody is different, but for me it comes down to: I'm a guy, I was born with a body that can't do what, being a guy, I want to do; I'm fixing it, as best as I know how. Nobody would criticize a cis guy who lost his penis in an accident -- or even at birth from a circumcision mishap -- or due to cancer and wanted to have it reconstructed. And yet, people both inside and outside ostensibly trans-friendly circles have opinions on what I want to do with my body that aren't positive. There are radical trans folks who say I'd be happy if I only understood that I don't need a penis to be a man, and there are conservative cis folks who say I'm mutilating a healthy part of my body. They all sound pretty similar in my ears. The bottom line is that no one else's ideology is going to change my neurology. In one sense I wish that it could, so I could avoid having surgery and spending a lot of money; in one sense I don't, since if I changed my brain, I wouldn't be me anymore. Anyway, I'm just not cool with double standards in which a cis person gets framed as having the right to have surgery to return their body to the state it's "supposed" to be in -- whatever that means -- but where a trans person gets framed as doing something all whimsical and weird by bringing their body close to the image of it that's hard-wired into their brain.
I thought long and hard about writing this post, which really amounted to thinking about whether to talk in public at all about having genital surgery. I didn't feel like I could just mention it was happening -- except maybe very cryptically, and that's not usually my style -- without giving a lot of detail and a lot of explanation, given all the misconceptions and ignorance around the subject. When I had top surgery, I could basically allude to it, maybe even make a joke about being glad to have that off my chest, and that was it; the concept was pretty understandable, as were my reasons for wanting to do it. But now, I've had to think about all the social stigma around talking about one's genitals or one's sexuality in general, as well as the countervailing belief that trans people deserve no privacy about their bodies and cis people are entitled to ask us entitled questions all the time and everywhere. In the end, I say to the first one: fuck all of that, a lot. Keeping us silent about bodies and sexuality doesn't serve my interests or the interests of anyone I care about. Shame, guilt and embarrassment literally kill people, and I'm in a privileged position such that I can afford to hit back at those forces with little cost to me. I'm not going to apologize for having a body, having a sexuality, or for not feeling like the way cisnormativity tells me I'm supposed to. As for the second, I can only add a disclaimer that just because I'm discussing my embodiment very candidly here constitutes neither permission for you (the reader) to interrogate any trans person you meet about similar matters, nor irrevocable permission for anyone to ask me anything about those things ever.
In exchange for reading this far, you now get to ask whatever questions you want to. Of course, I still get to not answer if I don't want to, and delete comments if anyone decides to be a shithead. Asking general questions whose answers can be googled for makes kittens cry, by the way. If you want to know something about my experience or opinions, that's fair game, as long as you can be respectful about it. Also, in before "that takes balls!"
ps -- I sometimes forget that some things are not as obvious to the rest of the world as they have become to me. I use the term "genital reconstructive surgery" because it's descriptive. The more common terms "sex reassignment surgery" or, worse, "sex change" are misleading, because the surgery I'm having isn't to change my sex or to make me into a man. I've always been male, I just have some anatomical features that are atypical (though not rare) for men to have. Transphobic fundamentalists (both of the right-wing religious kind and the second-wave feminist kind) like to say that "nobody changes sex", and they're right, but not in the way they think they're right. There are all kinds of unfortunate things out there in the mass media, like the bit in the movie "Transamerica" where Bree says that after "the surgery", she'll be a woman, that some people have come to believe it. But terms like "sex reassignment surgery" reflect an ideology that I don't share and that runs counter to my interest, so I try not to use those terms, though sometimes, as when talking to health insurance company people on the phone, it's an unfortunate necessity.
Specifically, I'm having metoidioplasty (abbreviated "meta" since whoa that's a lot of letters) and scrotoplasty, with Dr. Toby Meltzer in Scottsdale, Arizona. To understand how meta works, it's useful to know that what are often called "male" and "female" genitals are actually much more similar than most people think they are. (Go ahead, read that post, it's really good.) So, even though I was assigned female at birth, I have a phallus, and so does almost everyone else who was assigned female at birth -- it's just smaller than the phalluses of most people who were assigned male at birth, and is held to my body by a ligament that prevents it from protruding outward the way the androtypical model does. Also, in case you're not aware, introducing exogeneous testosterone into a body that hasn't been producing it causes your phallus to grow -- pretty dramatically. (I've been taking testosterone for 4 1/2 years now.) Some guys say "about the size of my thumb" but either they're exaggerating or they have larger thumbs than mine. So anyway, meta is a procedure that involves cutting that ligament so that the phallus can stand out, allowing the owner (or other people, you know, hopefully) to handle it in a way more akin to the way in which one handles an androtypical penis. In addition, the surgeon will use various bits and pieces of extra tissue that's currently hanging around that area to lend more girth to my penis, because as you know if you've seen "Happiness", it's all about girth.
The scrotoplasty, which is a separate procedure, involves constructing a scrotum (as you'd guess) from what's currently my labia majora. This is also a pretty natural thing to do, since in fetuses, it's the same anatomical structure that develops into either a scrotum in androtypical fetuses or a set of labia in gynotypical fetuses. Currently there's no way to implant functioning testicles in a guy who was born without them, so instead I'll get saline expanders at first, and in a second procedure in a couple of months, silicone testicular implants. (Yes, like Neuticles, but you're not allowed to say that.) In the meantime, I'll have to inject saline solution into my scrotum every week, which sounds a bit scary but then, I never thought I'd be able to handle injections of any kind and now I inject myself with testosterone every week. It sounds like the expansion process is, um, interesting; the surgeon's instructions include some comment like "you may have to modify your clothing style." Because I'll be walking around with a nutsack the size of a volleyball, I guess? It's all part of the journey. Finally, I'll be getting a mons resection, which basically involves tightening everything up so that my penis can be moved up front and center rather than hanging down from where it's currently positioned.
Some guys get a procedure called urethral lengthening (UL) which relocates the end of the urethra to the tip of your penis. This generally means you can pee standing up easily, without using a stand-to-pee device, after surgery, though not always. I'm not getting UL right now since it's the source of most complications resulting from meta. I've read about what some guys end up having to go through with strictures or fissures, and for me being able to stand to pee more easily, while nice, isn't worth that. I can always get it done later if I choose to. The other reason I'm not getting UL is that with most surgeons (including the surgeon I'm going to), getting UL requires a vaginectomy. I'm pretty deeply ambivalent about having a bonus hole; there are things I like about it and things I don't. For now, I'm too ambivalent to give it up. So, after surgery, I'll have both a penis and a vagina, which is pretty fucking badass. I'm not sure what having a vagina with no labia will be like, but I know it'll be good to not have labia preventing access to the good stuff. My penis won't be very big, but it will be within the range, size-wise, of what's possible for male-assigned-at-birth people. It'll be obvious from looking at me naked that I'm someone who has a penis and scrotum, and not someone who has a vulva. (This is important mostly for me, in the mirror.) I knew for sure I wanted to have meta when I looked at this link (NSFW images), of a guy who had surgery with Meltzer as well. Meltzer has done a ton of these surgeries and I trust him when he says that meta without UL has very few potential complications. He was the only surgeon I considered -- of the others in North America who would do the same procedure, many of them would have turned me away because I'm too fat, and I didn't feel up for leaving the US for surgery right now (oddly enough if you don't know the backstory, one of the best surgeons for all-things-trans-guy is in Serbia).
I'm hoping that surgery will lower my high (probably higher than I'm often aware of) level of background anxiety (the theory is that when your brain is screaming at you every minute "wtf am I doing with this vulva, I'm a dude" it all starts to sound like white noise pretty quickly, but loud white noise) as well as enabling me to do the kinds of sexual things I'd like to do. I probably won't be able to penetrate anyone's ass or vagina with my penis, but I'll be able to get blowjobs in a way that's not fundamentally different from how any other guy who has a cock gets blowjobs, and jerking off will feel like jerking off. Beyond the particular in-bedroom details, I feel like more broadly, I don't approach people for sex or dating as much as I would if I had the kind of body I need to have. My subconscious looks ahead, imagines a scenario where disappointing or frustrating sex happens (for me, because I still don't have a penis at the end of it, no matter how attracted I am to the person), and says "no thanks". I've been in gay male cruising spaces a few times, and even had the nerve to remove my clothes, but in the end I always felt like my body was saying something that wasn't accurate about me, and that hooking up with anyone would involve so much explanatory labor to compensate for that that in the end, it wouldn't be worth it. It's a lot easier to have someone look at your crotch and be able to guess accurately at what you're interested in doing than to spend half an hour explaining it. I have a hard time articulating this even though it makes perfect sense inside my head, but basically, my brain is wired to need to have a penis and there's just no way around it. I've tried using a strap-on to fuck a partner (with more than one different partner) and I was super-conscious of having a strap-on on, and it basically had the opposite effect it's supposed to, of making me more aware of the way my body isn't where my brain needs it to be. For me, I think I just really need to have a phallus that's part of my body and wired into my nervous system. I'm aware of how ridiculous it is for me to type these words when we all take it for granted that this is true for every cis man. But for some reason, when you're a trans man, you have to say that explicitly because otherwise most people seem to just assume that you don't need a dick.
The other main type of genital reconstructive surgery that trans guys get is phalloplasty. Phalloplasty involves taking a flap of skin from elsewhere on the body (forearm, hip, or abdomen, usually) and constructing a tube that has the same dimensions as an average penis owned by a guy with a cissexual body. Actually, it sounds like a fair number of guys end up with above-average-sized results (but I would reckon that most of them would be happy to be average!) The technology doesn't exist yet to construct an adult-sized penis that can get erect spontaneously, so usually, guys who get phallo get a pump-like device put in that allows them to get an erection by squeezing a bulb or pressing a button. In contrast, guys who get a meta get spontaneous erections, since the underlying tissue already had the ability to get spontaneously erect (fun fax: clitorises get erect, too!) Generally, phalloplasty constructs the new phallus around the old one, so that the small phallus gets buried inside the larger one and gets stimulated indirectly when someone squeezes the penis. There are only a few surgeons who do microsurgery (possibly only one) so that the larger phallus has erotic sensation all the way down to the tip. Those were all reasons for me not to get phallo, as well as the higher cost and the fact that because I form hypertrophic scars, I'd probably end up with a very bad scar resembling a large burn scar on the part of my body that the skin graft was taken from (if that was the forearm, it would be hard to explain to people). However, it's possible to get a phallo on top of a meta, so there's always room for me to change my mind in the future, especially if the technology improves. I should point out that lots of guys get phallo and are happy with the results, and there's no need for me or anyone else to tell them they shouldn't be satisfied with their bodies. It's just not for me right now.
Unfortunately, I happen to live in a country where health care isn't considered a universal human right, and where it's standard for insurance companies to deny coverage for procedures that only trans people have even though these procedures are medically necessary for trans people (if an organization as conservative as the American Medical Association has admitted it, which it has, it's probably true). Due to some peculiarities of my job, I don't even have any health insurance coverage through my employer, and I only have a minimal individual plan for catastrophes. So I'm stuck paying $25,000 out of pocket. For me, the only way to finance surgery anytime soon was to go into debt; of the costs I've had to pay so far, I paid the majority from CareCredit (a medical loan service) and the rest from a credit card. It's definitely less than ideal to take on that much debt, but I didn't see other options. I could wait until I saved up the money, but that would mean waiting several years and honestly, I'm not sure I can make it that far. I figure it's better to take on the debt now in exchange for having an extra couple years of my life that are happier and more productive than they'd be otherwise. I also consider myself extremely lucky for having access to credit and for having the educational privilege to work in a field where I can fairly easily get a high-salary job that will allow me to pay back large amounts of debt in less than 90 years.
Oh, and I probably won't be able to ride my bike for a while, so that blows.
Anyway. There's a lot of politics and drama among trans men about genital reconstruction surgery, which is part of why I wanted to write this post. Everybody is different, but for me it comes down to: I'm a guy, I was born with a body that can't do what, being a guy, I want to do; I'm fixing it, as best as I know how. Nobody would criticize a cis guy who lost his penis in an accident -- or even at birth from a circumcision mishap -- or due to cancer and wanted to have it reconstructed. And yet, people both inside and outside ostensibly trans-friendly circles have opinions on what I want to do with my body that aren't positive. There are radical trans folks who say I'd be happy if I only understood that I don't need a penis to be a man, and there are conservative cis folks who say I'm mutilating a healthy part of my body. They all sound pretty similar in my ears. The bottom line is that no one else's ideology is going to change my neurology. In one sense I wish that it could, so I could avoid having surgery and spending a lot of money; in one sense I don't, since if I changed my brain, I wouldn't be me anymore. Anyway, I'm just not cool with double standards in which a cis person gets framed as having the right to have surgery to return their body to the state it's "supposed" to be in -- whatever that means -- but where a trans person gets framed as doing something all whimsical and weird by bringing their body close to the image of it that's hard-wired into their brain.
I thought long and hard about writing this post, which really amounted to thinking about whether to talk in public at all about having genital surgery. I didn't feel like I could just mention it was happening -- except maybe very cryptically, and that's not usually my style -- without giving a lot of detail and a lot of explanation, given all the misconceptions and ignorance around the subject. When I had top surgery, I could basically allude to it, maybe even make a joke about being glad to have that off my chest, and that was it; the concept was pretty understandable, as were my reasons for wanting to do it. But now, I've had to think about all the social stigma around talking about one's genitals or one's sexuality in general, as well as the countervailing belief that trans people deserve no privacy about their bodies and cis people are entitled to ask us entitled questions all the time and everywhere. In the end, I say to the first one: fuck all of that, a lot. Keeping us silent about bodies and sexuality doesn't serve my interests or the interests of anyone I care about. Shame, guilt and embarrassment literally kill people, and I'm in a privileged position such that I can afford to hit back at those forces with little cost to me. I'm not going to apologize for having a body, having a sexuality, or for not feeling like the way cisnormativity tells me I'm supposed to. As for the second, I can only add a disclaimer that just because I'm discussing my embodiment very candidly here constitutes neither permission for you (the reader) to interrogate any trans person you meet about similar matters, nor irrevocable permission for anyone to ask me anything about those things ever.
In exchange for reading this far, you now get to ask whatever questions you want to. Of course, I still get to not answer if I don't want to, and delete comments if anyone decides to be a shithead. Asking general questions whose answers can be googled for makes kittens cry, by the way. If you want to know something about my experience or opinions, that's fair game, as long as you can be respectful about it. Also, in before "that takes balls!"
ps -- I sometimes forget that some things are not as obvious to the rest of the world as they have become to me. I use the term "genital reconstructive surgery" because it's descriptive. The more common terms "sex reassignment surgery" or, worse, "sex change" are misleading, because the surgery I'm having isn't to change my sex or to make me into a man. I've always been male, I just have some anatomical features that are atypical (though not rare) for men to have. Transphobic fundamentalists (both of the right-wing religious kind and the second-wave feminist kind) like to say that "nobody changes sex", and they're right, but not in the way they think they're right. There are all kinds of unfortunate things out there in the mass media, like the bit in the movie "Transamerica" where Bree says that after "the surgery", she'll be a woman, that some people have come to believe it. But terms like "sex reassignment surgery" reflect an ideology that I don't share and that runs counter to my interest, so I try not to use those terms, though sometimes, as when talking to health insurance company people on the phone, it's an unfortunate necessity.
(no subject)
Date: 2012-01-23 07:29 am (UTC)I don't know who first used the phrase "reconstructive surgery" in this context, but I definitely like it better than the alternatives (the only problem is I don't want to abbreviate it as 'GRS' because that's confusable with "gender reassignment surgery", a term I hate).