I’m now 54 days post-op from Stage 2 Phalloplasty and while I’m not out of the woods yet, I’ve made it through the crucible of the first 6 weeks of acute recovery and that feels like an appropriate junction at which to take a step back and acknowledge the experience.
Since my only prior experience with Phalloplasty was my Stage 1 surgery in May, I have only that compare to, but it’s like comparing apples and oranges. Though Stage 1 did prepare me somewhat for Stage 2, especially in terms of logistical planning, the surgeries and recoveries are quite different. Even though my hospital stay for Stage 2 was shorter and easier, I had much less pain than I expected, and the wound care was generally less involved, there were more wounds to deal with and several bumps in the road, which combined to make recovery more mentally taxing compared to Stage 1. And let’s not forget catheters! Ultimately, Stage 2 Phalloplasty recovery is a unique experience that I couldn’t have fully prepared for, even with Stage 1 experience under my belt.
[My Stage 2 Phalloplasty surgery was performed by urogynocologist Dr. Kamran Sajadi: vaginectomy, closure of canal and pelvic floor restoration; and plastic surgeon Dr. Jens Berli: urethroplasty, scrotoplasty, perineoplasty, and burying of clitoris.]
My concerns about Stage 2 surgical pain—from the Vaginectomy specifically—didn’t come to pass. In fact, I had ZERO surgical pain until Day 8 when my scrotum got sore and I did some gentle icing. The only pain I had before this was nerve pain in my sacrum from being on the operating table for about 8 hours. (That took a week or two to ease up.) I had one or two shots of Dilaudid right after surgery but only Tylenol and Ibuprofen thereafter.
Recovery wasn’t pain-free though. The pain that I developed in my scrotum I would describe as a nagging pain, like someone is yanking on your hair. (And my scrotum was SO itchy it was making me batty!) Sometimes I’ve experienced piercing, stabbing pains but these are brief sensations. I didn’t find Stage 1 or Stage 2 to be very painful, but I had more consistent pain from Stage 2. I still have some pain in my scrotum and sitting isn’t very comfortable but I’ve stopped taking Tylenol as of today. The pain always lessens when I lay down, so I’ve spent most of the past 6 weeks in bed.
I had a misconception that Stage 2 recovery would require less downtime than Stage 1 but this was not my experience. While I was on strict bed rest for 3 weeks after Stage 1, with no elevation of my upper body, overall I wound up being in bed more during Stage 2 recovery. I ate meals in bed and I worked from bed. I walked only to the bathroom, and sometimes out to the living room in the evening for a little TV. I went outside only when I was going to weekly follow-up appointments. When my wife and I went out for an Italian dinner in November, it was my first time going anywhere other than OHSU for over 5 weeks. I was in bed a LOT for this recovery!
One Wound, Two Wounds
My Stage 2 recovery also had more wounds to deal with. The wounds weren’t as big compared to Stage 1, and the wound care was less involved, but it seemed like for every wound that would heal, another would present itself: first a perineum tear, then scrotal separation, a fistula at the base (now healed), another possible internal fistula (now healed), and an ingrown hair that required surgical excision. With Stage 1, I was preoccupied with two areas of concern: my penis and my donor site. Big concerns to be sure but Stage 2 healing felt like one bleeding, oozing thing after another and that there was no clear road map for how and when everything would heal up. The unexpected twists and turns made recovery feel LONG and mentally taxing!
I had two catheters after Stage 2: one in my penis for 11 days and a suprapubic catheter for just over 5.5 weeks. I’m relieved to say that I had ZERO issues with the caths! No infections or bladder spasms. I never took the Oxybutynin bladder med. Sure, being attached to that urine bag was annoying and had a bit of a negative effect on my mood, but I’m really happy that this was all I could complain about catheter-wise. I don’t know how I managed to escape the common catheter woes, but I did do a few things that I hoped would help: I stayed super hydrated, drinking 3-4L of water a day. I drank no caffeine teas or coffee, only herbal teas. I took a cranberry supplement and a homeopathic remedy for bladder pain. And I guess I got lucky.
If Stage 1 is a Sprint, Stage 2 is a Marathon
Even though I had much less pain than expected, less severe wounds, and no catheter issues, Stage 2 recovery required more time in bed, had more wounds to deal with, and had more twists and turns, and these made it mentally taxing. My first Phalloplasty surgery didn’t fully prepare me for what this latest round of recovery would be like, but it did allow me to go into Stage 2 with more confidence, which has helped me get through it.