The past year has sometimes felt like a dream, seesawing between surgeries and recoveries. Now that I’m preparing for what I hope will be my final stage of Phalloplasty, I feel like I’m in the homestretch. There’s some comfort in that, but also trepidation because I don’t know yet exactly what surgeries I’ll be having next month in Portland.

My Stage 3 could be one or more surgeries and I won’t know for certain until I see Dr. Berli for my pre-op appointment. I do know that my first surgery will be the insertion of testicular implants, specifically the Coloplast Torosa saline-filled implants. (These are the only FDA-approved testicular implants and as far as I know, the only ones that OHSU uses.) But I have another surgery tentatively booked the following week, to take place in the clinic OR.

Let’s back up a little…

Angry Hair Strikes Back

After Stage 1, I had two episodes where (what I thought was) an angry suture caused swelling of my penis, as well as bleeding in the urethra (corresponding to the central point of swelling.) Dr. Berli said that he could repair this during Stage 2 but in the end decided not to mess with it because by the time I got to Portland for Stage 2 that spot had healed up. Or so we thought.

A couple of weeks after Stage 2, that little spot turned black and Dr. Berli pulled out… an in-grown hair. A-ha! Now we knew the culprit. He wanted me to see the electrologist to get that follicle zapped but two nights before I was set to go home after Stage 2, my penis swelled up and there was some bleeding in the urethra again. The electrolysis was called off and instead Dr. Berli did a mini-surgery on me, excising the hair follicle. This left a wound that was about the size and shape of a pencil eraser, located on the underside of my penis, on the suture line, about 1” from the tip. This wound looked well-healed when I had the suprapubic catheter removed at 6 weeks post-op but 5 days later a small leak developed there.

I tried a few different topical solutions in the hopes of healing it, including Medihoney and zinc cream, and alternated wet/dry, drying it out with a hair dryer after urinating. I obsessively kept an eye on it and it did get smaller but it didn’t close completely. At less than 2mm, this is a relatively easy fistula to have. (I know what a not-easy fistula is like.) It doesn’t cause functional problems; when I pee, I just put my finger over it. Nevertheless, it’s annoying and understandably I want it fixed.

Insurance Ain’t Buying It

Despite the fact that the repair for this fistula would be simple and straightforward, it would still run over $20,000 USD to get it fixed at OHSU. Because this could be repaired locally for much less, my provincial insurance won’t cover a repair at OHSU. (There isn’t OR time or a urologist available anyway.) As a tax payer, I understand this but at the same time getting it fixed locally is unappealing to me for a number of reasons (which I won’t bore you with.)

Situations With Solutions

I have a couple of other cosmetic concerns, namely that the glansplasty mostly flattened out, and I think my penis is too long. These led me to propose a potential solution—a way to deal with the fistula as well as the cosmetic concerns in one fell swoop: I asked Dr. Berli if a length reduction and another glansplasty could be done, lamenting that there probably isn’t OR time available for this. He surprised me by saying that these could be done in the clinic OR and I would only have to cover a clinic fee. My insurance wouldn’t have to be billed. Another upside is that unlike a urological fix for the fistula, I wouldn’t need to be back on a catheter bag for a month.

Now, there’s no sedation in the clinic OR, only local anaesthetic and the idea of watching my penis get cut into while I’m awake makes me understandably uneasy. Then again, that’s exactly what I did when the hair follicle was excised. We didn’t even use lidocaine for that because I didn’t have any sensation in my penis at that time. I still don’t, which is why this is even a possibility. We need to discuss more in person before committing to this plan of action, so for now I have to just ride the wave, surf down to Portland in a couple of weeks, and trust that everything will work out as it should.

Logistically, preparing for Stage 3 has been a snap. My surgery date was confirmed with much more advance notice this time, allowing me to catch a good seat sale on flights and get my hotel room booked early. For supplies, I just had to refer to my previous lists and Amazon order history, omitting the urinary stuff. I cross-referenced these with the list of supplies that I left stored at the hotel and the supplies already packed in my travel case and in less than 20 minutes I had everything ordered, shipping directly to the hotel. (Basically, all I bought was supplements, Arnica gel, Dude Wipes, Kerlix gauze rolls and ice packs.) Order total: $343.08 USD.

So! I’m back on a countdown to departure, having seesawed out of Stage 2 recovery quite successfully, pendulating on to another surgical event (or two.) Some of this feels like Old Hat to me now, but with Phalloplasty nothing is for certain and I have to stay rock steady for the unknowns that lay ahead. (Good grief, this stuff is character building!)