Inflatable Erectile Device & Glans Implant

Inflatable Erectile Device & Glans Implant

Within months of my phalloplasty two things became very clear to me: 1) I did not want a permanently flaccid penis and 2) I needed a glans revision since about 80% had already flattened out. It is incredibly common for the glans ridge to flatten out over time and, since the start, it's been a big deal for me to have some kind of definition in that area. I was excited to learn that Dr. Crane had started doing silicone glans implants. He basically carves a circular disk from silicone and implants it under the skin like one would see with general body mod work. A few months post-op I scheduled an ED implant, glans implant, and testicular implant surgery set for exactly one year from the date of my initial phalloplasty.

Erections

I totally became that guy who felt sad and impotent with a flaccid penis. I know that some guys are totally okay without an ED, but jerking off a flaccid dick made my soul hurt. And, every bone in my feminist body did not want my experience to be like this...cause, come on, erections don't make a man. Ugh. I wanted to believe that and be okay with a dick that didn't need any more surgery. But alas, I succumbed the patriarchy once again and desired a dick that could stand up and maybe even wink at me in the mirror. I think I'd like a brazen penis.

For internal erectile devices, there are basically two options: semi-rigid/malleable rod or inflatable pump. If you want to read someone's thoughts on the pros/cons, check out the Pump vs. Rod post on the MyPhalloplasty blog. It's an awesome blog and there's great info - no need for me to repeat. The short version for me is that I wanted the sensation of becoming erect and I didn't want my dick to be somewhat firm all of the time. I had the length and girth that I wanted and I didn't want to manage anything thicker or harder in my pants on a daily basis.

The inflatable ED that my surgeon uses is the Coloplast Titan OTR 3-piece inflatable pump, with a strong preference for implanting the largest individual cylinder that can fit (many people get two cylinders). It's made up of three pieces: a reservoir that holds the saline in your abdomen until it's time to get hard; the cylinder that is sewn into your pubic bone and runs the top length of the shaft; and, the pump that helps push the saline into the cylinder, topped with a release button to return you to a flaccid state. The pump takes the place of one testicle, so if someone wanted two testes, they could have one testicle implant placed side-by-side with the pump.

Surgery and Recovery
On Dec. 1st 2017, I had I had the Coloplast Titan OTR 3-piece inflatable pump erectile device implanted (with one cylinder) as well as a glans implant. Unfortunately, my scrotum wasn't big enough to hold more than the bulb for the pump. The surgery lasted only 90 minutes and I will freely admit that I was in a ton of pain when I finally came to. The nurse only gave me one Percocet and then was trying to wheel me to the bathroom with my feet dragging on the floor.

I'm not sure if you can imagine this, but get into a sitting position and try pulling your feet up off the floor. Gotta use your ab muscles, right? Yeah, that's what was hurting like hell and she was asking me to lift my legs up or deal with them being dragged. Hell-to-the-fucking-no. After what felt like forever and me screaming that I needed a wheelchair that had feet stirrups, we resolved that issue (in addition to getting another Percocet). It still amazes me sometimes how bad medical providers are at their jobs.

I slept the rest of the day and then got this weird insomnia for the next few days. I hated being on Percocet (never again), so I weaned myself off of it within 48 hrs and transitioned onto full doses of acetaminophen and ibuprofen (and a multi-vitamin and probiotic). The day after surgery, I came down with a cold and spent most of the next few days laying around watching TV, drinking tea, and eating soup. I had surgery on a Friday and my post-op appointment was on the following Tuesday. Dr. Crane took a look and noticed that the bulb of the pump had already started to ride really high in my scrotum. He told me everything else was healing well, but that I needed to start tugging the bulb down at least once a day to keep it from riding up anymore. While I still had cold symptoms, I was generally feeling pretty good and wasn't experiencing any discomfort.

I was sent home with half a stiffy and the schedule I was given for recovery was as follows:

• Try to sit in a reclined position for the first 4 weeks as to not put pressure on the base where it's attached. Don't sit straight up with feet on the floor in a chair for more than an hour.
• Once the swelling goes down enough where you can feel the release button on the pump (2-4 weeks), start cycling the pump daily by inflating it all the way and deflating it all of the way. At that point, you can leave it deflated during the day.

Why half a stiffy, you ask? As you heal scar tissue is forming around the components of the pump. For your body to have enough room for the cylinder to fully inflate and the reservoir to fully inflate, there needs to be some saline in each for the first several days of healing. Hence, the semi-erect state, which ended up being about 3.5 weeks for me. 

The day after my post-op appointment I had a 14 hour travel day to get home, which included two flights and a 3-hr bus ride. It was totally fine. I had done the TSA Pre-check so there was no crotch groping and I made sure to get seats with extra legroom and as close to the front of the plane as possible. I carried on a sweatshirt in case I needed any propping up to get comfortable in the seat. It wasn't needed. I was surprised by how smooth the travel day was. Granted, I was obsessively reading my way through Ready Player One, so that helped.

...in my next post I'll go into more detail about my recovery from surgery and share tips/tricks for inflating and deflating the pump...cause it's not as easy as it looks.

1 Year Post-Op

Notes on 10 Months

The remaining 10 months of my first year post-op were not easy. It was a slow climb to getting my life back...for many reasons. The first of which is that I experienced a significant period of depression. This was unexpected for me since it had been about 15 years since I was on anti-depressants. It was also confusing to know which of my symptoms were a normal outcome of surgery that would pass and which were an expression of a more serious depression. I finally saw a psychiatrist, went on meds, and (after two dose increases) felt like I could start to get my life back.

In the mix of all of this, I went back to work too early. I was out on medical leave for 10 weeks, went back half-time for one week, and then dove right in. The mix of depression and recovery from surgery looked like this - I went to work, had a few hours of great productivity, slogged through the rest of the day, then went home and fell asleep about 2 hours early. Every weekend I would nap for 3-4 hours each day. Lather, rinse, repeat - for at least the next 2-3 months. I don't know what might have made this better - taking another week or two at home, taking another week half-time, or that it was going to happen anyway. I only had 12 weeks of FMLA and I was worried that I wouldn't have any time to spare if I needed an emergency surgery or repair within that year. I made the logical decision to save that FMLA time, but in retrospect it was obvious that my body was not ready.

A lot happened (and didn't happen) in the first year post-op, so I'll whittle it down to the following lists. I'd be happy to expand on one or more topics if that would help others. Feel free to leave a comment on this post.

The Emotional Ups/Downs of Healing (Top 3 Lists)

WINS:

• Standing-to-fucking-pee. This should not be underrated. I love it. Love, love, love it! And, I was never one of those guys that used an STP. I'd pee on myself and I hated them. Think about this - how much time, energy, and mental space do you use on thinking about where you can pee? Like, do you remember to pee before leaving the house or a space you know? Do you eat or drink less? Do you totally avoid certain places (like bars or concert venues) for fear there will be nowhere to go? Do you get anxious every time you enter a bathroom that the stalls will be occupied by a bunch of cis guys taking a dump? I DID. All of this. And it's a waste of our damn time that I no longer have to deal with. What a relief! Also, there's something so freakin cool about holding your own dick and peeing out of it. I can feel it swell up when the stream is passing through. Hell yes!
• Jerking off. Being able to grab something that's not the size of a peanut or where I'm not doing the wax-on-wax-off business is miraculous. I get to tug on my dick for pleasure. Enough said.
• Bulge in the pants. It's nice to no longer feel like something is missing. It's chillin between my legs and every now and then I'll subtly poke it with a finger just to feel it there and remind myself it's real. I never had a ton of dysphoria in this area and rarely wore a packer, so I'm surprised by how much I like it.

DISAPPOINTMENTS:

• Arm healing. It took one part of my arm 9 months before it stopped blistering. That's a long fucking time to deal with that wound. The corresponding part of my leg where the thicker chunk was taken has also noticeably scarred, where you usually don't see scarring where the surgeon took the split-thickness graft. One the inside my arm there is a long streak of thick, red, and raised hypertrophic scarring that hasn't gone down. A small area is pressing up against my nerve and it hurts like hell if someone happens to grab my arm in that area. I'm not sure what my options are, but for now I'm seeing a dermatologist to find ways to reduce the scarring. If that works, but the nerve tenderness is still remaining I may need to pursue fat grafting in that area.
• Sensation. I have minimal-to-moderate sensation. I can feel my penis if I run my finger nails along it or if I touch it through soft underwear, but other than that I don't have much sensation. I can't feel temperature (yes, I held a frozen burrito to it and didn't feel a damn thing), I don't have erotic sensation other than what I have in my buried clit, and I don't really feel it as a part of me. It's hard to describe, but if I didn't feel it pressing on other parts of my body or feel the weight of it, I wouldn't necessarily know it was there. This is a total bummer. And, I've talked to a lot of post-op guys about this. It appears that there is a huge spectrum of feeling that guys who had a nerve hook up get. Some people get super erotic, tactile, and temp sensation within the first several months post-op, some people it takes 2-3 years to get this kind of sensation, and others get lower levels of this sensation or only one kind. It's kind of a crap-shoot. I read a post from a guy yesterday who was 3 years post-op and he said that it had only been in the last 8 months or so that he started to notice temperature sensation. Dr. Crane says it can take up to 3 years for the nerves to mature and for you to feel a deeper and broader range of sensation, but that some may never come in. I guess I have two more years to wait. 
• A big flaccid dick. I didn't realize how unsatisfying it would be to jerk off a flaccid dick. It was...deflating. At least this was a sign that I really wanted an erectile device. Before my phalloplasty, I wasn't sure how I'd feel about an ED and I was hesitant to sign myself up for another surgery. But, it was clear to me within a few months that I couldn't go much longer without one. A big flaccid dick is also heavy and it dangles straight down, snaking through any type of underwear that aren't briefs or boxer briefs with a pocket. Thank goddess for that invention! And, it looks weird to me in the mirror - like it's disproportionately big. A part of me wishes I had considered a smaller dick, but I also don't know what the erect experience will be like. I'm sure post-op folks all feel in some way like the grass is greener on the other side.

WHAT THE FUCK JUST HAPPENED:

• Who am I. Really. If anyone can make sense of my life and body right now, please volunteer as tribute to get in my head and organize my thoughts. I think I'm still in shock. My head is having a hard time making sense of my new body and I'm incessantly having dreams about still having a front hole. I'm definitely working some shit out. We'll see how that unravels over time.
• Transitioning has been my life. I started T over a decade ago and in the last five years I've had four surgeries (hysto, meta, meta revision, and phallo). I feel an odd mix of relief, grief, anxiety, excitement, and disappointment. I am just an average dude now and it's hard to imagine a life where I'm not constantly chasing the next body modification. I know I'm not done, but there's something bittersweet about seeing the finish line. The universe is forcing me to live more in the present, which is a source anxiety for me. I could probably use some daily meditation.
• I suddenly don't want to talk about it. After spending so much time and energy thinking about, planning, and preparing for my penis, I am like a church mouse now that it is here. That came as a surprise to me. It is, however, somewhat similar to when I had been on T a few months. Out of nowhere I got really quiet, introspective, and cagey. I felt incredibly alone in my experience and even the thought of sharing my feelings and reflections with another human being was to frightening to bear. I'm definitely in that space again and it's a self-defeating cycle where I feel alone and those feelings keep me from letting others in. This is something I'm trying to take baby steps to overcome.

Next Stage

Dr. Crane suggests that patients wait 9 months before getting implant surgery. I needed to re-up my FMLA coverage and the winter is usually a better time for me (and my partner) to take time off from work, so I scheduled my implant surgery for a date that is exactly a year from my stage 1 surgery. See more info on implant decisions and surgery in the next post.

My Quest for Underwear

Seriously? This is where my life is at right now?! Yep - finding underwear to meet all of the needs of my brand new fragile-and-unique-as-a-snowflake penis.

This is what I've learned:

1. I used to LOVE briefs and now I prefer boxer briefs so that my clothed cucumber is rubbing up against clothing and not against my bare thigh. Who knew this was a thing?
2. I'm super self-conscious about the post-void drips in the undies. It doesn't always happen, but when it does and it shows I am mortified. Don't get me wrong, it's not like a Billy Madison "peeing your pants is cool" kind of leak. It's only a few drops. But, I usually wear chinos and it is noticeable. I'd rather not have to feel insecure about this after every time I pee. 
3. Extra room in the front of underwear is necessary to hold these goods. Regular undies squeeze in the too much and are very uncomfortable. 
4. Without a separate pouch that holds everything in front of my body, my scrotum drops between my legs and my penis will go everywhere - bend upward, slink down the leg, fall between my legs. Everywhere. WTF? Not cool.
5. I have thick thighs and it takes some stretchy material to keep the legs in boxer briefs from riding up. (Hint: riding up is not a good thing)
6. A lot of underwear with a large front pouch also has a seam running down the middle of that pouch. I don't like that this seam leaves an imprint on my dick even after only an hour of wear. 

After trying at least a dozen different brands and styles, here are the results...

Definite NO:

• David Archy Micro Modal Separate Pouches - Adequate sized pouch for the dick, but the outer pouch bent my dick too much where the head was pointing back towards me. It left me with very visible creases at several points along the bottom of my shaft and when I wore them it felt like I was almost going to sit on my dick several times.
• GKVK Men's Briefs - The front pocket was designed for an elephant trunk. 
• Lapasa ELS Combed Cotton Hip Brief Stretch Underpants - The front pocket is not big enough and the cotton doesn't stretch that well. These may be great in a few months and they're my preferred style of underwear. I'm going to wait and see on these. 
• MyPackage - Separate compartments for penis and balls. The area for the penis is not large enough and you have to put your genitals through a hole that doesn't align well with my body.
• Saxx - Stretchier material and no front pocket. Instead there are mesh-like wings (reminds me of panty-liners) that are in the front to separate the twig from the berries. I can see why cis guys would like this, but it doesn't work for me.
• UFM 3.0 Adjustable Athletic Boxer Brief - The front pocket was too tight and having to tie my bits in a sling and squeeze them into a tight pouch wasn't worth the effort.
• Calvin Klein Body Micro Modal Boxer Briefs - Great thick waist band, comfy material, and large front pouch. Sadly, my penis rolls all over the place (and down the leg) in these. They're now my weekend/lounge undies.
• MeUndies - Comfy material, but that's all I can say about these. Thumbs down.
• 2xist Men's Sculpted Contour Pouch Brief - Oddly, not enough room for the goods.

Pretty Good:

• Andrew Christian Trophy Boy Tagless Brief & Andrew Christian CoolFlex Boxer w/ Show It - Great front separate pocket that holds the goods in front of my body. There is no center seam in the briefs, but the rim around the bottom of the pockets in both is inflexible and puts too much pressure behind my scrotum. The material are very soft and comfortable and all of Andrew Christians underwear is super sexy! If it weren't for the discomfort on my scrotum, I'd wear these more often.
• Lapasa Men's Micro Modal Boxer Briefs Low-Rise No Fly Trunk - Very soft and stretchy material. Supports my dick enough to make a "package" but not too much to crinkle it in a ball. Down side is the center seam leaves a noticeable indentation along my dick, even after an hour of wear and the legs ride up. 
• Obviously AnatoFree Briefs - Not bad for short trips to the gym. They're supportive and have good sized front pouch. Down side is the center seam.
• Obviously AnatoMAX Boxer Brief 9" - I love the length of the briefs, but the "MAX" line (their biggest front pouch) lets my dick fly a little too free. Under athletic shorts this isn't a big deal, but in pants I need more support. Another down side is the center seam.
• Obviously Essence Naked Boxer Brief 9" - These have become my regular underwear for working out. I love the long legs for running, the material is soft and has great stretch to it, and the size of the pouch is perfect. Like other Obviously products, I'm not a fan of the seam in the front pouch.

My Favorite - 2UNDR Swing Shift

These underwear have everything that I want and need. First, the modal material offers enough stretch that the legs don't ride up my thighs. The front area has enough space and the "joey pouch" comfortably holds my penis and scrotum in front of my body. It stays nicely in place all day and in all types of pants. The "no drip tip" is basically an extra layer of mesh-type antibacterial fabric that catches any post-void run off. I have no insecurities about drippage when I wear these. The material also helps me stay dry and while I don't use it, these also have a built-in fly, which may appeal to some. They also come in a huge variety of colors, materials, and leg-lengths. I LOVE these underwear!! 

After having several pairs for 4+ months, I have found that the materials hold up well to regular laundering in a washer and dryer. I have yet to see a hole or the fabric wearing thin. The one downside I've noticed is that the legs are starting to creep up my thighs, which makes me think that the spandex-type quality wears down in these over time. 

 

2 Months Post-op RFF Phallo

The theme of this post is The Good, The Bad, and The Ugly since that pretty much sums up this recent phase of my recovery from surgery.

The Good

I can masturbate to orgasm. There, I said it. And it's true. It. Works!!!! At 5 weeks post-op I got an itch that I had to scratch and thank the sun and the moon and the stars that it still works. I can get off and I can get off by jerking on my dick. Let me write that again, I can get off by jerking ON MY DICK. Does anyone else hear the Morgan Freeman voiceover? Because I am in heaven. I got teary-eyed, too. What a beautiful, affirming relief to get pleasure from my very own penis. There is nothing in my life to compare this too. Nothing would do it justice, so trust me when I say that it is life-giving and magical.

Moving on. I am also starting to see some noticeable changes in my energy and healing. The last scab on the head of my dick fell off and it's almost all healed up. I went back to the gym at 6 weeks post-op to start walking on the treadmill. The first few days I was just walking, then I would walk two minutes, jog a minute. Now at more than 8 weeks post-op I'm going to the gym about 4-5 days a week and walking a minute, then jogging for two for about 25-30 minutes. For the first two weeks of returning to the gym a small walk/jog would sap my energy for the rest of the day. It's slightly better now, but I'm also pushing myself to go for longer period of time. I find this is a good marker of my energy level and a reminder that I'm not ready to be back at work yet. If a 30 min walk/jog wears me out, a 9-hour stressful day is gonna knock me on my ass. As of today, I plan on going back when I complete 10 weeks post-op and I may try to go back part-time at first.

The top layer of my arm graft is still an open wound (see below), but the good news is that it has been healing faster during the past few weeks. My local occupational therapist has experience with wound care and, after examining my arm, he suggested that I try a different approach to wound dressing. He switched me from Adaptic to Xeroform and he placed an ABD pad on top of the Xeroform to help pull the moisture up and away from the wound. He also switched me from changing my dressing everyday to every other day. Between the moisture and the dressing changes, the skin that was starting to heal kept getting ripped off, slowing down the healing process. This OT also confirmed my suspicion that this was a full thickness graft, not a split-thickness one. If I haven't described it before, the surgical team took three separate pieces of skin from my legs - two from my right thigh and one from my left - and these where placed on my left forearm to cover the open wound left from creating the phallus. I noticed early on that one section from my leg was cut deeper than the other two. It was and is slower to heal and hair was removed with it. While the other two are itchy and look varying shades of pink, this one is still producing blisters and scabs 8 wks post-op.  Likewise, on my arm, that particular graft started off yellowish in color (not red) and you could see some hair follicles in it. I don't know why it happened and it could have easily been an accident. I'm not particularly bothered by it since the graft took and never became infected. It is irritating that it is healing so slowly (at least 4-6 weeks behind the other two graft sections) and it's impeding my ability to do more aggressive therapy to help loosen the grafts and increase my range of motion. BUT, this goes in the good section because I think I'm on the right track to having it heal up in the next 2-3 weeks thanks to this new wound care regimen. My OT also moved me back to a small compression glove (from my medium) which fits better now that so much swelling has gone down.

Top of arm - red area still healing

Underside of arm - no open areas

The Bad: Tender Nubs and My Underwear Adventure

At about the 5th week post-op a small black scab on the underside of my scrotum flaked off revealing some uncomfortable yet minor issues. It had been covering a still-healing drainage tube hole, which at close look still had a small black thread sticking out of it. :) Fun, right? Next to thread was a pink inflamed nub of skin that was tender to the touch. Let me just say that, in my mind, I'm mildly convinced at this point that this little black thread is like the loose thread of a sweater - once tugged on, the whole thing comes unraveled. And, I pulled on it a little to see if it would come off easily. Unfortunately, this little black thread seemed to be suffering from separation anxiety and wasn't budging. A small panic set in. I took a picture and sent it to Toni to ask what I should do. She encouraged me to go ahead and pull out the thread and she said that the pocket of tissue might be hyper-granulation. It could go down on its own or, if it doesn't, I can have my PCP remove it with a treatment of silver nitrate. Thank you, Toni, for anticipating my catastrophic thinking and texting me that there was no way the thread was connected to anything important! Still, I couldn't stomach it, so this became a job for my partner and his firm yank released the unwelcome guest. Success!

Sadly, the nub of tissue enlarged to about the size of a pencil eraser and was very tender to the touch, especially whenever it rubbed up against underwear. About a week later, I went to my PCP who called Toni to confirm what needed to be done. She gave him the option of doing straight up silver nitrate to burn it off or cutting it and then cauterizing the incision with silver nitrate. If you've never seen a silver nitrate treatment, the chemical is on what looks like a large matchstick and it basically burns the skin. This PCP is a very cautious person and from his perspective the stalk of the nub was not thin enough for him to feel comfortable cutting it. He used three different "matches" to get the whole nub and since I can't feel much in that area, I got to miss out on the burning sensation that usually accompanies a silver nitrate treatment. It did, however, turn my skin in that area a grey/silver color. The next day, the outer layer came off like a miniature swim cap, leaving a much smaller nub behind. It shrunk even more over the following week, but it's not completely gone and still tender so I got a referral from my PCP to see a local plastic surgeon to get it removed. It's a pain, but more annoying than anything. On the upside, my PCP had an assistant "health coach" that he was teaching, a guy in his 20s. I'm pretty sure my new dick blew his mind. I was impressed at how mindful he was to ask helpful and medical-related questions, like "what does your timeline for recovery look like right now?" rather than all of the potentially invasive ones that people tend to when they meet trans people.

Now, I'm switching gears and I may seem naive in saying this, but I really didn't think through how much dick would be present in my underwear. I was never like, "hmmmm...my flaccid dick will be the same size as an avg erect dick. That's normal and not a problem." Ugh. I wish I had. Not that it would've changed my mind on the size I wanted, but it might have prepared me for greater body acceptance. Here are the deets - my scrotum is empty and takes up a negligible amount of space...but, my dick. My dick is approximately 12.5 cubic inches or about 204 cc's in volume. That is a lot of flesh to wrangle into underwear and pants. Before going into surgery I wore medium-sized briefs and 34x30 pants that weren't "skinny" or "slim" fitting, but they weren't loose either. Post-op nothing fits, not even a little. I've been on an active search for pants with more room in the crotch (sometimes called a gusseted crotch) and for underwear that won't smash my lovely $170,000 dick. What I'm coming to discover (and accept, albeit slowly) is that most 34" waist pants do not have enough room for my hips, butt, and dick. Neither do medium underwear, even those with extra-roomy pouches. That has been a big mental adjustment for me and will be costly to have to likely switch out my entire wardrobe of pants. On top of that, the styles and brands that used to fit me now look frumpy on me in a size 36 waist. This is a bummer.

Update: I ended up finding a great style of chinos that are flexible and roomy enough in the crotch that nothing is getting squashed: Levi's 541 Athletic Fit Chinos. And, because they are stretchy my regular 34x30 size fits perfectly! Going up a size to 36x30 I found that the Levi's 502 Regular Taper Fit Jeans fit well, too, especially now that the post-op swelling has gone away completely.

My adventure for finding the "right pair" of underwear has been disappointing. I went off the suggestions of numerous guys who "swear by" a certain brand and none have been satisfactory yet. They are also wicked expensive. I'm doing a separate post all dedicated to underwear since this is the bane of my existence.


The Ugly - Depression

I am 3 months late on finishing and publishing this post because of THE UGLY. And, the ugly my dear friends is/was post-op depression. I went into the surgery knowing that this was a possibility and quite common given how many hours we are under anasthesia, the length of time we are on pain killers, and the length of time that our sleep is interrupted. For me, even the routine of Tylenol had me waking up every six hours, which was preventing me from getting a sound night's sleep. Additionally, phalloplasty surgery is a major life-changing event and whether this language resonates with you or not, it did feel like a trauma to my body. Add these together, especially with any history of depression, it was likely that I'd be feeling the blues. I just didn't expect it to settle in and last for so long. (For additional insight from another post-op phalloplasty guy: Reasons for Post-Op Depression and Post-Op Depression Resilience)

It caught me by surprise since I didn't experience post-op depression after any of my previous surgeries (chest, gusto, meta, or meta revision). I also haven't experienced symptoms like this in well over a decade: problems falling asleep and staying asleep, feeling like crying in the middle of the day for no apparent reason, infrequent suicidal ideation, the impulse to call in "sick" rather than go to work, missing bill payments, feeling irritable and overly sensitive, and spending evenings and weekends mostly in bed. All of this persisted even after trying lots of things that would normally help when I'm feeling down (exercise, eating better, etc.). I've never to this extent felt like saying "fuck it" to so many things in my life.

Luckily, I had a good friend hold up a mirror to me that this was very out of the ordinary and she encouraged me to see a Psychiatrist. I'm grateful that she did this as I had too many "explanations" that were keeping me from getting help. Fingers crossed.

1 Month Post-Op RFF Phallo

I have a lot of exciting news to report now that I'm one month post-op! This post is mostly about urinating, but also includes details from my last post-op appointment (w/ Q&A) and some ongoing maintenance.

Urethral Lengthening/Urinating
I was given the green light to try urinating out of my phallus on the Friday following my second post-op appointment. I must admit I was pretty nervous. I knew this would reveal any fistulas (holes from the urethra to the outer skin), strictures (blockage in the urethra from scarring) or any other complications. And, I thought it might be painful. At this point, the majority of my pain has been confined to my arm and I was unsure how bad it would feel to try to urinate out of something that was still healing.

I woke up on Friday morning at 8am ready to go. In preparation, I put a chux pad on the floor thinking that (a) it would keep the floor clean if I were to spray or leak anywhere and (b) it would be noticeable if I were leaking out of a fistula. I decided to sit on the very edge of the toilet and hold my penis above a graduate container so that I could measure how much urine came out. I thought that since it was my first time, sitting would help with the muscle memory and it would let me relax a little more. Toni had reminded me that the trick is to relax and let go and that some guys feel like they need to push it out and that keeps them from going. I closed my eyes, repeated a mantra in my head of "relax" and it flowed right on out!!!!! SUCCESS!! My dick works! And bonus - NO LEAKAGE.

How did it feel? Other than a huge fucking relief?! I felt sore where I imagine the neo-urethra connected to my original urethra and it was the most bizarre experience to see it flowing out of the tip of my dick, but that I couldn't feel it. It's like, "I can see this is happening, but I can't feel it happening." Really really wierd. The color of the first few seconds of the stream was a bit orange, which I imagined was some blood in the urine and when I looked into the graduate cylinder, it looked like there was a lot of slough floating around in it. It kinda had a granulated appearance.

I emptied about 150cc's of urine into the graduate cylinder and then emptied the rest from my bladder into the second container. A whopping 325cc's were left! That's a lot and I only had 4.5 days to flip that ratio around to ensure I'd get my SP catheter out. I needed to be consistently peeing about 2/3rds to 3/4ths of my bladder out of my urethra. Naturally, I kept a chart. Here's a line graph I made out of it - the green representing urine from my urethra and the red representing the remaining urine I had to empty from my bladder. The goal was to have a consistently large gap between these two lines and to keep the red line from peaking above the green.

The key takeaways - After the first pee, I was pretty easily able to hit the ratio I needed with some exceptions. Usually, the longer I waited between urinating, the more urine there was remaining in my bladder, which was most noticeable duringthe first pee of the day. l got in the habit of drinking a lot of water and "practice, practice, practice" :) I continued to have that granular looking pee on and off for a few days and once or twice had the orange blood-tinted urine at the start, but overall it was quick to normalize.

I was pretty confident that I would not have any fistulas as it seemed from the experiences of other guys that they were noticeable from the first pee. Since they are incredibly common, I expected that I'd either have a fistula or a UTI, but it looks like I'm at least in the clear for the former for now.

There are two more things that I'll add before moving on. The first is that within a day of peeing from my urethra I started getting pain where my SP catheter was coming out of my pubic region. It felt really sore and that hadn't been the case before. I assumed that it would eventually bother me, but this was more achy than I expected. At one point I decided to completely empty my bladder from my catheter (not marked on graph) and that fixed it! I'm not sure if there was pressure built up that was causing the pain or what, but it didn't come back. The other thing I'll mention is that on the second night of peeing I heard and felt a "pop" coming from in my urethra behind the base of the penis. The next time I peed about an hour later some blood was in my urine. I'll admit, I freaked the hell out! I posted about it online and some guys said not to worry and that it could be a suture coming loose and at this point they were starting to dissolve anyway, so it probably wouldn't be an issue. I couldn't stop thinking about it and texted Toni the next morning. She said it'd probably be fine and it was. But, boy did it scare the beans out of me.

Last Post-Op Appointment
I felt really good going into my last post-op appointment with Dr. Crane and Toni since I was urinating so well, appeared to have no fistulas, and my energy was slowly coming back. I had to pee before coming into the office, but wasn't sure if Crane wanted/needed to see it. FYI - he doesn't. I snuck out of my appointment to run to the bathroom. *Face palm* The good news, I dropped my pants and his reaction was priceless. "Wow! You ended up with a nice big dick." Then goes on to say that when it heals I should send a photo to his admin staff to put on the website, if that's something I'm comfortable with. Um...hell yes! I was proud of my dick to begin with, but that was a wonderful affirmation that it's coming along. (Keep in mind, it was still fairly swollen.) While we were talking, I overheard a guy in the room across the hall, so I asked Dr. Crane if he was doing a phallo consult with someone else and offered to show that guy my penis if he was up for it. I never had the chance to see a post-operative dick in person and felt like it was the least I could do for another trans guy trying to figure out if this was the next right step for him or not. Dr. Crane and Toni were pleased by the idea and I got to meet another trans guy with my pants around my ankles. Ha ha. I could tell he was happy to have the opportunity to see the goods before making his decision.

After my show-and-tell I got the last two staples taken out of my arm, got my dressing changed, and had the SP catheter taken out. It was an odd sensation, but Toni described what I'd feel before taking it out, which helped me be chill about it. The process was over in seconds after a snip and a tug.

I had a handful of questions for them, too:

1. Can I start sleeping on my side? (I'm a side sleeper) Yes as long as it doesn't hurt and you're not cutting off circulation to your phallus.

2. Do I need to keep using the arm brace? Nope.

3. When can I start exercising? 6-8 weeks Post-Op.

4. When can I masturbate or have sex? 2-3 weeks from now.

5. Should I be concerned at all about traveling or going to a much colder climate? Nope. Just don't drive if you're on narcotics.

Ongoing Maintenance
I'm still keeping my dick propped almost the entire day, which is helping with the swelling. I can tell because it's slightly more flexible. I started wearing loose boxers regularly this week. I got sick and tired of wearing nothing and it helps me feel better. It is hard to wear anything that compresses and it's clear that none of my briefs will fit again. My dick is too big to squeeze into that little area. I'm changing my dressings and the top graft on my arm is still healing way behind the rest of my arm. I'm able to shower without covering it and clean it with Cetaphil. I hold my arm out of the water and after soaping it up, I rinse it by letting the water drain down my arm first and trickle onto the wound. I'm not supposed to have it directly under the stream. Toni says it'll take at least another 2-3 weeks to heal. Bummer.

I'm also back on narcotics after trying to wean off them. The night after I went from a low dose to just Tylenol I woke up with horrible pain in my arm. It was aching and throbbing and I decided to go back on the low dose for the remainder of the week and through 30+ hour drive home. I learned my lesson when I had my metoidioplasty and tried to go off narcotics during the drive - it sucked. You never realize how all of those little bumps small movements can make you sore. We made the 30+ hour drive home in 5 days (returned last night) and I had no problems with pain or the drastic change in temperature. Now that I'm home I'm going off the narcotics. *Fingers Crossed*

I had my last OT appointment my final day in Austin and got some new stretches and movements for hand therapy that I hope to put in a more comprehensive blog post. I have a very limited range of motion in my wrist although my finger movement is great. It was also suggested that I start wearing a compression glove on my hand to reduce the swelling, which will help with movement and decrease the nerve pain I'm having in my thumb. They didn't have my size (medium) at the OT clinic, so I ordered it on Amazon and it arrived today. It feels really good to have on and Toni told me to wear it 24/7 if I can stand to.

21 Days Post-Op

Today marks 3 weeks since my RFF Phalloplasty with Dr. Curtis Crane in Austin, TX. I'm happy to report that quite a bit has changed in the last week. I had my second hand therapy/OT appointment and my second post-op appointment with Toni and Dr. Crane this week. I'll admit, it's been hard staying up-to-date with this blog for a number of factors. My mental processing is still pretty slow, I have a hard time concentrating for long periods of time, and my arm is relatively immobile and achy a lot of the time. All of this makes it hard to type at length. I'll go back and do a 1-week and 2-week recap in the next few days.

Overview of Changes - Good News
The big highlight is that I continue to feel more and more like a normal human being. I still have a hard time concentrating and my mental processing and memory are subpar. However, I can tell that my brain is clearing up (thanks in part to getting off narcos) and I've been able to start reading and playing board games again. I'm beginning to get tired of watching TV and movies and I really can't stand being nakey from the waist-down all day, so I started wearing loose boxers. I feel better being able to wear clothes!! And it's nice to have some dick coverage. I wear the boxers and sometimes sweatpants over them most of the day and even on short rides to pick up food or something, but if we're going to a doctor's appointment or making an excursion, I put the mesh briefs on to strap the little guy in.

It looks like my phallus is healing well, although I'm such a competitive person that I kept wanting to hear from the docs that I'm ahead of schedule or that I'm healing exceptionally well. Really? I can be such a teenager sometimes. Back to my phallus - some of the spots that were black (primarily on my scrotum and along the glansplasty) have sloughed off and turned to pink and the swelling in my scrotum has gone down noticeably. It has a little movement to it that it didn't have before and is starting to look more symmetrical. One side, probably where the drain was in, is still misshapen and hard/firm. The swelling has gone down slightly in my phallus, but it is only noticeable in the morning when it feels less full and has a bit more flexibility to it. By mid-day, it is back to feeling full, heavy, and more rigid. We are using less bacitracin on the wounds in the genital region since some of the suture lines, like the one under the phallus, are already healed up.

The swelling and pink appearance of the suture line along my right hip/pelvis for the artery and nerve hook-up has gone down. However, a small portion of the suture nearby appears to have opened up a bit. I sent Toni a picture of it via text late last week and she said it looked okay and to keep and eye on it. She was still unconcerned by the time she looked at it at my post-op appointment. Either way, I've been putting MediHoney on it and that seems to help keep it from opening up further. I anticipate that area will scar more heavily.

I got the staples out of my arm!!! Boy, they were bugging the crap out of me and I couldn't wait. I could feel the ones along my wrist and they were soooo uncomfortable.  It's amazing how many Toni took out! (Of course, we thought we got them all, only for me to find 2 more in the shower later that morning. They were hidden by large scabs. Yuck.) Only a few of them hurt coming out. For the most part, I couldn't feel them being removed, fortunately. Parts of my arm graft are healing very well. There's a section that's clearly miles ahead of the rest. It's looking nice and pink and healthy. And, I'm getting more mobility in my arm back. It is still hard to flex my wrist back (little to no movement), but flexing my hand and fingers forward is getting better as is rotating my arm in/out. It's hard to rotate it outward, but that's still progressing. The pain on my thumb is decreasing/changing, but definitely not gone. I'm not sure how long it'll be here. It's annoying and one of the more painful parts of this whole experience.

Now that my arm, overall, is healing well, I can wear the brace sparingly. My hand therapist also suggested that I use HTCC.org to find a certified hand therapist back home to continue my care. I called someone a few minutes from my house and I'm waiting to find out if they have experience with grafts and wound care. Back to the brace - mostly, I wear it when I'm sleeping and when we're out and about running errands. I don't want to accidentally bump into anything this early on. Also, I am able to shower with the dressings off and use a mild soap (Cetaphil) and water (not directly from the shower head) on my arm. I was incredibly nervous the first time I did this. So nervous, actually, that I kept pacing around in front of the shower and finding last minute things I simply had to do before getting in. It was laughable. I didn't know what to expect or what it would feel like. Clearly, I survived the experience to tell about it. I must say that seeing my arm exposed for that long was, well, creepy. It's totally creepy looking. But, I gotta give thanks to the selflessness of my left forearm for donating most of its skin to my dick. Thanks, Lefty!

In the past week+ I was able to reduce my narcotic intake from 2 pills every 4 hours to 1 pill every 4 hours (Tylenol every 6), and then to 1 pill and 1 Tylenol every 6 hours. Today I'm trying out 2 Tylenol every 6 hours. I'm still on a full dose of Ibuprofen - 4 pills every 8 hours. Don't get me wrong, I'm still achy and in pain, particularly my arm. But, I know it's going to be a while before that's totally gone. And, I discovered yesterday that I had gone an hour without noticing I had missed my dose of Ibuprofen, which tells me the pain is lightening up. I'm not in a race to get off narcotics, but I also don't want to drag out my use of them. Weaning off of narcotics is a precarious thing for numerous reasons. You can experience physical pain from withdrawals, which is not the same as actually having pain from your wounded areas. That makes it hard to trust your body as to whether or not you really need them. I also found that no one really tells you how to do it. I've looked up tapering guidelines and they're primarily directed towards people taking much higher doses than we get. They suggest going down 20%-50% of the dose each week and increasing the intervals. I found this Opioid Tapering document fairly helpful although, again, the focus is on higher doses than we're on. If it gives you some perspective, I as able to go from 2 pils every 4 hours to Tylenol in about 11 days. Toni suggested taking the first two steps that I mention in terms of lowering the dose and increasing intervals, but not how to get off them entirely. Another thing to keep in mind is, as the narcotics are replaced with Tylenol/acetaminophen, make sure that you're not exceeding the daily amount of acetaminophen. Research over the last several years has shown overdoses of this drug to be deadly! Seriously, don't F around. The narcotic I was given was mostly acetaminophen, so tapering off meant that I could only take 1 extra strength Tylenol at each 6 hour interval until I was completely off of the narcos, then I could up it to the full dose of 2 ever 6 hours. The bonus to fewer drugs/longer intervals meant longer periods of uninterrupted sleep throughout the night. Hell freakin yes!!!! What a gift!

Last, but not least...drum roll, please...I get to try urinating out of my phallus tomorrow!!! Woohoo! I am ridiculously excited and pretty darn scared, too. The process of urination tends to reveal all of the trouble spots that haven't healed yet and many guys find that they have small holes (fistulas) that urine leaks out of, usually behind the scrotum or between the scrotum and the phallus. It is incredibly common and Toni told me to be prepared that it might happen. The majority of these heal up on their own by 3 months post-op, but if that's not the case, then a revision surgery is necessary. The goal is to urinate 2/3rds to 3/4ths of the contents of my bladder out of my phallus and empty the remainder from the catheter. If I can do this successfully and consistently by the time of my next post-op (on Tuesday) and there is little to no leakage elsewhere, then I can get the suprapubic catheter out. I don't want to get ahead of myself, so we'll see how it goes. If I have to leave it in for longer, no big deal. It's not too annoying and it sounds super easy to remove on your own. I'm simply thrilled to be able to try peeing from my dick. That seems pretty spectacular all on its own.

Wish me luck!

Challenges/Bummers
I thought I'd start this week off by sleeping in a normal bed with my partner and pushing the sofa bed I'd been sleeping on back in for good. To me, this seemed symbolic of the next step in the healing process and had me feeling like I was getting back to normal routines. Well, it didn't quite work out. The rental we have has a master with a double bed. I'm pretty sure we were not entirely comfortable sleeping in it together before I had surgery. There simply isn't enough room, especially now that I need to be on my back and use extra pillows to prop up my arm. I woke up with a sore arm, feeling defeated. It was easier to reconcile this loss when I remembered that the pull-out bed gave me all the room I needed...and, I'm still healing. It's a much longer road than I want it to be.

Now on to my body. The hair on my phallus that I didn't get completely removed from only 6 months of electrolysis has grown in and while it doesn't look horrible, it's a bit hard for me to see. I feel sad when I see it, like it is some marker that I don't quite yet have the penis that I want. I'll have to wait until I'm 4-6 months post-op before resuming electrolysis and hopefully it'll be quick and relatively painless. Even though I built up a great relationship with my electrologist, I'm feeling more sheepish than I ever imagined about going back to see her. Undoubtedly, I will. Still, I didn't expect to feel so...um, modest? about the whole thing. When I think about it, I'm not sure why I'm so surprised by this. It is my genitals after all.

Another new development that is relatively annoying is that the plastic-like thread they use to suture the wounds is popping up all over the place. There are these clear thread spikes all around the top of the glansplasty and on the sides and undercarriage of my phallus. Some of them seem to be growing in length, too. Toni said they'll fall out on their own or I could probably even pull them. I took a deep breath and tried on a few, but they wouldn't come out. Why am I complaining? They catch on everything and scratch the side of my leg when my penis is resting against it. Also, some of them seem to be opening up part of the suture as they break through the skin. Like the staples, that'll be another thing that I'll be happy to have gone, sometime soon I hope.

The skin graft on the top part of my forearm isn't healing well and I'll need to keep putting dressings on it for at least another 2-4 weeks longer than normal. Many guys get to switch from an arm dressing to a sleeve at this point or within the next week and that won't be the case for me. I had a feeling this was the case since that part of the graft is obviously a different color then the rest - mostly yellow/pale white with some spots of red showing through. There's no sign of infection, but Toni and Dr. Crane want me to keep an eye on it in case it does get infected. The hand therapist said her impression is that it's healing from the inside out, which is why you can see the healthy red parts coming through. I think it's supposed to all turn that reddish color before healing like my other grafts.

Soon after surgery, my partner noticed that I had a little piece of skin, a skin flap, in my butt on my perineum. Once I was able to feel around back there, I found it and it was pretty noticeable. I mean, in a flat crack anything would be and this small flap of skin definitely is. It's not a huge deal, but it's something that my mind continues to obsess over. We'll be riding in the car and I'll think to myself, "Great, I have a fucking flap of skin by my asshole. Gross." I talked to Dr. Crane about it and he said that it happens sometimes when they're closing things up and it's better to let some of the skin poke through like this rather than to have the opposite happen. He said it should go away on its own or he'll remove it when I come in for my next stage. Nevertheless, it's unpleasant and it makes me feel a little weird about that area of my body now.

Another thing that is on my mind, which may sound silly is that I have no idea how I'm going to get my dick into underwear. It's a big flaccid penis. I'm getting suggestions from guys on FB and I think it'll be trial and error for a while. Luckily I still have another 6-8 weeks before returning to work, so I have some time to figure it out. Yikes! I'm worried I might have to get some new pants, too. I hope it doesn't end up costing too much.

OMG, I almost forgot - Anal Cramps! Yep, you heard me right. Two nights this past week I woke up with severe cramping pain in what felt like my asshole, which I found out later was the spasming/cramping of my perineal muscles. Holy shit it hurt! The first time, I couldn't move and screamed to my partner (who thought I was dying and panicked), and in his moment of fear was able to get me the right medication - the muscle relaxers that were prescribed specifically for bladder spasms. We figured, what's the difference between spasms? and we were right. Within a few minutes, the pain started to subside and I could go back to sleep. When it happened a few days later, the pain wasn't as bad, but it lasted longer or seemed like the medication took longer to kick in that time. I really hope that's behind me now (pun intended), but at least I know what to take for it.

Recommended Supplies

Months before surgery, I scoured several blogs and FB groups to find the definitive list of what to bring with me to Texas. I ended up finding a few comparable lists and went with those. I started a registry at myregistry.com to afford them and invite people to help, and then packed several bags of said items into my car for the 30+ hour trek. I drive a 4-door sedan and we were packed to the gills between the post-op supplies, our dog (and her supplies), and our clothes, blankets, pillows, etc.

Now that I'm almost 3 weeks post-op I can say that there were things on those lists that were game changers for me and things I never used. Below are a few items that fall into the first category that I want to encourage folks to think about having with them:

A person who is kind, patient, and good to you and your body -  In my case, this was my partner. Not only did I need the emotional support (and patience) of a kind human being, there were things that I either couldn't do on my own or that would have taken me all day to accomplish had I not had someone else around. My partner helped bathe me in the shower and reach parts that I couldn't. He helped put bacitracin over the sutures, especially in places I couldn't reach. He changed my arm dressing every day (virtually impossible to do one handed). He helped make food (although we ate out or got pre-made stuff a lot), did the dishes and laundry, and helped me arrange my medicine cycle and alarms. I had little to no energy in the first two weeks, limited mobility, and was in pain/drugged up. There were also times where I just couldn't bare looking at or touching certain areas of my body - it was emotionally overwhelming and sometimes scary. I cannot imagine doing this without him. He was also another set of eyes on my body to see if there were any trouble spots or things of concern. And, he was a super cheerleader - reminding me how great it looked, how well I was healing, and to keep the big picture in mind. I think a family member could have helped in a similar fashion, but I would have had to do more of the showering/wound care on my own and I don't think the experience would be as body-affirming.

A blow dryer with a cold setting - I have used this at least once a day since I was released from the hospital. Not only are there places after a shower that I didn't want to or couldn't fully dab dry, but a large swath of the xeroform on my right thigh weeped for a solid 3 weeks, mostly after each shower. It was easy to step out of the shower, dry most of my body down with a towel, and then grab the blow dryer to get the sensitive parts and the thigh. It's important to have a cold setting because of the lack of sensitivity we experience post-op. I couldn't really feel the heat when the blow dryer was aimed at my genitals or even at my thigh, so I kept it on the cool setting so I didn't burn myself.  

Towels - Staying clean and sanitary is an absolute must after surgery. I used a different clean towel after each shower (daily) and since we didn't have a washer/dryer in our rental unit, we had to buy a few more towels so we'd have enough in rotation in between trips to the laundromat. Early on (weeks 1-2), I ended up accidentally getting blood/goo on some of the towels, so we stayed away from white ones when we made our purchase and I got careful in avoiding touching certain areas and using the blow dryer instead. You may also want to consider getting extra sheets for that matter. The more you can rotate in clean items, the better.

A wedge pillow or recliner - I think the items that dramatically helped my comfort post-op was having a wedge pillow and a leg pillow for my bed. I was able to lay with my head up in a comfortable/reclined manner and laid that way all day and even through the night during the first two weeks. Propping pillows is an option, but it's just not the same. I did that when I had chest surgery and the problem is that layers of pillows still sink in the middle and move around when you get in/out of bed. Adjusting them is a pain. The wedge was solid, stable, and very comfortable. I put my memory foam pillow on top of it and was set! The leg pillow I already had since I'm a side sleeper and I usually put it between my legs at night. In the propped position, putting this under my knees allowed my back and body to be in a more natural position. All I can say is I remember trying to recreate this with pillows and blankets when I was healing from chest surgery and was unsuccessful. These two pillows were a life saver. And, I put recliner in here because one of the ICU nurses mentioned another guy found that to be a lifesaver during his recovery period and he was able to rent one for a reasonable price and have it delivered to where he was staying. It's the same concept, I think - being able to lay comfortably for the period of time where that's literally all you're doing.

Pill baggies - This was a great recommendation from another guy. I got a pack of 50 and could have gone with more/less. The first week I was taking several medications and a bunch of supplements (I stopped most of these after the first week due to stomach irritation) and it was really helpful to be able to set my medication schedule, put the pills in labeled bags, and keep those bags by my bedside for every time my alarm went off. It was most helpful in the middle of the night. I'd have my 4-5 pill bags by my side and just lean over to take them, checking that the label on the bag matched the time on the clock. There's a lot of medication to take at exact times and danger in taking the wrong ones. And, it's not easy to keep things straight when you're waking up every few hours in the middle of the night to take your meds. These simplified the process, drastically.

Comfy loose clothes - I sought emotional respite in the physical comfort that some of my clothes brought. These "creature comforts" seem to be few and far between when recovering from surgery and having clothes that were soft and loose on my skin and that kept me climate controlled were everything. I expect you'll want that too. Surprisingly, there were things I ended up wearing daily that I didn't expect I would: 1. A hooded sweatshirt that I ended up cutting half of each sleeve off of on top of a t-shirt. And 2. Boxer shorts (preferably old, soft, and loose ones). 1. Even in Austin, TX, I find that my comfy/cozy place is in a hooded sweatshirt. I brought one of my larger ones down with me knowing I'd probably live in it. Nope. No matter how baggy the sweatshirt was itself, the arm and wrist portions were still tight on my arm brace and that was really uncomfortable. Not wanting to ruin that shirt, I went to Target and bought a cheap, very soft, normally-sized hooded sweatshirt that I cut the arms off of at the elbow. Perfection! I wore that bad boy over a t-shirt every single day, even after the brace came off. 2. Boxers - In the hospital, they started draping a "modesty cloth" over my penis so that people coming in to bring me food or clean the room didn't have to come face to face with my dick every day. For some odd reason, I kinda got used to this and put a portion of one of my disposable pads over me when I was laying around (like, 95% of the day). It also helped cover the goopy areas that were covered with bacitracin, keeping that from getting all over my blanket while sleeping. At some point, I realized that the disposable pad was trapping in tons of heat and moisture (not great when you're trying to keep that area dry) and having nothing on from the waist down all day kept me feeling infirmed. It was fine being partially nakey for several days, but at the 2-week mark I was done and the mesh underwear I had with me was too tight for daily use. The mesh underwear provided great support for daily excursions, but not for laying around. Here come boxers, with enough room for me to drape my penis down one of the legs (it kept coming out the bottom to say hi) and to prop it up while I was laying around. Since I was using less bacitracin at this point, the boxers provided nice breathable coverage for my genitals that I could cover with a blanket at night. They did get some goop/blood on them, and while most of that washes out, you may want to hold off on wearing your favorites for a while.

Multivitamins - I started off my post-op routine taking a ton of supplements that were suggested by other guys only to find that between supplements and the medication I was getting horribly painful acid reflux and indigestion that wouldn't go away. At my first post-op appointment I found out which drugs I could stop and which ones I actually needed. I cut out all supplements with the exception of the Cranberry Pills (to reduce UTI's) and I started weaning off the muscle relaxers, the anti-anxiety pills, and lowering my pain meds. Within 48 hours my symptoms were gone. At this appointment, the PA suggested I take a multivitamin and get as much protein in my diet (or with supplement powder) as I could. The multivitamin I chose is Nature's Way Alive! Adult Gummies. I take three a day and they're tasty. 

Baby wipes (Pampers Sensitive) - I could probably write a book about baby wipes a la "100 uses of duct tape," so take this as you will. First and foremost, there is no toilet paper soft enough to wipe your butt with after a vaginectomy. None. Doesn't exist. That area between the scrotum and rectum is tender and full of sutures. It wasn't actually that painful for the first few weeks with the exception of a few spots, but in general, I can't imagine trying to use toilet paper (sutures and scabs, remember). Butt wipes are great for this. Two big suggestions on this front. 1. Try to throw them out rather than flush them, especially if you're using more than one each go around. They can cause major clogs in plumbing, especially older/shoddy plumbing. And 2. go with Pampers. I found out the hard way years ago that I have a sensitivity to a preservative (methylisothiazolinone or methylchloroisothiazolinone) found in more than half of the baby wipes on the market. Pampers Sensitive are also alcohol and perfume free. The last thing you want is to find out you have skin sensitivities to these ingredients while you're recovering from surgery. In addition, I used the wipes to clean the valve on the catheter after every time I used it to drain my bladder.

Latex-Free Gloves - Again, you don't want to find out that you or your caregiver have a latex allergy at this point in the game. We've almost emptied our 100 count box now three weeks in. We put them on for dressing changes, for putting on bacitracin, for when I want to inspect things. And, we put them on then pump Purell on them before touching anything. Seriously, keeping everything as sanitized as possible is incredibly important. The opportunities for infection are endless and it's so easy to just grab gloves if you have a stack handy. I got purple nitrile exam gloves in Large. I probably could have gone with Medium, but my partner has bigger hands than I do. While the black are pretty bad ass, I thought it would be easier to see blood, etc., on the purple than on the black.

Disposable Underpads (Chux) - I use at least 2 each day and have them draped over wherever I am sitting or laying down. Not only do they keep me from touching unsanitized fabrics on chairs, couches, beds, etc., but they also keep me from leaving little spots of blood everywhere. I'm 3 weeks out and from time to time I still expel a drop or two of blood from the tip of my penis and, especially after shower and bacitracin time, I goop/bleed in tiny spots on whatever I'm sitting on. I dispose of them every day to keep things clean and was able to get a few packages of 25 online for a modest price. 

2 Graduated containers - The primary purpose of these is to be able to measure the amount of urine that comes out of your penis vs. what's left in your bladder (that you expel through your catheter) once you start urinating. The suprapubic catheter needs to stay in until you're consistently urinating 2/3rds or more of the contents of your bladder out of your phallus. How would you know unless you were measuring it? Having 2 can be helpful if you have a fistula or leak and want to measure how much is coming out of that hole(s) vs. your phallus. Additionally, I preferred putting the container on top of the toilet seat and urinating in it, instead of in the toilet, after surgery. This allowed me to have a sense of how much I was urinated vs. how much I was drinking and the color was easier to see (undiluted by toilet water) so that I could be more sensitive to how hydrated I was. I got two that were tall and triangular.

Entertainment device - There is a lot of laying around that happens for hours and hours and hours. I love to read and brought a few books with me, but it took me at least 2 weeks before I could read again. I tried earlier, but between the anesthesia and pain meds, I felt woozy and couldn't concentrate. Hence, needing some passive entertainment. We brought our smart TV device which had our movie libraries, streaming services, and rentals all at the tip of our fingers. Early on, it was more background noise since I slept a ton or just stared, and then around weeks 2 and 3, it was a much-needed form of entertainment. I made daily outings for 1-2 hours at a time, but that's it. I would have gone a bit stir crazy without it to keep my brain occupied. It also helped to have my tablet and computer to keep in touch with friends and the outside world. 

Arm covering for shower - I had to have my arm covered during my shower for the first 2.5 - 3 weeks post-op while still showering every day. While not ideal, I got the seal tight cast/bandage protector. It absolutely kept the water out and I had no fears of getting wet in the shower. The down-side is that it was so tight that it required someone else pulling it open for me to get my arm in, and the grip stymied the blood flow and made my arm ache slightly after using it. You might be able to find a better option, but in general it was a relief to have a reusable product that I could slip on/off and not worry about.