When Planning For Bottom Surgery, Don’t Settle
By: Riley Black
Tags: Queer, LGBTQ, Surgery, Medicine, Transgender

Photo by Arseny Togulev on Unsplash

“Do you want to get pregnant?”

For a split second, I thought about responding “Buy a girl a drink first!” I almost wish I had. Instead, assuming that the nurse meant “Do you want to preserve your gametes so that someone can have your biological child at some point?”, I said “No.” And over the few minutes of my bottom surgery consultation that followed, I’d say “No” to the same question a few more times.

I wasn’t entirely sure what to expect when I started to video call with the people who — if all went well — might be turning my current set of bits into shapes better matching my gender identity. I knew I’d be asked about therapist’s letters and laser hair removal (yow), but there isn’t exactly a guidebook for talking to a surgeon about vaginoplasty. I tried to be informed and to have some questions ready, but I was still a bundle of nerves as I ran through the initial questionnaire.

“At what age did you realize that you’re female?” came another form question. Well, hold on, I wanted to say. Do you mean ‘When did I realize I’m a woman? There’s a difference between sex and gender…’ I’m female in some ways thanks to hormone replacement therapy and its effects, but I feel like the key question here is about my gender and not my hormones or gamete size.

The same disjunct came up again moments later. “And you live with a female partner?”

“My partner is a cisgender woman, if that’s what you mean,” I replied, and I could tell that the nurse was a little flustered by my reply. I was starting to worry about exactly who would be looking after me if I went through with all this.

I continued on anyway. “What are your goals for vaginoplasty?” the nurse prompted, “To have it look good, to have penetrative intercourse, or to feel better?”

“All!” was what I thought. To my mind, all these things are connected. If I have genitals that match who I am, and I can roll around with my girlfriend like I want to, then I’ll feel better! I explained this to the nurse. But, as we went over these goals with the surgeon, he laughed and said “Well you have to pick one.”

Ok… I don’t like that.

What followed felt awfully bizarre. More discussion was spent on me saving my gametes than on how the procedure would unfold or my aftercare. The vibe was “This is your Last Chance to have babies,” and it didn’t seem to matter at all that I said I’d already had a vasectomy years before. Intentional or not, I definitely got the pervasively-Utah vibe of “You’re a woman and you should want children.”

The surgeon’s summary of what I should expect from the procedure didn’t help either. “Would you be ok with two to three inches of vaginal depth?” he asked. I had heard the average for vaginoplasty was higher, more like four to six, and so I said “I could live with that, but I would prefer more.” This was waved away. Two to three inches is what it would be.

We ended the call with next steps for me to take, namely coaxing letters of support out of therapists and getting my perineum blasted with lasers to remove whatever hair is rooted there. But the more I thought about the conversation, through the following morning, the more uneasy I felt. I had stated what I wanted, and what was important, and instead the impression I had was “This is what you’ll get and you’re just going to have to be happy with it.”

I canceled my future appointments to move forward with this surgeon. And I’m glad I did. Turns out that this particular fellow is a male fertility specialist who just happens to do bottom surgeries, not someone versed in the care and wellbeing of transgender patients. I might as well go to my local mechanic and ask them to do the operation. “Could you check my headlights, too?”