Today’s post wouldn’t have been possible without my very special guest, Melody Maia. She’s a 48 years old transgender woman who started on HRT about 9 years ago and had sexual reassignment surgery 7 years ago.

Q1: Was there a point in time you felt the surgery just made sense? Was it pre HRT? Was it during HRT? Or was it when you started to have less functionality?

A: When I started on hormones in October 2010, I felt, at that time, I was pretty okay with what I had, but I did believe I would prefer to have a vagina. Ultimately, it would be okay if I didn’t get surgery right away. What I found after having been on HRT and started to live life as Maia full time is all of a sudden I had the urgency to get bottom surgery. To the point where I actually got a job at Disney in April of 2011 just so I could have the surgery covered. Within a month of going full time at Disney because I started part-time. So in June 2011, I had money down for my surgery in May 2012. It became like a runaway train, this is a phrase some people use to describe transitioning quickly and I was on that train.

Q2: Were there any restrictions at your place of work that you had to abide by to be granted the surgery? Was there a certain time of employment required prior to undergoing surgery?

A: I did work there for a year before I had the surgery but I was surprised with how quickly I was able to get the process started. Only a few weeks into working there I went down to their very nice health center and spoke to them about what I was dealing with. One of the first things I asked for was an advocate at the health insurance company. Without any delay, they assigned me one. This advocate helped step me through the entire process. If at any point prior to the surgery I had lost my job or quit, of course, the surgery would not have happened.

I always encourage people to get the best surgeon you can because this is something you can’t fix very easily afterward. Some of the potential problems you may run into is additional scaring and unnecessary skin grafting. Skin grafting can get really messy so you have to fully trust the doctor because you do not want to end up with more scarring than you actually need.

I asked Dr. Bowers last year – what is the number one complication you see from surgery?  She goes in and does revisions for people. She says cosmetic results are not exactly what you wanted them to be. This is why you want to start off with the best surgeon for you. If you don’t want to fix it later on.

Q3: After having the surgery done did you have any complications?

A: I did happen to have a complication. The complication was so common that it is was actually on the list of things that you can expect. 

One thing I will say is, Dr. Bowers did give me her personal cell phone number so if anything came up I would have a direct line of contact. Her office staff was also very informative. Helping answer any questions I had and giving me additional contacts which made me feel I had a great medical support system, even if I needed help in the middle of the night. These are essential things you should look for when choosing a surgeon. 

My complication involved the folded in 2 pieces of skin that make up your labia (down towards the bottom of the vaginal opening). This is actually the only place you can see any kind of stitching because the rest of the stitches are done inside. All of which are dissolvable. This is why they tell you, in the beginning, not to get them wet. All the way in the bottom of the vaginal opening my stitches started to come undone. Just a little bit. It’s very scary to see because you can see right inside there. My immediate response was to take a photo and send it to my doctor. She responded by letting me know it’s okay and I’ll just need to ensure the area stays clean. So I had to put antibacterial cream over it. 

Over time that area filled in with skin and healed perfectly. Once you’re done healing it’s pretty flawless. I  identify as a lesbian and have had sexual relations with a handful of cis-gender women, all who clearly know what a vagina looks like. They all have said if I had not told them I was transgender, then they wouldn’t of know.

Q4: What other steps did they require you to get in advance?

A:  The only reason I knew to get an insurance advocate was because of my connections with another transgender woman. We as trans women form a network where we talk to each other right, and she’d mentioned she had an advocate and recommended I asked for one as well. I didn’t even know such a thing existed. So naturally, it was the first thing I did. Note that they are not specialists in transition, let alone, in bottom surgery. I had to do a lot of educating on my behalf because of that.

One hoop they made me jump through, that really annoyed me, was the insurance company made me fly to San Francisco about 3 months prior to my surgery date. The doctors’ office fought this a lot, as the typical protocol was to be checked a few days before the surgery. But ultimately the insurance company got there way and I just reminded myself I was still saving thousands of dollars even with this additional expense.

When it comes to medical, there are two standards usually. WPATH standards and the standards of the insurance company. Essentially the insurance company made me jump through additional hoops as they lagged the WPATH standards. One of these hoops was they required I get two letters (where the WPATH only required one). They claim it’s to protect you, but really it’s to protect themselves. It was actually a big pain to have to jump through all of these hoops.

Q5: When asking for letters, were you able to utilize existing doctors/psychologists or did you have to seek out professionals?

A: I really only had one therapist at the time. I had a therapist in Orlando, who had a Ph.D. (something the insurance required one of the letters to have). Then I needed a second letter from another therapist. So naturally, I reached out to my previous therapist in Houston who I saw while living there and coming out. She said yes after a quick exchange of “hey I need a second letter,” then charged me about $200 for her time and within days I had the letter.

I then forwarded the letter to my insurance company who turns around to tells me, “We can NOT accept this letter. It has to be from a current therapist or someone in your state.” So I’m out the $200 dollars and have no additional connections in the state and my time was ticking. I had to find a way to get the second letter. Well, it just so happened that one of the local support group leaders was also a certified therapist. After hearing my struggles with the previous letter she ended up writing me that letter for free. Thank god for connections!

Q6: How long must you dilate after the surgery?

A: Different surgeons have different standards of how long and how much you dilate. Dr.  Bowers asked in the beginning (for the first month) that I dilate 3 times a day for 15 minutes. I have seen much higher numbers for other doctors. It really doesn’t hurt, but it is a little uncomfortable, and I wouldn’t say it was a joy! The required time quickly goes down to twice a day and then once a day till about a year out from surgery then it becomes once-a-week. Technically you have to do it for the rest of your life, but sexual activity that involves penetration counts. 

The technical need for dilating is that the pelvic muscles are used to being forced together and not separated (which is what happens during surgery). They have a tendency to tense up over time and need to be reminded that they should be separated. Elasticity is an issue as well. It is not there as we really do not have the same kind of folds a cis-gender woman’s body would that allows them to push out a baby.

The second thing I would say that you really have to keep on top of is masturbating, it’s something they want you to do. Once you get that chance you need to relearn how your body works because it is completely different. Both the kind of pleasure that it derives and the kind of things you have to do to get there. It feels really weird. I’m kind of convinced actually that a lot of women who say they’re not orgasmic after they have had surgery, which actually has a pretty low percentage of about 5% or less, is because they give up. I know that the first time took me a very, very long time and a completely different mindset.

Q7: How much of a change was going to the bathroom and was it weird to adjust to it?

A: I actually asked my roommate the same exact question prior to surgery and she says it’s like cutting out the middleman and that’s exactly how it is. You do have to wipe differently so you don’t give yourself a UTI. But you should also be prepared for a lot more messiness, than before. It’s not nearly as clean. The other thing is your urethra is not going to be perfectly straight causing the stream to project at a weird angle. I personally find If I lean a bit forward I avoid making a mess on my thigh area.

Q8: Is there any sort of wetness that you get? Or is lubrication always needed?

A: I don’t lubricate as well as a cis woman would, although there are cis women that have that issue as well. Whenever I dilate I do use lube. I prefer to use a water-based lube that’s sensitive but it’s important to test out what works best for you. Note that you can be allergic to certain types of lube so if something feels off consult your doctor.

Interested in seeing what content we created for her channel? Check out our discussion on being on/off hormones and not desiring the surgery here.