The day after I turned 19, I underwent gender confirmation surgery, or GCS, in Bangkok. An announcement like this is usually followed by a slew of questions, often from total strangers, including, “Do you have a vagina now? If so, does it ... you know ... work? Did it hurt?” and many others.
Actually, when people find out you’re transgender ― whether you’ve surgically transitioned or not ― the questions start almost immediately and they pretty much never stop. They’re often deeply personal questions ― ones you would never dream of asking a cisgender (non-trans) person, but because society typically treats trans bodies as public property, we don’t receive the privacy or dignity that everyone else receives.
Even if these inquiries come from a place of genuine compassion or curiosity, being trans can be an incredibly painful and traumatic experience, and when trans people are asked invasive, often quite rude questions by people who have no right to the answers, it only exacerbates that pain and trauma.
That said, I understand the curiosity that drives these questions. I really do. I understand why it can all seem a bit confusing at first. And because I believe that if there’s a silver bullet for prejudice, ignorance and hate, it’s education, I’ve decided to set the record straight, once and for all, from start to finish. No holds barred. No punches pulled. I will be completely honest about what I went through and how things changed when I came out the other side.
I’m going to do my best to answer these questions so that maybe people will stop asking them. Of course, everyone’s transition is different, and every experience of GCS is unique. Everyone has their own story. This is mine.
“If you’ve ever been through puberty or menopause, you know how awful sudden hormonal shifts can be. By the end of it all, I was physically and emotionally exhausted, and the hardest part hadn’t even begun yet.”
GCS is not something you do on a whim. In Australia, where I live, I needed to have lived full-time as my true gender and be on hormone replacement therapy or HRT, for one full year before I was even allowed to apply for surgery, and it is never legally performed on minors. After that, both a psychologist and a psychiatrist had to sign documents certifying that this procedure was not only very much desired but medically necessary for me.
I also had to choose a surgeon. After an exhaustive search, I chose Dr. Chettawut Tulayaphanich, who specialises in treating gender dysphoric patients and who came highly recommended by my endocrinologist. While there are surgeons in Australia who offer GCS, surgeons overseas, particularly in Thailand, tend to be more affordable and have more experience with the procedure.
After that, all my travel documents had to be lined up — no mean feat when you’re halfway through legally changing your name. I had to undergo a battery of physical, blood and STD tests. My results were then emailed to the clinic overseas. Around this time, I also had to stop taking my HRT until after the surgery. If you’ve ever been through puberty or menopause, you know how awful sudden hormonal shifts can be. By the end of it all, I was physically and emotionally exhausted, and the hardest part hadn’t even begun yet.
My surgery was scheduled for Friday, May 25, 2018. Between the flights, the hotel and the surgery itself, the bill came to about $20,000 AUD. I landed in Bangkok at 2:00 a.m. on the Sunday before my surgery. The following week was a barrage of more tests, consultations and preparation for what was to come. On Tuesday, I was ordered to fast until Friday.
On Wednesday, I had my big consultation with the surgeon himself. I had to take off my clothes in front of a room full of strangers (and my mother) and have the most intimate parts of my body examined, probed and photographed. Dr. Chettawut explained to me the exact process of the operation using multiple, very detailed, very realistic diagrams. You can read more about this process and see one of those diagrams here.
The most common method for creating a neo-vagina is a “penile inversion” technique where the genitals are, just as the name implies, inverted. In my case, the procedure was a little more complicated. Rather than being inverted outright, the genitals are removed and then reutilised to create different parts of the neo-vagina. The vaginal lining is made up of scrotal tissue and groin skin grafts. Because of this, unlike many other post-op trans women, my vagina can self-lubricate thanks to the preservation of certain secretory glands around the urethral and vaginal opening. Penile and prepuce skin was used to construct an anatomically accurate labia minora. The result is a vagina that looks and functions, sans periods and childbirth, more or less identically to that of a cis woman.
On the day of the operation, a car picked me up from my hotel and took me to the clinic. I surrendered my clothes and my phone and lay down on a gurney and waited to be wheeled into the operating theatre. You may not believe me, but at that moment, I wasn’t scared ― not even a little bit. Maybe I was too exhausted to be afraid. Or maybe it was because I would rather have died on that operating table than go on living in the body into which I’d been born.
At 2:58 p.m., the nurses wheeled me into the operating theatre, and the anaesthesiologist placed a breathing mask on my face. I remember making a bad joke about the taste of the gas in my mouth as the lights went dim and I drifted into unconsciousness.
When I woke up, everything was a blur. The voices I heard sounded like they were far away, and I could feel the hands of the nurses on my body as they moved me from the operating table to a gurney. I felt absolutely nothing between my legs. I couldn’t move or speak.
They wheeled me to a small room outside the operating theatre, and someone said something about checking on me later. Then I was left alone in the dark. I remember feeling thirsty, and I found myself struggling to breathe. Every breath felt too shallow, like I couldn’t get enough air into my lungs. I drifted in and out of sleep, content to simply lie still in the dark. At that point, there was no pain ― that came later.
The next day, I was moved to my own room and finally given water to drink. After that, I was gradually allowed to start eating again. Soon, the pain started. At first, it was a dull ache, but within 24 hours, it had become an unbearable agony that radiated out from the surgery site up through my entire abdomen.
I spent three or four days at the clinic before being moved back to my hotel. My daily routine consisted of taking several different kinds of painkillers and antibiotics at breakfast, lunch, dinner and bedtime, and watching a lot of Netflix to ease the boredom in between my doses. The idea was to medicate me enough so that I would be comfortable during the day and sleep through the night, but the painkillers always wore off too quickly. Each night became a gruelling marathon of agony, and I would wait, desperate for the morning ― and my next set of pills ― to arrive.
I slept in stops and starts during the day, when the pills softened my excruciating pain into a strong but bearable ache. I cried at least once a day when I was alone, sometimes from the pain, sometimes from missing my partner, who was waiting for me back home in Sydney. Often, I found myself crying for no reason at all.
Each day, I was visited by nurses from the clinic. After about a week, I was told it was time for me to start dilation. For the uninitiated, when a seven-inch hole is created in your body, your body treats it like a wound and tries to close it up. Obviously, that would defeat the purpose of GCS, so the vagina is kept open using glass cylinders called dilators. I was given five of them, numbered zero to four, all about eight inches long, ranging from one and a half centimetres to about one and a half inches in width. Thanks to the technique my surgeon used, my vagina was able to accommodate a little more than seven inches in depth. Many trans women get five inches, sometimes even less. It all comes down to the skill of the surgeon, how diligent you are about sticking to your dilation schedule, and luck.
“After about a week, I was told it was time for me to start dilation. For the uninitiated, when a seven-inch hole is created in your body, your body treats it like a wound and tries to close it up.”
The process began with the nurses performing the dilation, and after that, it would be up to me. That first time, when the gauze packing was taken out of my vagina and that first, narrow glass rod (about the width of a large pen) was placed inside me, I lay back on the bed and caught my breath as I stared at the ceiling. It hurt a little, but not as much as I’d expected.
The sensation of something being inside my new vagina was beyond description. The novelty, the strangeness of it, the sudden sense of my mind and body being in harmony with one another after so many years of dissonance ... I can only imagine it might compare to how Dorothy felt stepping into Oz and seeing her sepia world turn to colour. For the first time, I felt the reality of my new body set in, and despite everything, at that moment, I felt utterly breathless with joy.
One thing I expected after the surgery, but which nothing could have prepared me for, was the bleeding that I experienced after the gauze was removed. The amount of blood I lost over the next several months was almost unimaginable. When someone tells me I’ve never had a period and therefore I can’t possibly imagine what it must be like to be a “real” woman, I like to joke that I did have periods, I just got all of them at once. Every time I limped to the bathroom, a trail of blood followed me there and back. I changed my pads twice a day for a month, and every morning, the hotel staff would come and change my sheets which, despite the extra-absorptive pads I wore overnight, were soaked through with a massive pool of blood.
Two weeks later, a week before I was set to return home to Australia, the nurses noticed something off about how I was healing and I had to go back under the knife.
The first time I was operated on, I received general anaesthesia. This time, I was awake and the anaesthesia was local. It took three separate needles in my new vagina to administer the numbing agent, and even with it, over the next hour and a half, I felt everything, and I mean everything, as my new vagina was cut apart, rearranged and stitched back together. It was and remains the single most painful experience of my life.
By some miracle, I was still able to go home the following week. The second surgery had gone well, and I was starting to heal properly. I could now walk short distances with the aid of a walking stick but I still needed a wheelchair at the airport to make it to the plane. It took another two months before I was even close to being fully healed.
I’ve since read many accounts by other trans women about what dilation was like for them. Some of them almost never have to dilate after seven or eight months. A lot of them say the pain was negligible as they continued to dilate to keep their vagina open. I wasn’t so lucky. The best way I can describe dilating after I left Thailand is to liken it to inserting a serrated knife seven inches deep into an open wound and then holding it there for two and a half hours. Even now, four years later, I still need to dilate for one hour a day to maintain my depth and elasticity. The pain started to taper off after about three months, and I barely think about it now. It’s as much a part of my day as brushing my teeth and taking a shower. It seems strange now to think that this isn’t the body I was born into.
A lot of people have made headlines ― not just recently, but for years now ― talking about GCS and transgender people more broadly. Almost all of them have one thing in common: They’ve never actually been through it. I’d be willing to bet they’ve never even spoken to someone who has. I have been through it ― and it was harder than words could ever describe. It was terrifying. It was expensive. And it was the best thing I have ever done for myself.
I say this to all readers, but especially to any who might be thinking about undergoing GCS themselves: It doesn’t fix everything. When you’re finally healed and you go back to your day-to-day life, you’re still, at your core, the same person you were before GCS. You don’t live the rest of your life in a state of perpetual bliss. But what did change for me is that now, when I look in the mirror or when I look down at my body, I see my body, not someone else’s. When someone touches me, I don’t flinch or feel ashamed and disgusted. When I feel the right parts between my legs, most of the time I don’t feel euphoric, but I feel OK, and after a lifetime of agonising incongruity between my body and brain, just feeling OK is absolutely priceless.
So there you have it. Now, let’s quickly get a few of the other more common questions out of the way: Yes, it looks like a vagina; yes, I can have vaginal sex and orgasm; no, I can’t give birth; yes, it was absolutely, beyond a shadow of a doubt worth it.
Lastly, it’s important to note that not every trans person wants or needs to undergo GCS. Some trans people only go on HRT, and some only transition socially. Gender originates not in the body but in the brain. Studies have shown that the brains of trans people are structurally closer to those of the gender they identify with than that of the gender they were presumed to have at birth.
To say I was born with a female brain in a male body is not just an expression, it’s a material and scientific fact. Wanting to express yourself and live as your true gender is not, as Bill Maher so crassly put it, analogous to wanting to be a “pirate.”
There is no one right way to be trans, any more than there is one right way to be a cis man or woman. I needed GCS just to feel comfortable in my own body, but not everyone feels that way, and many people that do need it can’t access it.
It can cost $50,000 or more to undergo GCS in Australia, and for plenty of trans people — for whom rates of poverty and unemployment are significantly higher than the national average — even the $20,000 I paid (half of which my parents covered) is out of reach. It doesn’t mean their gender is any less valid or that they should be treated any differently.
“There is no one right way to be trans, any more than there is one right way to be a cis man or woman. I needed GCS just to feel comfortable in my own body, but not everyone feels that way, and many people that do need it can’t access it.”
I’m incredibly grateful to have been able to undergo GCS. It’s no exaggeration to say it saved my life, and the fact that it remains inaccessible to so many people who need it is heartbreaking.
Gender dysphoria can be painful, and for some of us, myself included, it’s unbearable without medical intervention. I’m also grateful to have a family that supported me both during and after the procedure. Too many trans people (some of whom I know personally) have been either shunned or abandoned outright by unsupportive families after coming out.
Everyone’s experience is different, but for me and many other people, being trans is hard, even without factoring in the stigma and hate that is still so rampant in our society. But that does not mean that trans people are broken. It doesn’t mean they’re oddities or freaks. We’re different, and different can be confusing. Different can be scary. It seems written into our DNA to be scared of what we don’t understand. But the more we know, the less confusing and scary these identities and experiences become. That’s why I wrote this. And there are resources available online, at your local bookstore and at LGBT community centres.
Ignorance isn’t a virtue. If you don’t understand something, educate yourself. Research, read, and if you know a trans person and if they’re comfortable with talking about their life, ask (politely). But be OK if they don’t want to answer your questions. Many trans people don’t, and the obligation shouldn’t be on us. We’re human beings and deserve to be treated as such. We deserve to be treated with respect and dignity, just like you.
Elizabeth Walker is a 23-year-old trans woman living in Sydney. She studies animation and works part-time as a freelance writer. She started transitioning at the age of 15 and hasn’t looked back. Her hobbies include photography, ice skating and trail hiking. She has a loving partner of four years and two fur babies that she loves with all her heart.