How to get bottom surgery in Boston, Massachusetts

How did we get here?

Before starting estrogen HRT in 2021, things were really tough! A generalized feeling of body-related wrongness was pretty much always available to me if I cared to feel it (I often did not care to feel it, so I mentally detached myself from my body instead). Starting HRT had physical effects, of course, but the most significant immediate change was lifting that mental fog a bit, and making it easier to avoid that detachment day-to-day.

I actually quite like being present in my body like that, it turns out! It became clear to me that certain parts of my body made that very difficult. Sex became a delicate balance: I not-totally-consciously started mapping physical sensations onto anatomy I didn't have and often felt extreme distress when that didn't work, which was… often, at least at first. Showering and using the bathroom became a little fraught. Certain kinds of clothes that I liked wearing otherwise (dresses, leggings, tighter pants…) were mentally extremely uncomfortable, and while tucking helped slightly, it was another thing I had to keep track of and worry about.

I lived with this for several years. Intellectually I knew surgery was an option, but it didn't feel quite right. I only really knew about "full-depth" bottom surgery (penile inversion/peritoneal methods specifically), in which surgeons create a vaginal canal; I had complex feelings about the recovery process and lifelong dilation required to maintain the canal. For most of this period, I also didn't consistently feel like I had a support system that could help me through recovery (more on why that's needed later!).

I eventually learned about minimal-depth options, which were immediately very appealing to me. In a minimal-depth vaginoplasty, surgeons form the external genitalia, but do not cut through the pelvic floor to create a full-depth vaginal canal. Instead, they create a canal that does not cross the pelvic floor boundary, so that the vaginal introitus still looks aesthetically correct (this is usually maybe a couple of centimeters deep, if that). This option involves significantly less pre-op hair removal (for me, none at all), a lower risk of complications, slightly faster recovery time, and no dilation requirement. The downside is, revisions to add depth after a minimal-depth procedure are very complex and riskier than just doing a full-depth procedure in the first place, as I understand things.

This overall sounded great to me, but that downside meant I had to think very seriously about what I really wanted. I knew that I was physically and mentally capable of handling pre-op hair removal and lifelong dilation if it really came down to it (I'm very stubborn!).

After what turned out to be a very agonizing year reading other folks' stories on r/transgender_surgeries (don't do this, you'll get brainworms, there's a reason I didn't link it) and soul-searching, I eventually stumbled on something quite surprising. When I thought through the physical act of dilation (or any receptive penetration with my hypothetical vaginal canal), I experienced a constellation of feelings that I can only describe as gender dysphoria. So, it wasn't that I was interested in minimal-depth for only convenience's sake; full-depth vaginoplasty might not have actually solved my problem! (This feeling persists post-op.)

So, I asked my primary care provider for a list of local surgeons who performed vaginoplasty and started working through the list.

Consultation and scheduling

The first folks I talked to were at the Beth Israel Deaconess Medical Center gender affirming surgery program, led by Dr. Marissa Kent (urology) and Dr. Ryan Cauley (plastic surgery). I was able to schedule a consult with Dr. Kent less than a month out (called in mid-August 2025 and got an appointment in mid-September).

There is not a lot of info about Dr. Kent or her work available on the public internet, but she was clearly very knowledgeable and experienced with this procedure. She anticipated nearly all of my questions before I asked them, answered everything concisely and completely, had been doing this type of work for 4 years at the time of the consult, and had performed dozens of minimal-depth procedures. She was able to show me five examples of her prior work, and I was reasonably happy with the aesthetic outcomes. She claimed a very good track record for major post-op complications. Shortly after the consult, I was able to track down a patient who had a full-depth procedure with Dr. Kent; she corroborated all of this.

At this point, I had a good deal of trust in Dr. Kent and her team, and didn't feel the need to schedule consultations at other hospitals.

Before getting a date for surgery, I had to schedule a second consultation with Dr. Cauley (late October 2025, largely pro forma, but good to get to know him). I also needed letters from my HRT prescriber and a mental health professional confirming that I was a good candidate for surgery. Fenway's Behavioral Health folks were able to help me with the latter; if your primary care physician is at Fenway, this is probably your best option; I only needed one visit to get a letter and there was little to no gatekeeping involved. But note that two letters is not always sufficient for health insurance to approve coverage for gender-affirming surgery; some plans require an additional letter from another mental health professional.

I was scheduled for surgery on April 6th, 2026 (the day after Easter, very fitting), though I didn't learn about this until late January, which gave me about two months to coordinate post-op support. (I think the program is now regularly scheduling further in advance; when I consulted they were not able to schedule more than three months ahead.)

The weeks before surgery

…were some of the most emotionally difficult of my entire life, thus far. Knowing that I should imminently be getting a life-changing medical procedure felt fantastic. But not having certainty that it would actually happen was challenging: what if one of the surgeons got sick? or if I missed some critical pre-op prep step, or caught COVID, or had some other complication just before surgery?

As it turns out, that last thing is not really an issue. Pre-op labs are standard 30 days before surgery; they'll take a blood draw and urine sample at the hospital campus. You should complete these as early as possible in case there are issues. They test to check that your blood clots as they expect (important since you'll be stationary in the hospital for a little while), whether or not you have infections based on your white blood cell count, and whether or not you have bacteria in your urinary tract (important because they're relocating that). If there are any issues, they are unlikely to be a big deal; I had a few oddities show up in labs but Dr. Kent's PA was able to get me all sorted out.

Beyond that, though, the week before surgery made me realize just how much I needed to have this done — I could tell I would break down crying if it was delayed for any reason. But at the same time, it made me worry that I wouldn't have an outcome I was happy with — I somehow ended up on r/transgender_surgeries (you may recall I told you to avoid that because it gives you brainworms) and found a Kent patient who wasn't happy with her aesthetic outcomes. I got over this quickly, but I felt very shaken by the whole thing.

I was forced to reckon with the fact that surgery is really like an on/off switch that you only get to flip once. I was fortunate enough to be able to slow-roll every other step of transition prior to this one, and test the waters to make sure I liked what I was getting into. But you don't get an "undo" button for removing a bunch of your anatomy and replacing it with a new set. I couldn't even pattern-match to the experiences of other trans women to comfort me here, because of how unique the situation was with my depth-related gender dysphoria. In the moment, it really felt like I could've done more in advance to emotionally prepare for this all, but thinking about it now, I don't know what that could've possibly been.

My support system, and the familiarity of Easter, were my saving grace. I was able to get three folks I was close with from Alabama to fly out and help me out: my partner, her other partner, and her other partner (isn't poly so cool?) showed up, took paid time off work, and helped me for about a week each. (Thanks, y'all, I really could not have done it without you.) My partner showed up a few days early to attend some Easter liturgies with me, and I kept busy with lectoring and bell-ringing (chiming at two services and one change-ringing practice at Old North). I prayed about all of this more intently and often than I had ever prayed about everything before. All of this helped more than I can express.

About a week before surgery, you'll get a phone call from pre-admission testing (or you'll have to visit in-person, in extenuating circumstances, but you'll know this in advance if that's the case). They're just checking to make sure that there isn't anything weird you'll need to get put under general anesthesia.

The 48 hours before and during surgery

…were strangely calm. The Easter liturgies really helped. I leaned into the rebirth narrative and applied it to what I was about to experience, perhaps too much. Saturday night we got "celebratory pizza" from Pino's in Cleveland Circle; it was great.

Sunday afternoon I was asked to eat only a light lunch (one slice of pizza), and Sunday evening I was asked to not eat anything at all. I did bowel prep with magnesium citrate (liquid form) to help avoid post-op constipation, and washed with hibiclens soap the night before and the morning of to help prevent bacterial infections. Ironically, I cut my finger on the hibiclens soap container twice. Go figure.

The morning of surgery, we arrived just after 6am. Check-in was straightforward and I wasn't billed for anything on the spot. I was called up at around 6:15am; my partner was called up very soon after. We gave the hospital staff her phone number; they called her with updates when surgery was finished and when I made it to an inpatient room. I'm told there was also a screen in the waiting area with folks' statuses she could look at too; she got a little index card with a patient ID number for that screen.

I met with the anesthesia team, Dr. Kent, Dr. Cauley, and a couple of other folks before getting wheeled to the OR. The pre-op nurse had me take some Tylenol and other pre-op medications; note that the Tylenol might be really chalky; I had a hard time swallowing it (you might be able to ask for applesauce or something). The anesthesia nurse placed an IV needle in my left arm nearly perfectly; I literally did not feel it go in. I still don't understand how she managed this.

My partner took my non-clothing valuables home, including my phone; this was a mistake for reasons that will soon be revealed.

I was wheeled into the OR at around 7:30am, and pretty quickly put under general anesthesia; the last thing I remember was putting on a breathing mask. Based on my clinical notes, there were no complications during the procedure, and I was under for about three hours. I didn't experience any intraoperative awareness or anything like that (this is 99.9% of cases, but I was still worried about it for some reason; the anesthesia team did a great job though).

Waking back up

At about 11:30am I woke up in the recovery room. I only know this because I happened to catch a glimpse of a clock when someone on hospital staff was messing with someone else's curtains, it was pretty hard to tell what time it was otherwise, so bring a watch or a phone with you. (At BIDMC any personal belongings you brought with you and gave to hospital staff for safekeeping will end up with you in the recovery room, but nobody told me this, and they were not in my line of sight, so I didn't know until many hours later.)

I woke up with a very thick compression dressing over the surgical site (secured with sutures), two penrose drains at the perineum to drain fluids (one on either side, also secured with sutures), a gauze dressing to absorb fluid from those drains, a catheter tube, and disposable mesh underwear covering everything. Not everything was immediately obvious; I gained awareness of these over the next several days.

While in the recovery room, I had monitoring devices attached to me that were continuously taking blood oxygen saturation, breathing rate, heart rate, and occasionally blood pressure. If anything was off a little bit, something would start softly beeping. This happened to me very frequently because I would often become aware of my breathing and then, just… forget to continue breathing. Apparently this is somewhat common and related to anesthesia.

Lots of nurses and doctors stopped by while in the recovery room, mostly just to make sure I was okay and nothing looked way off. Some plastic surgery folks stopped by a couple hours in; this was the first time I got to see what things looked like down there. There was not a lot to see other than swelling and the dressing (which I was told was normal and seemed great). Still, I started quietly crying (joyfully!) because I could feel the absence of what used to be there.

I was in the recovery room until about 6pm. This is a long time, as I understand it! I think they wanted to get me up to an inpatient floor around 3pm but weren't able to for some logistics reason.

Recovering in the hospital

…was the most mentally difficult part of all of this.

You can't enter most inpatient floors at BIDMC as a visitor after 8pm, I didn't get up to the floor until 6pm, and the hospital staff didn't do a great job of letting my partner know when I got up there, so we were both pretty worried we wouldn't get to see each other that day! I couldn't call her from the hospital room phone either, because even in the year of our Lord 2026, you can only make local calls. Great reason to not leave your cell phone behind. This eventually got sorted out and we were reunited around 7pm :)

The rest of day 0 was pretty uneventful. One of the nurses offered me some graham crackers right after I made it up; by virtue of not having eaten for 30 hours, this was the best food I have ever tasted. I was able to order some real dinner too (I was not put on a restricted diet; this is probably different for sigmoid colon vaginoplasty patients). Though the timing was a bit tight, because…

A brief aside: Food Services

At BIDMC you order food by calling "7FOOD". It's called 7 food because you can get food until 7pm. They are open from 6am to 7pm, so the timing for ordering dinner on day 0 was rough!

It took me a few calls to 7FOOD to figure out the optimal conversation flow. "Hi, this is Tris Wilson in Stoneman 545" (building/room number), waiting for them to say okay, then "can you send up [items]" seemed to work pretty well. It usually took 45 minutes to an hour to get what I ordered.

If you're like me, you sometimes beat yourself up about food waste. Not to worry, portions are pretty small. But you should still give yourself a lot of grace here (foreshadowing…).

Here is a tier list of BIDMC hospital food:

• A Tier: Most main dishes. Turkey, pasta + meatballs were great. Everything in this column on the menu they seem to make to order, and they bring it up on this heavy covered plate, so it's less likely to be cold when it arrives.
• B Tier: Most sandwich fixings. (Pro tip: You can order sandwich components without bread.)
• C Tier: Soups and oatmeal. Serviceable, but a little cold by the time they got to me, and not anywhere near as good as I make 'em at home.
• D Tier: Cheddar cheese. I don't understand what happened here.
• F Tier: Rice. I really don't understand what happened here. It was so undercooked both times I ordered it!

The rest of the day ("post-op day 0") went fine. My pain didn't get worse than mild-to-moderate and was well-controlled with acetaminophen and toradol (an NSAID, same class as ibuprofen). My partner was able to visit for an hour or two, around 7pm. The night was quite an adjustment: folks were coming in the room at all hours of the night; you will probably not get much sleep.

The next day and night (Tuesday) I was expected to stay in bed the whole time. Can't complain! I wasn't in any shape to walk. I started having some urinary tract pain related to the catheter around here too; I was prescribed phenazopyridine (pyridium) for this pretty quickly; it helped a lot.

Wednesday was when things got rough! I started having pretty bad nausea that anti-nausea meds didn't help with, which meant I wasn't eating much (and was having trouble keeping food down, when I was able to eat). This also meant I had some issues taking medications. The nurses will crush pills and/or get you some applesauce if you ask; this helped a lot.

One of the night nurses (thank you Sandy, you are so cool) figured out the nausea was likely a side effect of the narcotic pain medication I was prescribed. I'm still not sure if this was the true root cause, but we switched to another medication and I was mostly able to avoid narcotics at this point anyway, and things eventually got better.

I was also under a lot of stress that day! Urology wanted to discharge me that afternoon, and I felt a little pressure to try to make that happen. I was barely able to walk; between that and the nausea, leaving that day was just not plausible. I was a bit of an emotional mess from everything going on and had a hard time advocating for myself as a result; my partner helped immensely here.

Eventually we got to talk to a physician assistant who told us I'd be able to stay longer, given how I was doing. Apparently staying 3 nights (instead of 2) used to be pretty standard, and still is for full-depth patients, so this wasn't particularly worrying.

By Thursday early afternoon, the lack of substantive food started causing real problems; I had pretty low blood sugar and felt like garbage as a result. Apple juice pretty much fixed this for me. (I probably would've asked for some earlier, like, a whole day prior, had I realized that was available and would've helped so much.)

By Thursday evening I was doing much better, keeping food down, and was walking around the floor pretty well. I didn't have any substantial issues with pain or nausea that night, and by Friday afternoon I was out of the hospital.

At this point, I wasn't allowed to sit upright (and even if I was, it would've been very painful!). On the way out my partner asked hospital staff for a waffle cushion. This and a reclining seat helped a lot on the way home.

Recovering at home

Dr. Kent's patients are sent home with catheter/drains/dressing intact, to be removed at an office visit at 10 days post-op. The catheter here is the most annoying thing; there were a few days where I probably would've benefited from a short walk outside, but this was all but impossible. I also had to stay on pyridium and an antibiotic while the catheter was in place.

The hospital got me set up with visiting nurses before I left. They visited a couple of times per week to make sure everything was going OK with the catheter, that I didn't get any infections at the drain site, that the dressing was looking right, etc. My insurance covered 100% of the cost here, and I found it comforting to have a medical professional keeping an eye on things, so this was very positive!

We tried to get the catheter/drains/dressing out on the 16th. This mostly went without complications or pain, with one important exception: a couple of stray stitches caught one of the drains during surgery. It took a while for the PA helping me to figure this out; it ended up dragging out what would've usually been a 30-minute office visit to 3 hours. Them trying to remove that drain caused me the worst pain I've ever felt in my life (way worse than anything during my hospital stay), too, so uh, be prepared for that, I guess.

I was able to walk around outside a little bit (about a mile, though this was really pushing it) a couple days after.

Until about 2.5 weeks after surgery, I was pretty much not capable of taking care of myself at home (didn't have energy to cook, couldn't consistently walk or take transit to get groceries, etc). The 3rd week was rough, but I was starting to get some of this ability back. If I didn't have folks staying with me this whole time, this would've been pretty much unworkable, I suspect.

During this time, I spent a lot of time laying down in bed or on a couch. Walking to anywhere interesting was still pretty difficult, sitting upright was still very rough, and standing for long periods of time was pretty hard, which is why taking transit was out of the question. I'm usually very active, and get most of my socialization needs met outside my apartment, so this was hard for me! It really helped that the folks taking care of me were folks I was very comfortable just hanging out with too — but in any case, having some books to read, TV shows to catch up on, etc, is a great idea.

I didn't return to work until about 4 weeks post-op, at which point I was pretty much back to normal, except for still needing a cushion to sit sometimes. (The waffle cushion provided by the hospital was OK for this, but at a nurse's recommendation, I eventually switched to this gel cushion which provided a little more support, but was a lot harder to carry around.)

At ~5 weeks post-op I consistently didn't need a cushion to sit anymore, and the stitches holding the remaining drain dissolved enough that it fell out without any trouble.

At ~6 weeks post-op I was able to get back into bellringing. I was a little winded after raising a fairly light bell, but I think this is just because I hadn't done anything strenuous at all for 6 weeks. After this point things felt like they were basically completely back to normal, and we discontinued nurse visits. (Normally we would've done that a few weeks earlier, but because a drain site is a likely place for infection to occur, and I still had a drain in me the week prior, we couldn't.)

At ~7 weeks post-op I was able to ride a bicycle without discomfort. I'm told this is not really normal; 12 weeks post-op is more typical and what is recommended.

At 8 weeks post-op I was cleared to go swimming! I wasn't able to take the opportunity until a couple weeks later, but this was such a great joy.

Closing thoughts

Writing this 3.5 months after surgery — I'm very happy with how things are healing so far, and my bottom dysphoria is pretty much fixed. I have quite a bit of feeling back so far, and I can notice things improving on that front week-to-week still, which is about as expected. I am very certain I made the right call on minimal vs. full depth — recovery was already very difficult and exhausting for me; having to dilate on top of all of that, and pushing back some of these milestones, would've made things nearly unworkable with the way my brain works, I think.

Despite all of the mental turmoil and physical pain here, and having to basically pause my whole life for 6 weeks, bottom surgery was well worth it!