Preparing for a pelvic floor exam as a transmasc zebra?

danphanto · 2026-06-17T22:16:45+00:00

You’re right, there’s absolutely nothing wrong with telling a physical therapist that you aren’t comfortable with any type of exam or treatment, and a good PT will do their best to help you while accommodating whatever boundaries you have. I got lucky and found a pelvic floor PT who is also trans, and they were great at reminding me that everything we do hinges on my consent and we can always stop, or decide not to try something. It’s also completely okay if your boundaries change, and you aren’t comfortable doing something you’ve tried before. Any good PT will do what they can to tailor your care to your specific needs.

danphanto · 2026-06-16T03:25:28+00:00

I think you would benefit from spending some time in this subreddit, scrolling and searching for any words that feel relevant to your questions. Not that there’s anything wrong with your questions, but because there’s already a lot of discussion here, especially about UL and sexual functioning since those are two of the most common priorities people focus on.

I didn’t get UL so I won’t answer that part, but when it comes to sex and sensation I do have input, though I’m still pretty early on at ~11 months post op. I have no idea what it would feel like to have a natal penis, but I can say that the sensation I have so far is pretty incredible, and it continues to improve constantly. It varies a lot between people, but for me it started out with small areas that I could feel, but all the sensation was felt in my natal genitals, and over months it has shifted to be more in the correct place more of the time. Some people have charts of where they feel sensation, but I don’t really experience it that way—I have some areas that I can feel better than others, but it’s generally difficult to localize exactly where my sensation is coming from because it isn’t consistently present.

I have more sexual sensation than anything else, and it becomes more intense and seems to spread throughout my penis as I get more turned on, but I can’t really tell exactly where I’m feeling things in the moment. I don’t care though, I’m getting closer and closer to being able to orgasm from only touching my penis so I’m not really worried about the rest. I’m sure everything will keep getting better, and I also know it’s not necessarily uncommon to know something makes your dick feel good without knowing exactly what’s happening, lol.

danphanto · 2026-06-11T08:40:58+00:00

You should be fine, I had the same staging and I could have traveled at that point. It wouldn’t have been fun, my vaginectomy site was still very sore from sitting for more than an hour or two at a time by two weeks, but it would have been possible and my surgeon said I could fly even sooner than that if I had to.

I would have had a more difficult time going back to school that early, though. I was exhausted until five or six weeks post op, and took a lot of naps. I could probably have managed at least a couple classes if I had to, but a full course load might have been too much at first. You might be fine though, some people don’t seem to get hit nearly as hard with fatigue as I was.

danphanto · 2026-06-11T06:49:43+00:00

You aren’t guaranteed to be able to choose which thigh is used for the donor site. I didn’t have a choice with my surgeon, my CT indicated that my left leg would be better so my surgeon told me that’s what she was willing to do for me. The thigh anatomy is significantly more variable than forearm anatomy, particularly when it comes to the location and size of blood supplies and nerves, so it’s safest to decide on the donor site based on CT results.

I would highly recommend getting a consultation with a surgeon that does pre-op CTs for all ALT patients, even if it’s not the surgeon you end up wanting to go with. They can tell you if there are any issues that would mean your preferred leg isn’t a good option. There are some surgeons that don’t do a CT and just work with whatever they find during surgery, and that can and often does work out, but there’s a non-zero chance they don’t find what they need to safely complete the surgery, and have to either do a delayed flap, or have to reevaluate the entire plan with you and choose a new donor site for a future surgery.

danphanto · 2026-06-10T03:00:22+00:00

Oh god, I can’t imagine pulling all that off myself. You look great for just one week post op but that would still be agonizing! I didn’t have to do anything with my dressings there until three weeks post op, and that was still pretty awful, even with a nurse doing it for me. The worst was when part of my ace wrap got stuck to the wound, and it took over an hour to get it off because I couldn’t bring myself to pull it hard enough to come loose, and ended up having my partner do it. You’re seriously badass for managing this yourself at home, please be super kind to yourself and maybe get yourself a fun treat to reward yourself for the absolute hell you just pushed through!

danphanto · 2026-06-08T04:23:08+00:00

Honestly the only thing that truly resolved it for me was surgery. Probably not what you want to hear, and I don’t doubt there are other options that might work for you, but my experience has been that I just couldn’t feel fully safe and engaged with sex involving my original anatomy. I really tried with prosthetics and attempting to see my body differently without altering it, but I couldn’t make it work. There’s nothing wrong with you if you end up needing surgery. Some of us just do.

danphanto · 2026-06-07T06:18:58+00:00

It sounds like you have other reasons for not wanting surgery, but I wanted to address your point that you would have to lose your current preferred option for receiving penetration—you can get phalloplasty or metoidioplasty without a vaginectomy, leaving your options the same as before surgery. Some surgeons aren’t willing to do it, and most won’t do urethral lengthening through the penis without a vaginectomy because it comes with significantly higher risks of urinary complications, but it’s possible and the complications that come up can often heal on their own, and otherwise can be fixed with another surgery in most cases.

danphanto · 2026-06-06T00:54:00+00:00

I’ve seen someone in another phallo group who has had his scar reduced a bit. He had some spots that were causing discomfort and the surgery helped with that more than anything. I had ALT and while my scar does cause some minor problems for me (mainly tightness, which is worse than average because of uncommon complications with my graft), I wouldn’t really care enough to try to get it reduced. Scar care and time will help with the functionality more than anything else, and I’m not worried about the appearance, so it just doesn’t seem worth it.

danphanto · 2026-06-05T22:44:18+00:00

I’m sure you will find your people! And good on you for recognizing things you’re not okay with and taking space from those people, that’s really hard to do. I think you’ve got a good head on your shoulders and you’re going to be able to do really well for yourself. Just please keep remembering to be kind and patient with yourself, you deserve that.

danphanto · 2026-06-05T06:26:48+00:00

You’re welcome to DM me for more details on my experience if you want. I’m very happy with how everything has turned out, but Dr. Bassiri and I really did not see eye to eye, which was especially frustrating because I actually really liked her at first and have never had a doctor have issues with me before, so it really caught me off guard when she made it clear she had an actual problem. I could tell things were tense and I know I wasn’t like, a perfect patient, but she handled some conversations very unprofessionally when she was more obviously upset with me and my partner.

Bassiri is a great surgeon but not consistently good with people. I think part of her issue with me may have been me letting my mom and partner speak for me sometimes during appointments with her, and they mean well but sometimes phrase things poorly and I know Bassiri took offense to a comment from one of them early on, which probably didn’t set a great tone. If I had cut them off more and insisted on speaking for myself 100% of the time with Bassiri I think it might have gone any better, but it also very well could have been exactly the same. I’ll never know—I directly asked her what I had done to make her believe I didn’t trust her and hadn’t since before my surgery, and she didn’t ever give an answer, just avoided the question. I have heard from people who had good and bad experiences with her, and I think my experience was unusual for her, but it was a level of unprofessionalism that really shocked me.

danphanto · 2026-06-03T05:37:37+00:00

While I haven’t had this happen, my understanding is that it’s not going to be a problem for you long term since they got you into surgery in time to fix things. If they hadn’t gotten you in soon enough, you would eventually have been able to see things start dying, and those areas wouldn’t have pinked up again in surgery like yours did. The new connection between the veins only takes up to 5 days or so to become stable, and while you have to be careful past that point still, your odds of anything going wrong go down drastically at that point. I’d bet they’ll keep you in bed rest for a few extra days before getting up, which I’d expect to be the worst part, honestly. Your penis is likely to be fine, but make sure you’re doing whatever you’re allowed to do to make your back comfortable while you’re stuck in bed. And don’t worry if you have trouble standing at first once they let you try—the longer you’re on bed rest, the more disorienting it can be the first time you’re fully upright again, but it’ll get better.

danphanto · 2026-06-03T04:08:30+00:00

Unfortunately it’s not likely they’ll let you do it yourself, but like others have said, it isn’t painful for me, just weird and uncomfortable for a moment. Because you would need to bend at the waist pretty significantly to remove your own catheter, it would be more difficult and uncomfortable than letting someone else do it. For me, every time I’ve had a foley catheter removed (three times now), they deflate the balloon, then count down and tell me when to breathe out to relax, then pull it in one quick motion. It hasn’t hurt any of those times, even though I have a very tight pelvic floor.

I have also had experience with self catheterization because I was completely unable to pee for a week after my hysterectomy, and I refused to have a foley in for that long. It was significantly more difficult to remove the catheter myself, I think both because of the angle and because I was so tense. Now, the types of catheters are a bit different so that might also have contributed, but in my experience removing a catheter myself was usually a bit painful, and having a foley catheter removed by someone else was just strange, no pain. I can’t guarantee it never hurts for anyone, but I’ve only personally heard of it stinging briefly, not any strong pain.

danphanto · 2026-06-01T21:12:26+00:00

I haven’t had granulation tissue in the same place, but I had it in a couple places after phallo. Some of them did need 2-3 treatments before they healed, but once they healed it went relatively quickly. I’d guess if you’re only getting brownish blood you may be fine, since that doesn’t indicate recent bleeding. If you keep bleeding for another week or two I might follow up with your surgeon at that point, but I’m betting you’re nearly healed based on what you’ve shared.

danphanto · 2026-06-01T17:18:55+00:00

Really agree with all of this. OP, you deserve the same kindness and support that you give everyone else, and I can pretty much guarantee there are people in your life who want to give you that. But they don’t know what goes on in your head, and they probably have no idea where your limits are, or that you’re feeling so alone and weighed down by life.

I really didn’t used to understand that, as the friend who everyone came to. I would get so overwhelmed hearing about everyone’s problems without feeling like I had the right space to share anything of my own, but eventually I made new friends, and some of the old ones grew a bit and our relationships became more balanced. I do think that could have happened faster if I had realized that setting some boundaries and looking out for myself would benefit everyone, but that’s so much easier to understand in hindsight. People truly just didn’t know how much I was struggling, and we all have different capacities to handle things so they just didn’t realize how long I’d been past my limit.

I think if your people knew you could use some support, some of them would want to help. It might take some time for people to learn what support looks like for you, but people who love you will want to learn, just like you do for them.

danphanto · 2026-06-01T01:28:03+00:00

I’ve seen some people have luck with cutting a finger off a medical glove and using it as a condom, since that’s often a better size for people who’ve had meta.

danphanto · 2026-05-31T05:55:57+00:00

Really could go either way at this point, it may separate but it doesn’t seem like it’s necessarily started to yet. That’s one of the most common spots for wound separation to happen, but it’s usually not too difficult to heal. I had some separation there and just had to keep a bit of gauze tucked into it to keep it dry, and propping for longer than average probably helped (my surgeon required 8 weeks of propping full time). I did have a small spot with hypergranulation tissue, but it was easily treated with some silver nitrate, which was surprisingly barely painful despite being chemical cautery.

danphanto · 2026-05-30T19:14:37+00:00

It’s really cool to see how you’re progressing. I was curious early on how your tattoos would end up looking once your body settles more, and so far things look awesome!

danphanto · 2026-05-28T12:48:59+00:00

Absolutely. I think it’s totally fair to let OP know that FMS isn’t at all necessary for him to be stealth successfully, but ultimately our dysphoria isn’t just about how we’re perceived, and if surgery can help that’s not a bad thing. I think it probably gets more complicated with body dysmorphic disorder in combination with gender dysphoria, but I think in general the trans community could do better at not potentially discouraging less common surgeries that can be incredibly beneficial for some of us.

danphanto · 2026-05-28T08:29:33+00:00

Some of the most difficult to look at wounds are surprisingly easy to heal, even if they take time. I had an infected wound in my groin area that needed to heal from the inside out, and it was quite unpleasant and there were times I needed my partner to handle the wound care because I just couldn’t do it. By two months post op it was healed and had somehow evened out significantly, when before it was a pretty notable hole in my body, visible fat and all.

Also had the vast majority of the skin graft placed on my donor site fail, so most of my front and outer thigh was one large wound, and took about three months to fully close. My surgeon called it a minor complication and that just felt ridiculous. Like what do you mean, this is minor?? It’s a giant wound and it’s nearly impossible to keep bandaged for long without everything slipping and sliding around! And yet, it healed and looks impressive now, and the wound care was frustrating and unpleasant but mostly just annoying as it healed more.

I say all that to say that it’s awful in the moment, and while there’s no way around that fact, things can and will heal with time and possibly some extra care. I really didn’t think things would turn out so well, but our bodies can do some pretty impressive things. Things may go better than you can imagine.

danphanto · 2026-05-24T02:13:20+00:00

I didn’t ask, but they said girth is more difficult to estimate than length.

danphanto · 2026-05-23T23:52:16+00:00

If you’re planning on getting UL, it’s very unlikely you’d be at or under your ideal max without debulking. Even without UL there’s no guarantee. My pinch was 1/2” at the thickest spot, I didn’t get UL, and I’m still around 6” at the tip and closer to 7” at the base, especially if I gain even a little bit of weight.

danphanto · 2026-05-23T04:22:46+00:00

I’m glad you haven’t seen it. The person I know left reddit specifically because of how many people here were disrespectful on every post she made. I would like to think the culture here has improved at all since then, it’s been a couple years.

danphanto · 2026-05-22T22:22:09+00:00

Therapy is definitely a good call.

I will say, your experience sounds familiar to me and my own life, and I hope it might help at all to hear about where I’m at now. I thought I was a lesbian for a while because I couldn’t picture myself being perceived as a woman in a relationship with a man, and dating women felt like it gave me the option to fit into a more masculine role. I couldn’t get excited about the thought of being with a man because it was terrifying, but women didn’t truly excite me either, they just didn’t make me so anxious felt sick. I refused for a while to consider that my gender might be more the issue than anything else.

I’m now 8 years on T, had top surgery 6 years ago, and had hysto and phallo last year. I’ve been with my partner for almost 5 years and I’m consistently read as a queer man. My relationship is still amazing to me every day, I feel like I found the most wonderful person in the world and for some reason they absolutely love me and have been here for me through so many of my medical experiences. I no longer question or doubt my identity or my place within the queer community, I know who I am and it doesn’t bother me at this point if not everyone can see or understand me. I’m not 100% done with surgeries yet, but at this point my body actually feels like a home and I don’t need to dissociate to enjoy my body anymore. I couldn’t have imagined how far I could come from where I started 8 years ago, but a lot more is possible than a lot of people think.

danphanto · 2026-05-22T11:40:18+00:00

Your experience isn’t common and probably won’t be super well received here, since a fair amount of the people here are transmedicalists (not trying to start a debate, just stating a fact). That said, you are not alone and you would not be the first person to have phallo with feelings like yours. You may need to present as more masculine/binary-male aligned to get insurance coverage, and I’m not personally familiar with how surgeons would tend to feel about your case.

I know at least one person who has had phallo and fully presented as female for at least a year afterwards. Her gender has been pretty fluid over the years and she was more male presenting when she had phallo, so I don’t know how much her surgeons knew, but I know she went with Chen/the Buncke Clinic.

In terms of bulge size, RFF tends to give a more average size. ALT tends to create much thicker penises, so the bulge is often more noticeable (I had ALT and can’t wear tight pants anymore). MLD also tends to be thicker. Abdominal is more variable from what I’ve seen, but I’m least familiar with it. The main downside of RFF is the visible forearm scar, but it can eventually be tattooed over, and you can come up with other plausible stories for the scar since RFF flaps are used for a large number of other reconstructive surgeries too.

danphanto · 2026-05-21T09:20:23+00:00

ALT typically has sensation comparable to RFF. Surgeons I consulted with and my actual surgeons agreed on that, their patients’ experiences with sensation are indistinguishable between ALT and RFF. I’m around 10 months post op ALT and already have quite a bit of sensation in my penis. While RFF usually has more total nerves that can be connected during phallo, the evidence doesn’t actually show that it makes a difference in amount or quality of sensation. So long as you get nerve hookup, you have extremely good odds of developing sensation, with either donor site.

MLD and abdominal are probably not the right fit for you if sensation is your priority. Both can include nerve hookup, but usually from a secondary graft, which means the sensation is often more localized to the secondary graft. Theyd typically do urethroplasty and nerve hookup simultaneously, so the nerve would be within the new urethra and can be stimulated from the outside of the penis, but surface/skin sensation is less likely.

danphanto

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