I now have access to the accounts of many more SRS patients, including a better view of what can go wrong, and the insight that while complication statistics for the Suporn clinic very likely is still low compared to other surgeons, it is still higher than the numbers most often cited. Reading the stories of struggling girls scares me, it affects me a lot right now.

Part of me wonders if I still should not have aimed for the nearby clinic despite waiting times, just in case revisions are easier, even if that means waiting much longer. And part of me wonders if inversion vaginoplasty might be much easier dilation-wise given fewer stitches inside.

But in the end, I do not want inversion, I need that skin to be on the outside. And I’m sure every high-quality place I’d go to would have its share of issues and difficult stories. I’m queasy but I’m proceeding with my plans.

Given that I need to outline my fears, as now informed by the unhappy accounts I saw.

For a lot of women, it seems their main issue is that dilating to depth is physically difficult, stressful, painful, and that even into their second year post-op they may still have granulation tissue or bleeding, and may need to dilate daily, having to take painkillers to do so. I say a lot, but I don’t think they are a majority, but I don’t feel confident assuming I will not be one. I have to assume that daily dilation may have to be a thing for the next years. It’s somewhat similar in scope to the issues I lived with when I needed hours for angst management, that which I transitioned away from. So this I would not want permanently.

It’s a gamble. Chances are I’ll be OK. If I am not, I’ll try to have revisions. If I fail that, I’ll have to have some revision that has the vagina healing shut, giving me a zero-depth cosmetic outcome. If so I’ll regret not having inversion surgery, but if I have inversion surgery, I will also regret not having the Thai technique. So I am gambling on a no-regret outcome as a non-guaranteed possibility. Losing depth would leave me mourning a missing vagina just as much as I miss a uterus or XX karyotype, but would still mean being less dysphoric, and would still let me have outside sex. I would be in sorrow but I could live with it. And that means there is a worst-case scenario I can accept.

Worst-case in another regard is incontinence, if there is fistula or something wrong with the urethra. I don’t want to have to live with that permanently, having to wear diapers. So I’ll have to make sure I can fix that outcome if it happens. But there at least this is something that women do experience and there are surgeons who have dealt with it. Combined with the above, I feel tentatively OK in that it will be possible to deal with somehow, though I worry that any such additional stresses will be an obstacle for me spending enough effort to succeed in my work. I so wish I was a cis woman and did not have to worry like this. Though it is exactly analogous to the uncertainties of a cis woman having a baby.

Worst-case in regards to orgasmicity and clitoral sensitivity. I don’t think I can affect this save for asking for as much tissue reuse as possible. It’s a neuroanatomical lottery. My chances are probably good. But if I end up without that sensitivity, then my sex will be much like now – something I have for the sake of closeness and touch and pain, not for the sake of orgasm. I’ll mourn what I can still feel grinding against someone (and I’m really scared of this) but I know this is something that will be equally true regardless of choice of surgeon, and that the Suporn method is the one that reuses the most of the sensitive tissue.

Worst-case in regards to pain. Some women have ongoing pain, either too much from dilation, or too much when they get aroused, or from vulvitis-like symptoms, or overall. I might run this risk too. There is a small-ish risk I will have something like chronic pain. I suppose I will take this risk and then all I can do is prepare and be ready. It too should be no different between techniques.

So not all issues have clear solutions yet, though I think all eventually can be solved. There are worst-case fallbacks I would mourn but can live with. Mostly I worry over how much time this will lose me from working. Hopefully all will go well, and I will do anything and everything to improve my chances.

I feel sick from the fear, obsessive over it, but I’ve largely done all I could. I’m second-guessing my decision to have this surgery but I think that is an emotion that was to be expected and that I can keep on observing. I remain on schedule to have it, and I think I will process these fears by seeing things through their lens for a while. I’m really scared for surgery, because of the risk of imperfect outcomes, but I still want it. I must let myself navigate and experience that fear as I prepare myself.