Pump vs. Rod – How I Decided

To Pump, Or Not To Pump?… THAT, is the question!…

I’ve been getting this question A LOT, so I just decided to type it once here and just link folk to this posting because it’s not necessarily a one sentence answer. There are quite a few factors that went into my decision making process. And understandably so!

I never thought I would get the semi rigid when I first started my personal research into this process in 2005. Yes, 2005. Actually it wasn’t until only about 4 months ago that I experienced 180° turn in terms of my implant desires. Up until then I didn’t really fully relate to or understand how anyone would think it was the ideal choice to go with the rod if they had the option of choosing the pump. Logically I understood the idea of not wanting to have to replace it every so often with future surgery, but the idea of future surgery seemed well worth it to have a “naturally” soft penis when I wasn’t having sex or aroused. However, I’ve always had a really strong desire to have two symmetrical testicles which, with the pump is not an option. I know some people have questioned whether two testicular implants as well as the pump bulb might all fit into the scrotum. It’s worth noting however, that the UK found that one of the leading causes of pump failure was the scrotum being too tight around the pump bulb – and that’s with only one testicular implant! I also was not all that satisfied with the level of fullness that my penis had when in it’s natural flaccid state which the pump would allow it to be in the vast amount of the time when I wasn’t erect. I’m a very lean guy with thin arms which equates to not much fat in my penis. After trying a fat grafting procedure in June 2016, 4 months post stage 1 and the fat being completely absorbed by my body within a month’s time, I felt like the rod was just going to meet more of my needs. I LOVED how fat/full/thick my penis was right after the fat grafting and that experience made me realize that I would be a whole lot happier with my penis if it always had that level of fullness.

The main reason I went with the rod was because I wanted to have a larger appearing package all the time, first and foremost. And not only just in terms of appearance, but what I would touch and interact with when I reached into my pants. I’ve never been a size queen, but always when imagining my body after finishing all stages of phallo, I absolutely did picture myself having at least a mildly visible bulge in my pants, and I really didn’t have that once the initial stage-one post-op swelling went down. Maybe that would have changed a bit with the introduction of testicular implants but I also wanted the shaft to not only be more visible but thicker and dense. I just all around wanted more to hang on to.

Now that I have the semi rigid rod and balls I am wildly happy with the profile of my package. No, it’s not as floppy as a flaccid penis, and that has certainly been an adjustment. But I was willing to give up a flaccid, floppy penis if it meant that I would have a larger feeling, more noticeable package. I also was not a fan of the way my flaccid penis felt when it fell down completely between my thighs and just seemed to get lost. Sometimes even when wearing thin/light shorts with the way it fell it just didn’t look like there was much of anything there, even to me, and that was a really dysphoria inducing experience. I can’t say that I’ll never get the pump or that I’ll have this specific implant forever, because I don’t think that I will. In the future I would like to have some version of the pump or, even better, an altogether better/new model that is designed specifically for the anatomy of a neo phallus. It’s just that none of the erectile options right now feel like they could completely 100% meet my needs, and for the interim I knew I needed something to hold me over till there was a more suitable option available for us – which will be who knows when.

I thought I would list out my personally experienced pros and cons to the semi rigid rod. Please keep in mind that 1.) these are my opinions – and 2.) I am still in early recovery from having this device implanted (less than 3 weeks post-op). So these pros and cons could still very well shift as swelling and pain decreases and mobility and healing progresses.

 

my PROs:

  • Fuller, more girthy penis 100% of the time to interact with
  • Much more pronounced and visible”profile”
  • Less likely to have complications, infections, and mechanical breakdown than any of the inflatable options, giving it a potentially much longer lifespan
  • Allows for two symmetrical testicular implants

my CONs:

  • At least initial (temporary) audible clicking noise and palpable clicking sensation when changing position of penis
  • At least initially not able to sleep on belly while healing
  • Potentially might be unable to comfortably lay face down on hard or firm surfaces
  • Detaching device at pubic bone connection point is a risk (i.e. sports, falling wrong, a kick in the groin etc.)
  • Never being able to experience a flaccid penile state for as long as I have the device
  • Not being able to experience the full range of the erectile process

 

So there’s clearly more cons than pros, however the numbers in one category versus the other wasn’t what allowed me to make my decision. Not to mention that 2 months into healing the scales might tip in the opposite direction with hopefully making the first 3 cons non-issues. In the end it comes down to what your priorities are. What really REALLY matters most to you when it comes to a device, to your everyday state of being, to complication rates, mobility, comfortability, self confidence, etc. When I had this discussion with Dr Chen in August during my phone consult I asked a ton of questions to find out if one device was really better or safer for the penis in the long run. His reply was that wasn’t really a factor in coming to a decision about an erectile device. He said what it’s really more about is which one you feel more excited about. And truly that’s a damn good way of looking at it. This is your dick, and this is your dick with an erection. Which one feels more exciting??? Maybe that’s a really obvious question, but it worked for me. I was more hesitant about the outcome with the inflatable cylinders than I was about a semi rigid rod.

As I said before, this decision is right for me right now, and that could absolutely change down the road. One of the best things that a close friend reminded me of years ago when I was in the midst of making big decisions (that felt permanent at the time but weren’t) was that you just have to make the best decision that feels right for you NOW. And if at some point down the road things don’t feel right, you make another decision. There’s not too much in life (or anywhere for that matter) that’s truly permanent, and thankfully an erectile device isn’t one of them.

I hope this explanation of how I made my decision was helpful to you. If you haven’t read it already and are looking for more more details about what the rod is like, please first take a look at the exhaustively long:

2 Weeks Post-Op Stage 2 (Semi-Rigid Rod & Testicular Implants)

It goes into detail about everything I ever wondered about the semi rigid and testicular implants, and more… And trust me, I wondered a lot… It felt important for me that I make that available to others… So if you have questions, please read that before asking.

Thanks!

2 Weeks Post-Op Stage 2 (Semi-Rigid Rod & Testicular Implants)

My stage 2 surgery was on October 11th, 2016 with Dr Chen at the Greenbrae Surgery Center in San Francisco. The surgery itself went fine and there were no major issues.

TESTICULAR IMPLANTS: The right side of my scrotum ended up being a tad bit smaller than my left side and so Dr Chen had to shave down silicone-carvings-1 that testicular implant so that it would fit into the sack. Had he not done this it’s likely I would have had issues with erosion if he tried to force the full-sized medium implant in. The nice thing about the Silicone Carving implants that Crane/Chen use is that they allow the surgeon to modify and shave it down to the exact size of the tissue that they are working with. That way you aren’t limited to just small, medium, or large which is the case with any of the gel or saline filled implants – rather, you can get the perfect sized ones for your body with the carvings if the space you can accommodate falls somewhere between the factory issued sm/md/lg. The other thing worth mentioning that Dr Chen noticed while placing the right implant was that the skin was fairly “thin” meaning I could be at a higher risk for erosion on this side which was a contributing factor in his decision to shave the implant down a bit to take some of the tension off the already thin skin and smaller space. I appreciate his conservative approach and efforts to not make a risky decision even though I expressed how much I really wanted the largest implants possible and to have two symmetrical testicles. These factors weighed heavily into my decision making process when choosing an erectile implant type, but I far and away prefer having slightly uneven testicles than risking erosion and ending up with only one testicle, or even none! Ultimately though, my hope is that over time the tissue will stretch with the weight of the implant, gravity,  and by manually stretching it myself. Down the road, be that many months or years from now I think it’s reasonable to assume I’d be able to fit a full-sized medium implant in the right side as a small revision add-on while I’m having an erectile implant replacement/switch.

ERECTILE DEVICE – SEMI RIGID/MALLEABLE ROD: The model of erectile device that I had placed is called the AMS Spectra, one rod, not two. Prior to1-ams-spectra_300 surgery we had discussed doubling up on the Gortex sheath that he wraps the rod in, in order to further aid in bulking up the penis. Upon getting inside though it became clear that I didn’t have enough space to accommodate a second layer of the wrapping. So my surgery was similar to the technique he has always used when placing the rod. He also told me that he was really happy with the positioning that he was able to get and the angle at which the rod was mounted.
Everyone’s pelvic bones are angled just a bit differently, so they don’t know exactly how things will end up being mounted until they get inside and look. He said that in the OR he was able to fully bring my penis straight up against my stomach and that I had a great range of motion. However, since I woke up from surgery I have not been able to bring my penis up higher than a right angle from my body. I can make it stick straight out but I can’t

dacron
Image on right is similar to the Gortex (Dacron) used to wrap the rod

can’t bring it fully up against my belly. In the O.R. there is no swelling so it could just be that all the edema is what’s preventing me from getting the same full range of motion. However, I’m also noticing a strong tugging/tension on the underside scar (from stage one) that the runs the length from tip to base on the penis. The lower portion of the scar when I try to bring my penis upwards feels like the point of tension that is making me feel like I shouldn’t raise my penis any further. It’s also worth noting that this portion of the scar is hypertrophic (thick and raised, but clear/white in color) so it’s my intuition that this scar is what’s causing the issue and that the reason he was able to bring my penis all the way up in the OR, was because my pain from over-stretching that scar didn’t stop him while I was under anesthesia. However, Dr Chen said upon physically assessing things at my post-op appointment, that he believed it was the swelling at the pubic mound where the incision to insert the prosthesis was made (photos below) that is likely causing the current lack of mobility/tension. He told me to continue to gently but firmly test my limits for how high I am able to angle it and that he thought I should see improvement as the swelling subsides. I’m trying to stay positive while also being realistic. I truly believe it’s the underside scar that’s holding it down and I’m not sure if or how this problem can ultimately be remedied if that is the case. I don’t think it’s an issue that would inhibit sex, but it could potentially limit sexual positions and definitely already does limit positioning options in my underwear since wearing it down is the only angle it is comfortable in, pointing up is not an option. Time will tell if this ends up improving or presenting as a problem that needs correcting. One option I am beginning to mull over is potentially getting Kenalog injections along the scar which might help flatten it, but I’m not sure that it would impact it’s flexibility/stretchability at all, which I believe to be the true issue. Pre-implants I had been sleeping with my penis in an upright position to stretch/flatten this scar because I had noticed that it was thicker and almost seemed to bunch a bit from wearing my penis down all day since it’s right in the underside crease. I will continue to update about this issue as I gather more information about corrective options or as things hopefully positively progress on their own!

ERECTILE IMPLANT INCISION: I’ll be curious to see how the pubic scar on my mons from erectile-implant-incisionthe erectile implant heals as it’s about 1.5 inches below the SP scar, about 1.5 inches long and located less than one inch above the connection point/scar of where my penis is attached to my mons. I’ve had quite a bit of swelling at this site over the last two weeks. If I’m up and being more mobile (ie: cooking, driving, walking) I notice that the swelling here increases. I’ve been addressing this by icing 20 min on, 20 min off and that has helped to decrease the swelling.

SUPRA PUBIC CATHETER SCAR REVISION: This was a super minor revision and unrelated to the erectile or testicular implants. At stage one in February I chose to keep my SP catheter in for an additional 2 weeks because I had a bit of a urine leak coming from my scrotum. I chose to do this to allow further healing of the UL without the added pressure of urine constantly flowing through the healing fistula every time I peed. In doing so, I added to the amount of scar tissue that builds up around the SP tube from belly to bladder, since the longer you leave an SP in, the more scar tissue that grows around it. What formed was a thick stalk of scar tissue inside my body that ended up healing with some adhesion so that the skin at the point of the external scar does not float and move normally over the structures below it – it remains stuck . I’ve tried manually breaking up this scar tissue with massage,  but the stalk of scar tissue under the skin is far too thick. So I asked Dr Chen to break the adhesion since he was going to be “in the area”. sp-scar-revisionThe first 1 or 2 days post-op I noticed that the skin was free-floating and mobile. But after a few days had passed I tried to move the skin and it had adhered to the stalk of scar tissue below it again. I had a conversation with Dr Chen prior to surgery about the SP adhesion and I asked whether or not he would be removing the “stalk” of scar tissue as well, to which he said: no, he wasn’t going to chase the stalk because that increased the risk of damaging surrounding structures, and he wanted to be as minimally invasive as possible. We discussed this re-adhesion at my post-op appointment and he was disappointed to find out it had re-adhered. He said it was good information to know though, so that if he ever did this procedure for someone in the future he would advise them to constantly be massaging the scar early on post-op to discourage any re-adhesion of the tissues. I will probably have this adhesion broken again at some point in the future but I would only do so if combining it with other procedures. Again, it’s not a big enough issue that it causes pain or distress. I would just prefer the skin float rather than stick as it does make the scar a bit more noticeable. But still, really minor issue and not something that would equate to even being a minor complication, rather just a common factor in healing from any surgery that produces a scar -adhesion is always a possibility.

PERINEAL DIVOT REVISION: My body took a long time to heal from the revision I had back in June to remove some granulation tissue that had formed at the point of vaginectomy closure at stage one. I had a fistula (not urinary related, just a hole or opening) that had a lot of difficulty healing. When I had the revision in June it opened back up and again had trouble healing. When I finally used an antiseptic powder on this site, it miraculously closed. However, it was open for so long that it did leave me with a small divot once it finally healed. This time around this area has healed well and when he did the revision there was no granulation tissue at the site which is great! I haven’t gotten too up close and personal in that area because I’m still pretty limited in how mobile/flexible I can be. Squatting is quite painful and I try no to do anything that increases pain, as those were a big part of my post-op instructions. If it hurts, STOP – or DON’T DO IT! I have used the Columbia Antiseptic Powder a few times just to make sure that area is healing over well, but I haven’t felt or noticed any issues with it. However, it does feel like there is minor tactile difference/dip between the perineal raphe and where it connects to this revised area which is about an inch from the anus. It’s subtle but it’s there. So I’m not quite sure yet if the revision actually improved the divot or not. I thought I would include a diagram of the male perineal area which labels all the different structures as a reference point. I thought folks might find comfort in knowing that many natal males have a visible raphe/ridge that runs from the underside tip of their penis to the anus. Their bodies closed this gap in utero, whereas transmen who have phallo and opt-in for a vaginectomy and achieve this closure via an incision line really aren’t all that different from the natal male anatomy in this sense.

raphe_on_male_geniitalia_with_labels
This is not a picture of my anatomy, this is an example of a natal male.

 

PEEING W/ THE ROD: Initially it was a bit harder to urinate the a couple of days following surgeryholding-a as I’m sure I had a good deal more swelling than I do now. I was also in SOOO much pain when I stood up that once I got to the bathroom I needed to sit down to relieve pain before I was able to relax enough to pee. Sitting to pee is more difficult for me and I think it’s something about the changed angle of the neourethra with the natal urethra ever since stage one that has made it a bit harder to pee in that position. I’ve noticed it takes longer to empty my bladder and my stream is weaker when my body is bent at that angle. The differences I’ve noticed with urinating since the rod has gone in is that I prefer to hold my penis differently now. I instead of holding it in the “A” position (pre-implants) I now hold it in the “B” position. The reason for this, is the rod is now filling up my penis as much as is safely possible without minimizing the needed space for the urethra to expand and fill with urine. If I hold it like photo “A” gravity is angling the rod down and adding pressure holding-bagainst the urethra where my hand wraps around the underside and creates further pressure. I can still pee that way if I really wanted to but I can feel the urethra being somewhat compressed and it’s just more comfortable to give it the full amount of space by holding the sides or top half of my penis so that the underside, where the urethra runs is unobstructed. I meant to mention this earlier, but if the last sentence didn’t explain it and you’re still wondering, the rod is placed on the topside of the urethra… This dick-handling adjustment hasn’t been all that big of a deal. Grip “B” is not quite as instinctual or natural as “A”, but it’s a small price to pay for being the proud owner of a hard dick. Also, if I really wanted, I can easily pee without holding my penis at all since the rod really keeps it at whatever angle I put it in. But it just feels more natural to hold him while I’m peeing. And since I’m not really holding him UP exactly when I’m peeing, I’m really kind of just mostly using my thumb to guide him in the direction I’m aiming, if that makes sense.

BENDING THE ROD/STIFFNESS: The rod is actually a fair amount stiffer than I had anticipated. I messed around with the model that was in the office, but I’m sure that one has seen plenty of handling and was likely much looser for that reason. I do think that even in the 2 weeks since I’ve had it, it’s already started to loosen a bit and I’m quite happy about that. There was a palpable clicking sensation when pointing my penis in different angles. I could also hear a very soft clicking noise as the “joints” flexed into different positions, and I can’t say I found that aspect all that sexy. It made me wonder what that sensation might feel for my partner when I was inside them. I’ll have to get back to you on that one as it continues to loosen up. The good news is that I’ve talked with some guys that have had the rod in for months or even years longer than me and they reported that is did indeed go away! Otherwise the rod is easily bent and positioned with one hand. I can move it up to a right angle and even a bit higher. If I am laying down and I point it to a right angle my penis will stay pretty much at whatever angle I put it in. If I am standing it will want to lower a bit, but generally will stay close to the angle that I put it in when I take my hand away.

(GIRTH) SIZE INCREASE: At this point and there is likely still a bit of swelling along the shaft but not much, but I’ve gained close to 3/4 of an inch in girth. This might not seem like a whole lot, but slight increases in girth are much more drastic than slight increases in length, in my opinion anyway. I feel much more comfortable with my girth now. Ideally I would have landed squarely on the 5 inch mark for a nice beefy thickness, but the 4.5ish range feels like a reasonable size to me as well. I can comfortably live with that and feel satisfied.

GUESSTIMATIONS ON EASE OF PENETRATION: I honestly can’t speak from experience about this for obvious reasons. Being only 2 weeks out I’m nowhere near being able to use my guy for play yet. However, I will say that going into this, I anticipated having far less rigidity than I do. Obviously I was getting an erectile implant for the purposes of topping. But a VERY close second on that list was choosing an option that enhanced my current package and really beefed things up. From obsessively reading phallo listservs over the past decade, participating in groups, and talking with numerous guys who have had different models of the rod, I’ve heard more than a couple guys say they wished their erections were firmer and heard some guys have issues with buckling, or the tip of the head drooping over the end of the rod which was possibly placed very conservatively far back behind the glans, etc. But I must say, I’m impressed. My rod goes all the way to within one cm from the tip of my penis, so I don’t anticipate any issues with the head not being firm enough and causing issues with initial penetration. There is zero droop at the tip of my penis. The rod itself bends easily, yet gentle exploration thus far seems to look like it will be plenty firm enough for sex, both vaginal and anal. Again, I’ll have to give factual, experienced-based updates on this at a later time… for the good of science of course!

SENSATION/ORGASM: This is a big one and I almost left it out. Since the rod was placed I completely lost all sensation in my penis. ALL of it. I had the most sensation at the tip which was incredibly sensitive and a few large spots around the shaft where sensation was coming in. Dr Chen assured me that it really should come back and that it’s fairly common but that it could take a few months up to a year to come back and that it’s likely that the nerves are just in shock. I’ll be totally honest and admit that I’m pretty scared. This fear provoked me into making sure I still retained the ability to orgasm even in spite of not having any shaft sensation. I’m happy to report that all is ok. Although I don’t recommend it, since you’re risking detaching the erectile device, we do what we have to do to manage and get through these really difficult surgeries where there are of course no guarantees and a level of uncertainty even though most guys will make out ok in the big picture. I personally don’t know any men that are not able to orgasm. I know guys that don’t have much or any shaft sensation but orgasm is still possible. I won’t get too much into the mechanics of all that and exactly how it’s possible, but I’ll say that the base where my penis was fixed to my pubic mound, is HIGHLY sensate and erogenous. Actually quite a bit more so now with the introduction of the testicular implants and i believe also the placement of the rod had something to do with it. I can actually “reach” (stimulate) my original smaller buried penis easier than I could pre-implants. Hopefully the nerves are just stunned though and they’ll wake up soon. I’ve spoken with some other rod-guys and they had a similar experience. So chances are everything is fine. I also noticed post fat grafting that my sensation decreased a fair amount for a while. It makes sense if you think about it because they are jamming things down into the penis where the nerves are growing for both the fat grafting and for any erectile device, rod or inflatable.

THE BATTLE OF THE BULGE!: Ok, so I’m pretty IMPRESSED! Again, there is certainly some getting used to this aspect of having a firm penis 100% of the time and never being flaccid. BUT, I must say, I really am enjoying it so far! I feel like it’s definitely had the impact on my self confidence that I had anticipated would result immediately following stage one. Had my forearm contained a more dense layer of subcutaneous fat, I think it’s likely that would have been my experience immediately following stage one. But this stage feels really fulfilling for me because it’s finally “scratched that itch” that I’ve been desperately waiting for since stage one and just never felt like I landed on. I experienced some pretty heavy depression in February after my first surgery, I believe in large part because this basic need I had just didn’t feel met. But now I really enjoy how effortlessly I fill out my underwear and I love reaching down and feeling my full package. I can’t speak from the experience of having had the pump (since I haven’t) and being able to compare this to that. But I do believe this experience is a better fit for me, at least at this point in my life given the current erectile device options that are on the market as well as current options for insanely expensive, “permanent” (lasting up to 2 yrs) fillers to add fullness and bulk to the penis. The pump is absolutely amazing in that it allows for the more natural experience of a flaccid AND and erect penis and all the stages in between of becoming erect and filling up. I do hope I get to be able to experience that some day as well. Clearly that’s the more “natural” option for many, if not most guys that are seeking an erectile device. But with my circumstances, I really do like that even though I’ve ended up with a more modest sized penis both in length and in girth, that I appear to be a show-er now, even if there’s no growing that will be happening later on, no passersby actually know that. That’s been really exciting for me – a definite confidence booster. Here are some quick photos I snapped just to show what my guy looks like in undies. The bulge is definitely MORE noticeable with just underwear – and much LESS dramatic/obvious with shorts or sweats on over the top. Also, keep in mind that I do have some swelling still going on (mostly scrotal)… Once I get back home and have more clothing options to play with I’ll probably snap some better photos in a few different kinds of underwear and types of pants, shorts, sweats etc. and model those for you.

 

SLEEPING: It’s still very EARLY DAYS and so I’m sleeping on my back to not cause any pressure on the pubic connection point. This is pretty miserable because I’m predominantly a belly sleeper, and an occasional but much less frequent side-sleeper. I’ve done a bit of side-napping using two very fluffy pillows propping my legs apart and then propping my penis up a bit so it’s not dangling at a drastic sideways angle. But I’m really paranoid that I’m going to fall asleep and then try to roll the rest of the way over onto my belly. It’s hard to know for sure yet, but I think I should be able to comfortably and safely belly sleep in another 4-6 weeks. I am doubtful that I’ll be able to do as many belly facing yoga poses as I was able to in the past though. I can indeed see this device potentially limiting me in that sense when it comes to lying on hard or even firm flat surfaces. Being a really lean guy means that I don’t have that extra belly or thigh fat to buffer the rod that’s sticking out when lying on my stomach. Hopefully I’m wrong about this though. If it ends up restricting my mobility enough it could be the deciding factor in eventually switching to an inflatable.

THE SHWING!!!: Alright, so I am noticing a bit more movement and jiggling while I walk as the days progress. I’m sure the decreased swelling and the loosening of the joints in the rod are probably equally responsible for that. Things of course don’t flop around nearly as much as they did pre-stage two, and it’s undoubtedly a big adjustment. I enjoyed my floppy dick, but not all the time, and not all that much. I didn’t like how it fell between my legs when I was sitting or driving – I felt like it got lost down there. Of course, the lack of testicles I’m sure played a large part in that too. But overall, I wasn’t all that happy with the size of my package. I had always imagined myself having a lot more going on, even though I’m really not a size queen. Anyway, things seem like they’re loosening up a bit. I notice that it is more likely to swing left to right a bit than it is to go in any other direction when I’m walking. There isn’t much downward motion/bounce since the shaft sits firmly against my scrotum and I kind of curve him around my nuts. I wouldn’t mind a bit more of a SHWING when I walk, but I may get that over time as swelling continues to go down, and the device continues to loosen up a bit with some *ahem*, “use”.

WRAP IT UP: I think that mostly covers things for now. My next post: which is already in draft, will be an explanation of Pump vs. Rod – How I Decided. I’ve been getting that question at least daily and I figured it’d be easier to have a post to direct people too with the long-winded reasons rather than typing the cliff-notes version over and over… As always, if you have any questions please feel free to ask or make requests for specific topics to be covered. I will update on all of these topics again at the 1 month mark. I can’t promise that it will be posted exactly one month post-op to the day, but I am still aiming to get all the correct content in for the listed timelines even if they are days or weeks late to go live. Thanks for reading!

Stage 2 – Surgical Prep

~((( JUST A REMINDER: While these prep instructions may reflect the instructions of other surgeons and teams, these directions are specific to patients having any form of implant surgery (erectile and/or testicular) with Dr Crane & Dr Chen. )))~

There is some body preparation needed for stage two RFF (Erectile & Testicular Implants) however it’s very different from the body prep that is needed prior to stage one. There is no need for a bowel prep this time around!!! Hooray!!! However there are two things that were not required for stage one that are required in preparation for implants.

Prophylactic Antibiotics – Two mornings before your surgery you start an antibiotic called Bactrim. It’s a twice daily 10-day course. My surgery is on the 11th, so I start the antibiotics on the 9th which allows 2 full days doses and then one pill the morning before surgery.

Hibiclens Soap or Chlorhexidine Gluconate Wipes – This is an antimicrobial soap or wet wipe that can drastically reduce your chances of acquiring a surgical infection. You’ve got a couple options depending on which you’d prefer to use. Keep reading for additional info that might help you decide between these options.

What is Chlorhexidine Gluconate? Chlorhexidine Gluconate (CHG) is an antiseptic that helps reduce bacteria that can cause infection MRSA. Sage’s 2% CHG cloths contain FDA-approved formula that stays on your skin where it’s needed most. Ordinary bottled CHG soaps require rinsing in the shower. With Sage 2% CHG Cloths, none of the bacteria-fighting ingredient goes down the drain.

Further reading comparing the two if you’re a nerd like me —>  GEEK OUT

You can find SAGE Cloth wipes HERE

The Hibiclens soap you can find at any drug store, large grocery store, or Amazon.

EXTRA SKIN PREP & CLEANSING INSTRUCTIONS FOR THE TRULY OBSESSIVE (this is a 5-day prep pre-op and was not required by my surgeon but is by some other teams and for some other procedures) I don’t know that I’d use the CHG for 5 days prior, but the instructions to use a thin layer of Mupirocin (Bactroban) just inside the nose is a really good preventative, even if only applied the night before and morning of surgery – as staph likes to live inside the nose.

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The following are other items/supplements I chose to add into my recovery regime.

Homeopathic Remedies: I used these remedies for stage one as well and figured it couldn’t hurt to add them in for stage two. The suggested dosage is 5 pellets, 3x per day for each of the remedies. NOTE: 1.) Don’t touch them with your fingers (it affects the potency) tip the bottle upside down and twist the cap… 2.) Let them dissolve under your tongue, chewing/swallowing exposes them to stomach acid which affects potency… 3.) Take them one at a time, don’t dump all 3 different remedies under your tongue at once, again this can, you guessed it, affect potency.

Arnica Montana(30c): Helps with bruising, swelling, and pain

Staphysagria(30c): Helps with the healing of surgical wounds

Graphites or Thiosinaminum(30c): Helps reduce scar tissue.

 

Ice Packs (Thera Pearl): I bought two of these rectangular ice packs in preparation for surgery because I’m anticipating lots of swelling, especially in the scrotal region. I found them on Amazon as “add-on” items. They also come in a round option as well, which I imagine would probably be great for balls!

 

Mesh Underwear: Always a good call for a few days when things might still be oozing and bloody. You can also ask the nurses in the recovery room after surgery if they’d be kind enough to send you home with a few pairs, they’ll usually oblige.

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X-Top for Men: These are incontinence sheaths designed specifically for men. You can visit their website and request a sample of each of the three absorbencies to be sent to you absolutely free! The reason I thought to get these was because post erectile implant, while you’re still healing it’s advised that you not milk and shake the penis after peeing, or at least do so with extreme caution as this aggressive movement could cause the mounting point at the pelvis to break away. I figured this might be a good option to use that would protect my clothes and absorb odor. They are pretty pricey though,  so I only got the 3 free samples. Toilet paper will do just fine after I use up these freebies.

 

Edibles (Pain Management): I’ve historically had a REALLY difficult time stomaching any type of narcotic,deb483f7-5131-4b50-a3ca-dcb33f8a702f even with the use of antiemetics. For this reason, in addition to wanting to try something more natural, and because I heard more than a few guys suggest it, I decided to try edibles. If you’re not familiar, think weed brownies. The location where I’m staying in California is about a 4-hour drive from Oregon where they have legal recreational use of cannabis. So I took a drive up there to pick some up. The hope is to be able to strictly use edible THC and CBD to manage pain post-op and completely avoid nausea.

 

COLUMBIA ANTISEPTIC POWDER: I had SUCH good luck with this miracle powder completely healing a hard to heal wound in the past. I decided to have a minor revision on my perineum again and I wanted this close by to use prophylactically. If you are combining your implants and/or erectile device with any kind of perineal revision or procedure, I really can’t recommend this powder enough. Some wound beds need moisture to heal but the perineum is different, it needs to be kept dry.

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FLEXIBLE TAPE MEASURE: Also, really unrelated to recovery, though it could be used to track swelling. I brought a tape measure to see just how much girth the gortex and erectile rod will truly end up giving me.

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Stage 2 Pre-Op w/ Dr Chen

On October 6th, I had my pre-op appointment with Dr Chen. I thought I would do a rundown on some of the questions that we discussed at my appointment. It’s been a little over two weeks since I met with him about these topics and I didn’t write down too much in the way of notes afterwards, so I’m just doing my best to recall what I can and going off of the list of questions that I had prepared before meeting with him. Here they are:

Me: “Is the semi-rigid rod MRI safe?”

Dr Chen: “Yes, it won’t cause any problems.”

Me: “Will I set off metal detectors?”

Dr Chen: “No”

Me: “Are you familiar with the “no-touch technique”?

(SIDE NOTE: If you’re curious about what this technique is you can check out this link “No-Touch Technique“, in short it’s a draping method used to prevent direct contact with skin (which harbors bacteria) thus reducing the risk of infection during implant surgery).”

Dr Chen: “Yes. What we do is similar and in some ways and actually takes more extensive steps for cleansing the body. The body is cleansed multiple times, even inside the urethra since it’s skin, the body is draped multiple times, we changes gloves and gowns at different points during the surgery. Once we make the incision and create the area for the erectile device a solution is poured into the space and allowed to sit in order to cleanse the area while we change gloves and gowns and prepare the erectile device to be inserted.

(SIDE  NOTE: I wish I had taken notes on exactly what he said in regards to this explanation because it was the most detailed explanation of anything that he’s given me to date. He literally told me step-by-step exactly what they do from the time I was put to sleep up until the last suture is placed and they are finished with surgery. It was at least a 4-minute detailed explanation and really made me feel confident that extensive efforts are taken to prevent the risk of infection – which is a much higher risk with this surgery than any of the others).”

Me: “Do you prescribe antibiotics prophylactically for implant surgeries?”

Dr Chen: “Yes, we prescribe Bactrim which is started 3 days before surgery (technically 2 days, but you take your 3rd day’s dose the morning of surgery). It’s a 10-day course taken twice daily.”

Me: “Do you have any photos or a piece of the Gortex sheath laying around in the office that you use to wrap the semi-rigid in?”

Dr Chen: “Yes, I have some in the other room, one second:”

SIDE NOTE: Unfortunately, I accidentally deleted this photo from my phone, sorry guys. So I’ll have to describe it to you. As soon as I saw this material it reminded me of a Chinese finger trap for some reason, probably because of its tubular nature with an opening at both ends. It was dry and a bit stiff. But inside the body it would be moist and more flexible. It had the texture of a thick woven mesh and was an off-white color as I remember. The semi rigid rod is placed inside the sheath then the ends of the  Gortex material are folded tightly over both ends of the rod and then sutured down securely. It’s my understanding that the sheath is what makes it possible to suture this whole device to the pubic bone, otherwise they would need to puncture the actual device and thread the metal sutures through it which I imagine would eventually cause weakness and breakdown within the device. You have to remember that these rods were designed to be inserted and encapsulated with the corporal cavernosa structures which natal penises have two of. Since neo phalluses don’t have those erectile bodies, suturing this device to the pubic bone is the current work-around for this incompatibility.”

Me: “I’ve heard many guys report that in order to reduce the risk of erosion that very conservative measures are taken, whereas the tip of the erectile device is placed about an inch back from the tip of the penis. I understand that this drastically reduces the risk of erosion but that in addition it causes the head of the penis to kind of droop over the end of the erectile device. This drooping reduces the amount of usable length for penetration (even if only by a little) as well as making it a bit more difficult during insertion since the head of the penis is so squishy. How far back will you be placing the rod?”

Dr Chen: “We should be able to get it quite close to the very tip of the phallus, usually within about 1 cm. Safety is always the top priority though. ”

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Those were the main questions that seemed relevant to share with you guys. Next post will be an update from the actual surgery itself.

Phone Consult w/ Dr Chen Q&A (Stage 2)

The following is my best recollection from my notes following my phone consultation on August 25th, 2016 with Dr Chen regarding my quickly approaching “Stage Two” Semi Rigid Erectile Rod and Testicular implant surgery on October 11th, 2016. This is by no means a word-for-word account. Rather this is the closest I can share with you of the full extent of our conversation that makes sense to present via this type of platform. This also covers some questions that I have that are unrelated to the specifics of implants but I thought some of you might still be curious about regardless.

Dr Chen is a great guy and an extremely talented and innovative surgeon. I always appreciate speaking with him because he shares information with me that I haven’t had the opportunity to hear or learn about elsewhere. I value how receptive he is to the person he’s speaking with and how willing he is to go into greater detail when he senses someone’s desire to know more than just the glossy basics. I hope you come away with that feeling as well after reading this and learn something new today.

Me: I’ve been experiencing a disturbing dripping sensation internally at the place where I imagine the vaginectomy/colpocleisis was performed. I’m worried that this is a sign that a piece of mucosa that was missed during the initial procedure and that fluid is now building up in this space.

Dr Chen: We actually hear about a lot of weird sensations being reported within the first 6-12 months in that area. And that’s because we cut a lot of nerves in order to close up that area. You’re the first person that I’ve heard describe the sensation of wetness, whereas most others are describing the sensation of tingling or discomfort off and on. If you’d like I’m happy to write an order for a CT scan to take a closer look at that area, I’m not sure if insurance would approve it, but I’m happy to write an order for one and see if they’ll approve it because I’d be curious to see what it would show. But in general, odd sensations in this area are quite common up to around the 12 month mark since the nerves are the things that take the longest to heal.

Also, there is a technique that we used to use when creating the urethra that put the patient at a higher risk for having a urethral diverticulum. We used to use this technique because it minimized how many incision lines there are in the urethra. However, it created “outpouchings” (or side pockets) where urine could collect. It also made it necessary for a camera to be used to help guide a catheter because the the tip could caught in one of the outpouchings instead of continuing along the urethra. What we found is that very rarely, urine would pool and collect in this pocket and cause an infection. If this was the case it would require surgical correction. But we’ve only had one case where surgery was needed. However, I spent a lot of time thinking about how we could do this differently but in a safe way. Beginning August 1st, I started using a new technique. Since using this new technique which no longer creates pockets along the urethra – a catheter can now be inserted no problem without a camera! I mention this because I don’t know if these more recent patients might report a different kind of internal sensation in the first 12 months with this technique since it’s still so new.

Me: This is more of an aside question but just so I’m clear, does this mean that anyone that had surgery with the Brownstein Crane team (you or Dr Crane) before August 1st, would need a camera assisted catheterization?

Dr Chen: Yes, it wouldn’t have to be myself or Dr Crane that did the catheterization, but just as long as they used a camera to avoid those little pouches and be guided into the bladder it wouldn’t be an issue.

Me: I’m guess I’m most concerned about a situation where I might have some kind of emergency need for a catheterization but not be awake to let someone know that it must be camera assisted. If someone didn’t use a camera could they potentially damage my urethra if they tried to insert the catheter?

Dr Chen: It’s possible. I’ll say though that most health care providers are very gun-shy when it comes to new things and a neo phallus is a new thing. It’s much more likely that they would probably just automatically call a urologist.

Me: The other sensation I notice sometimes too is an odd buildup of pressure along the perineum. I’ve sort of asked around and I know that there have been some other reports of wetness sensation from other guys that have had the colpocleisis type of vaginectomy which only partially removes the lower part of the canal and then fulgurates (or burns) the remaining mucosa layer that cannot be safely removed with scissors, which would increase the risk for things like bladder, ureter, urethra, or rectal injuries. But I don’t know that I’ve heard of these same odd sensations being reported by those having a full vaginectomy, which is I guess is a more typical procedure in cases of vaginal cancer where it’s much more crucial that the entire structure be removed and thus the higher risks associated with that procedure are more warranted.

Dr Chen: The way we do it now, I’m VERY confident that I get all the mucosa. I check 2 or 3 times before I close up the vaginectomy site. The one CT scan we got for someone post-op where we used this technique I think is the only CT scan we have on record, which I believe was for a differently related reason. But I looked at the vaginectomy site to see if there was anything going on one month post-op in that area and I didn’t see anything, it was completely closed, totally obliterated. But of course, that’s only a sample size of one.

Me: I guess then I will wait out the odd sensations for now and see if that improves on it’s own. So I do have a very small divet where the hole along my perineum took so long to close/heal. Ideally I would like a flat surface rather than a dip at my perineum. I’m wondering how easily this might be revised during my implant surgery?

Dr Chen: We could. The only downside with that is that it lengthens the time of the surgery and it gets into the area behind the scrotum that’s closer to the anus which could put you at higher risk of infection of some sort. I try to do avoid that area is possible when I do these implants because that’s where a lot of bacteria lay. Now I’m not going to do anything silly like have the implant exposed while I’m doing the perineal revision. I do whatever I can to minimize the risk of infection, so the risk I think, overall is low, but it’s slightly higher when we do revisions in that area.

Me: I see what you mean, so there’s a higher risk of infection with regards to the IMPLANTATION area getting infected, not the perineal area?!

Dr Chen: Yeah, exactly.

Me: Ok, I think I’ll give that some thought then and make a final decision when I come out there to see you for pre-op and you have the opportunity to take a look at that area in person. Maybe in the meantime we can still add those tentative insurance codes to the pre-authorization just in case I decide to move forward with that procedure?

Dr Chen: Yeah, sure.

Me: So in terms of implants, I know I want the largest testicular implants that you can fit. And it seemed like you thought that I could probably accommodate the largest one. In terms of the erectile device I’m probably leaning more towards semi rigid rod than the inflatable, I’m not going to have insurance past around the December mark so I’m trying to think about what is going to give me the best shot at not having complications and also having something that’s going to last for a while. I’m not quite sure when I’ll have insurance again that would cover this. Girth is really the biggest thing for me and obviously I want an erectile implant because I want to be able to have penetrative sex but girth and fullness is really a big concern for me. All the fat grafting melted away and at about 4 or 5 weeks out it was totally gone. I was well informed that there was a high likelihood of that happening, but it was something I was willing to try. So really at this point I’m just focussed on coming up with a solution for what the best option is for giving me the most all around girth and fullness. Not even being super thick, but an all around very full appearing penis and I feel like it has kind of more of a deflated look than I want and so I’m wondering is the rod the best option in terms of fullness? I know you mentioned that the rod is about 30cc in size, what would you say the pump is when it’s fully inflated?

Dr Chen: The measurements for the fully inflated pump, the circumference is slightly larger than the semi rigid. That being said, the inflatable, we can’t wrap it in a sheath all the way to the tip, whereas with the semi rigid we are. So when we add the sheath over the semi rigid, they’re about the same size in terms of girth even though on paper it’s higher for the inflatable. I think girth-wise they’re gonna be the same but it’s basically which one are you more excited about. Is it the inflatable one that’s more natural with more moving parts and a high potential for revisions and surgery sometime in the near future? Or would you want something that’s always semi hard but has a lower chance of mechanical breakdown?

Me: I am leaning MUCH more towards the malleable rod, mostly because it’d be 100% the same girth all the time and then also I would be able to have two symmetrical testicles which feels pretty important to me… Is it possible, you said you wrap it in a gortex sheath, is it possible to layer up on that, to add more Gortex to give even a fuller look?

Dr Chen: We potentially could. I haven’t done that before but, we could. I don’t know what the performance characteristics would look like because we’ve never done that. But if it’s safe to do so we can try that.

Me: The other question I had in terms of girth and being creative and trying to find a solution for that problem because I know you have to be careful about how close to the tip you get with the rod with both the pump and the malleable, but have you thought about or has anyone asked you about using some kind of permanent filler like Juvederm as an extra or addition to the IPP to kind of fill out areas that the rod or inflatable might not reach, like the head?

Dr Chen: No we haven’t tried that. I think that’s a reasonable thought. I would think though that adding any foreign body into that area would require sticking a needle to get the Juvederm there and that then introduces a passageway for bacteria to get to that area. So, I’m not super excited about that, but that’s the main reason why. That’s the only hesitation I have for that. Bacteria.

Me: Ok, well then it probably makes the most sense to do just do the rod, layer up on the Gortex sheath if it’s safe and possible to do so, get the testicular implants, heal up, and then see where that leaves me a few months down the road once any remaining edema has subsided… In terms of how the rod is mounted, a couple of questions, 1.) Will the rod change the angle/direction of the base of my shaft, kind of making the penis come out in front of my body a little bit more?

Dr Chen: It could, for some patients it does, for others it stays the same so I can’t tell you for sure but that’s definitely a possibility.

Me: I enjoy doing a lot of yoga and I’m wondering if anyone reports issues with laying on their stomach? In terms of where the rod is mounted I’m worried that I might displace the mounting point even after it’s fully healed months and months down the road, even after I’m cleared for sex. What am I looking at in terms of mobility?

Dr Chen: Yeah, it can limit how active you can be because it’s always there. Certain positions are not good for it. Belly down might not be comfortable. If it’s not comfortable you shouldn’t do it. The biggest complication we’ve had lately is the attachment rips off the pubic bone. And that’s in guys who are unlucky that get kicked in the groin or pulled to hard, something along those lines. We’ve changed our technique a little bit as we’ve seen that. We’re now using stronger metal wire as opposed to the thick silk suture which is what we used before and usually that worked just fine. But we’re starting to use metal wire now to make sure that that risk goes down.

Me: I’m planning to take a full 6-8 weeks off of work and being incredibly sedentary and immobile during that time to ensure I don’t cause any added strain on the connection points, is it true that even going for a long walk is not advised?

Dr Chen: Yes, anything that causes discomfort. If it’s uncomfortable or painful, stop.

Me: I think those are most of my questions. I did want to also ask though about my SP scar. When I touch it and try to move the skin it feels like it’s completely adhered to my bladder? Would that be correct or maybe it’s muscle?

Dr Chen: Muscle.

Me: Is that something that can be released fairly easily? I know you had mentioned that it’s wise to let the scar mature for a year but I’m trying to finish everything up in this October surgery.

Dr Chen: It’s actually really close to the incision that I make to put the implant in, so there is a good chance that it would just be gone as a part of our procedure. But if it’s too high from where I make the incision I can easily just dissect that way and break the adhesion.

Me: In terms of making sure that I get the largest testicular implants that can safely fit, is that something that needs to be ordered ahead of time? I know a decision about erectile device needs to be made a couple weeks in advance so that it can be ordered.

Dr Chen: Nope, we have all the sizes here and I’ll put the biggest and safest ones in as possible. Safety will always take precedent, though.

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Well, that was pretty much the bulk of our conversation. There were a couple other minor things that I left out and will spare you, but nothing major. I will however be in the office next week for pre-op, so if there are any lingering or unique questions that anyone has that they haven’t been able to find answers for elsewhere I’m always especially eager to toss those out.

 

7 Weeks Post-op, & Stage 2 Update

Heys folks. Not really a ton to update about this week, in terms of things looking differently, so no pictures. I do have the last remaining stitches from my glansplasty finally flaking off, which is nice. My arm pretty much looks the same as last week as do the rest of my scars. I’m still having a bit of trouble with the hole along my v-nectomy and decided to have a “local” (90 min away) specialist look at it, just to make sure there is no infection and to have someone actually following me, since I’m really not seeing anyone right now. So this afternoon I’m driving to Boston to meet with a urogynecologist… ugh… It’s for the best though. After the appointment I plan to send an email to Crane and follow up with him as well to cross check any instructions I’m giving to make sure it’s safe and he concurs. The main thing I want to confirm is that there is no infection, which it doesn’t look like there is. Last weekend I was running a fever though and feeling really ill, so, another reason to be checking in with someone about it all. The other thing I’m not sure if I should be doing is packing the hole. I know a lot of guys have been instructed to pack their wounds and Crane never told me to do that when I had my last post-op appointment with him. Since I left CA, the hole did open a bit further into an area just below, where the incision line looked weak, so I was expecting that to happen. It’s still relatively small. I don’t think I could fit the tip of my pinky in their. So hopefully after meeting with him and emailing Crane I’ll have some further direction on how to move forward. I think it’s just going to take time, as my understanding with wounds that are holes is that they need to heal/fill in from the inside.

I’m generally feeling really well! I had initially taken 3 months off work and I’m now considering going back a month early! I feel strong. To be honest I probably could have gone back at 6 weeks, it would have been tough, and I’m glad I’ve had the extra time to take it easy and continue to heal, but I just don’t know that I need an entire extra month. Depending on how today goes, I might contact my employer and let them know. The hole along the v-nectomy is sore and annoying, but it’s really not bad enough to keep me from working. My arm is still stiff and not 100% but I think working will just be further exercise and rehab for it getting back to normal faster.

Lastly, I’ve scheduled my date for stage 2!!! I currently have a date to get the inflatable pump and one testicular implant on October 11th, 2016 with Chen! At some point I’m going to have a phone “consult” with him about some remaining questions that I have surrounding the surgery as well as the best practices they use. So I won’t get into all of that right now, but I will eventually do a detailed posting with the info I find out. I’ll check in again at 8 weeks.