---
type: post
title: Notes from Surgery Consult with Dr. Dugi
slug: notes-from-dugi
date: 2016-12-20
---

*This is mostly a scratchpad of notes right now; I will likely clean it up when I have more spoons, but getting my raw notes out felt like a good idea.*

Schedule
:  

    Next fall, probably september or october

    big effort to emphasize hair removal, usually the blocker

Staying in the area
:   plan on staying nearby for about a month

Surgery timeline
:  

    learn dilation during first visit (3xday 30min each) - pelvic floor pt for dilation within week before surgery

    Surgery 7-8hrs

    5-6 days inpatient after surgery, total bedrest

    2wk, 4wk, 3mo visits

    visit a 3-4 days before

Healing
:  

    wound healing shows up ~ten days

    two layers of dressing after surgery: a pack, catheter, drain, plus sew outer labia together, plus dressing on top of that (off day two)

    no wound infection with any grs patients (really rare with surgeries in the area due to good blood flow)

    shower twice a day, rinse, press dry, pads

    uti risk: higher after, because distance between bladder and world is shorter, less protective layers, etc. Always urinate after dilating/intercourse

History
:  

    Started six months ago, booked out a year

    normally booked out of state through kaiser, weird for me to not be kaiser

    Begin of practice started in 2011, opened for surgery in 2016

    About thirty surgeries to date, waiting list 10-11mo.

After
:  

    most common revision: remove extra labial skin (added to give room for swelling during post op)

    some choice on how much of the clitoris is hooded

    also inner labia some choice on how big

### Questions from the form:

How many patients end up regretting their GRS? Are there concerns about post-surgery depression?
:   Might experience a letdown in terms of "what do I do now?" Day after Christmas sort of feeling. No reported regrets for Dugi, less than 4% instance of regret in general. Greater incidence of regret when the results are unsatisfactory

I'm uncircumcised and have fairly severe phimosis, leading to a very sensitive glans. Can I expect it to remain too-sensitive after, or will it calm down over time?
:   Some people have hypersensitivity. Using more tissue for clitoral hood so shouldn't be a problem

How much does insurance usually cover?
:   Ask surgery schedulers

How much out of pocket medical costs should I expect related to my stay in Portland?
:   pads, surgilube, roll gauze

How does neovaginal wetness work? My understanding is it basically doesn't, so you still need lube
:   Moist but not enough for sexual intercourse, but some were wearing pads to deal with excess moisture. Definitely need lube for penetration to prevent pulling on grafts

On average, how long after surgery do your patients return to (physically light) work?
:   Definitely limit walking, no real lifting requirements, 1k steps per day within house for four weeks as a guideline. 6 wks back to work/light exercise, but let your body be your guide

How hard is it for nonbinary, dmab, prefer to stay primarily testosterone-based people to get this surgery?
:   Dugi would be very open to nonbinary folks, but a lot of that's on WPATH (which suggests a year of hrt) and insurance (both patient's and the practice's). Two letters for all genital surgery

How much say does the patient have in the appearance of the neovagina?
:   A little bit:
    hood of clitoris depending on skin behind glans - more or less hidden clitoris

    how much skin used for inner labia using similar skin

    Depth: depends what your body will allow through peritoneal reflection 4.5-6.75" (any more is unsafe), then lined with skin (two factors)

    mostly dependent on individual anatomy, and different folks will look different.
