Wandering Implant and A Lop-sided Scrotum

Below is my response to that which someone wrote in one of the FTM support groups about one side if his scrotum:
“When I massage the thing, it feels more fibrous than fluid-filled. I can see no signs of this thing deflating any time soon.”

The left side of my scrotum still feels this way (on the 27th I’ll be 3 months post-op). It is not painful or sensitive and the implant seems to be in a good place. It does not cause any issues with my penis. If anything, the “swelling” makes the scrotum look more natural. It hasn’t really changed much in a number of weeks now.

The right side, on the other hand, is “deflated” much of the time. The right implant is much deeper than the left. Sometimes the implant is where it belongs (lower) and the scrotum looks more full but not as full as the left side. Other times the right implant is high (up beside my penis) and the right scrotum looks deflated or shriveled. This can also cause discomfort, especially when my legs are closer together such as lying down or in certain seated positions, due to the implant pressing against the side of my penis.

I plan to have a mons resection this year and hope this “wandering implant” situation can be resolved at the same time.

2 Months Post-op (Detailed Summary)

My progress at 2
months:

General Healing
In general I am pretty comfortable most of the time. I am, however, aware of occasional discomfort. I don’t know if this is from the tissue around my penis pressing on it, or from swelling issues I’ve had with my scrotum. I have been working on losing some weight (a few pounds already) and will get back in
the gym next week. I hope that (a) weight loss will help; and (b) there won’t be any more infection issues in my scrotum.

  • The swelling in the left side of my scrotum is either gone or very little. The left side still feels as if there is scar tissue or something semi-solid in there (I can feel the implant as well as other matter). That side is still larger than the right but it is not painful to touch. I can’t tell whether the left side is swollen or just larger because the implant is closer to the surface of the skin (which it is – the right implant is certainly deeper).
  • Over the last week or so I have had no more discharge (neither pus nor blood) from the hole left from the vaginal closure (see posts here and here
    for more about past discharge issues).
  • I finished the antibiotics three days ago. I hope I will not have a
    recurrence of the infections I’ve had in my scrotum.
  • The midline of my scrotum appears to be healing nicely. There haven’t been visible stitches along the midline since my primary care physician removed some stragglers 19 days ago.
  • I can no longer see stitches where the
    testicular implants were inserted though the suture lines are still a little lumpy. These lines are also slightly tender when pressed firmly.
  • The spot where the suprapubic
    catheter was inserted continues to heal well. I have a slight depression at the site which is purple
    in color and about .25 inches across. It is not sensitive.
  • The inside of my
    cheek feels pretty normal and I don’t even think about that donor site unless I touch it with my
    tongue.

Positioning and Movement

  • At this point I’m more comfortable if I walk normally (when my scrotum is swollen, however, all bets are off). I am still careful while sitting or
    driving but that’s mostly about the crotch of my pants. When they pull tight I am uncomfortable. Long hours sitting (while driving in particular) can be uncomfortable so I wear jeans which are as loose-fitting as possible.

  • I’m able to sleep on my side with little trouble. I place pillow(s) beside me so I can place one knee/leg on them but I did this even before surgery. Now it’s as much about
    comfort in my back as keeping pressure off my genitals. In some
    positions I do feel slight pressure but it is no longer really uncomfortable and I’m able to fall asleep – I just have to take care not to “pinch” my penis between my legs.

Pain

  • I started back to work on the 18th (9 days ago) and I drive a truck for a living. Most days, near the end of a long day driving, I have taken a couple of RRET Tylenol. I don’t have pain, really, just quite a bit of discomfort. The discomfort is due to my jeans and underwear rubbing my crotch but I haven’t decided whether my scrotum or my penis is what’s really bugging me. Regardless, by the end of the day I’m ready to get my pants off!

Voiding

  • I still sit to pee. I have too much extra flesh around my penis (fat mons)
    to allow me to grip it to urinate. Also, the urine sometimes comes out in a fan or some other weird formation. Maybe in time I’ll be able to drop trou and urinate standing. Urinating through my fly won’t happen before the mons resection.

8 Weeks Post-Op

Today marks eight weeks since I had the metoidioplasty, scrotoplasty with implants, vaginal closure, and urethral lengthening. All things considered, I think I’m healing very well. I’ve been back at work 5 days now and I’m doing alright with occasional mild discomfort (I drive a truck about ten hours a day so the discomfort isn’t exactly surprising).

I will continue to give updates here if something changes but for summarized reports I’ll be transitioning to monthly reports rather than weekly reports. I’ll be making a two month report in a few days and I’ll get all the details down with that post.

Until then I hope you all are enjoying the holidays and I wish you well.

Third Day Back at Work

My job is driving a truck. For once I sort of wish I worked behind a desk. At least for the next few weeks anyway, haha. Well, maybe not. I’ve been there and I don’t care for it. I’d much rather be alone in a truck.

Work:
Three quarters of the day isn’t bad. No pain just a little odd now and then. The last few hours become more and more uncomfortable. The difficult part is that I can’t stay in a comfortable position. If I’m driving longer distances on the highway it’s easier but shorter distances with a lot of turning and stopping wear me down because my jeans keep riding up.

Even then, I don’t end up in pain. Just really uncomfortable by the end of the day. I’m a little uncomfortable starting out this morning which is unusual. I hope it’s a fluke. Otherwise my discomfort might grow as the work days accumulate and that would suck, lol. I’d hate to spend my three days off in bed recovering from six days at work.

I’m still taking antibiotics and should finish Thursday or Friday. I haven’t seen any discharge for a few days but the left side of my scrotum is still larger than the right. A lot larger (and the right side is deflated with the implant very deep). The left isn’t sensitive, really, but it feels like there’s either scar tissue or caked up gunk in there. After the infections I’ve had I really don’t know which is the case. Naturally I hope it’s scar tissue from where Miro took tissue for the urethra.

7 Weeks, 3 Days: Back At Work

First: Last night I woke (twice) to find myself on my side in a loose fetal position, legs together, without discomfort. I moved into a different position anyway only because it seemed strange.

Now: I started back to work today and I spent hours sitting behind the wheel (driving) so my scrotum is a bit offended. Operating a clutch wasn’t a problem at all since I have only a small amount of swelling (left side). But the hours of sitting in a very upright position made me a little tender – not painful, just a little uncomfortable. Nothing bad or worrisome, and so far not long-lasting. I’m lying in bed now and have no pain and only very, very mild discomfort.

If I had been able to wear track pants or sweat pants it would have been better for me. Sitting upright caused my pants to pull up fairly snug in the crotch. I wore blue jeans but stuck with my baggy carpenter’s style jeans (I don’t usually wear them at work). Mid-way through the day I began to unbutton and unzipped them while driving. This enabled me to pull them a little further away from my crotch and it helped a lot.

All in all it wasn’t a bad day. I was a bit uncomfortable at times but never had any real pain. Now we’ll see how it goes over the next couple of days and whether the discomfort is cumulative. I sure hope not.

Oh, I haven’t picked up any discharge today from the little hole left at the vaginal closure. Hopefully I’ve seen the end of that but I’m continuing the antibiotics until they’re gone.

7 Weeks Post-op (Detailed Summary)

My progress at 7 weeks:

 

General Healing

  • The swelling in the left side of my scrotum continued for several days. The tissue felt as if there were scar tissue or something semi-solid in there (I could feel the implant as well as other semi-solid matter). Three days ago the swelling decreased and I had more yellow-colored discharge coming from the hole at the vaginal closure. This morning, after my shower, I took photos of the area around the hole to get a better look and found that there were very small “chunks” or flecks of yellow stuff – as if the pus had partially solidified before it came out. (I contacted my doctor a few days ago when I found the new discharge and am staying on antibiotics an additional week. The last time I had this pus issue the discharge stopped after about 5 days. However, the last time I didn’t have semi-solid fluid so I have also emailed Miro. I am concerned by the thought that infection is sitting in my scrotum long enough for the pus to become semi-solid).
  • No itch attacks this week.
  • I no longer use a strip of gauze around my penis to protect that sensitive flesh. The flesh of my penis is still slightly sensitive but no more than it should be.
  • There are still visible stitches where the testicular implants were inserted though there are only a few. Occasionally I will notice a long end of a suture and I will cut it off.
  • The inside of my cheek feels pretty normal and I don’t even think about that donor site unless I’m brushing my teeth. It is still slightly sensitive (but not painful) to being brushed or bumped. It is less sensitive than it was last week, almost not sensitive at all, and only feels slightly uneven when I touch it with my tongue.

 

Positioning and Movement

  • I am still being careful while walking, sitting, and driving but I’m getting closer to normal movement. When my scrotum is swollen, however, all bets are off.
       

    • I am able to sit upright, especially on firm chairs, as long as I am careful. I am more comfortable than last week as long as I have no swelling.
    • I still walk with my legs apart slightly though I am able to walk with them together. If I have swelling in my scrotum I feel pressure and even discomfort when I walk normally. When I have no swelling I can walk normally with only a feeling of a bit of pressure.
    • When I need to do so I drive my personal vehicle without thinking about it. In a couple of days I’ll try driving at work (a truck with a clutch).
  • I’m still able to sleep on my side part of the night. I stack pillows beside me so I can place one knee/leg on them and keep pressure off my genitals. In some positions I do feel slight pressure but it is no longer uncomfortable and I’m able to fall asleep. (I still wake to move into and out of this position but there is much less discomfort than a week ago).
  • Again, I am able to do more and for longer than I could a week ago.

 

Pain

  • I had to take Norco a couple of times several days ago. I had swelling in my scrotum and that is painful if I do anything but stay on the sofa.

 

Voiding

  • I still get a little bit of burning at the tip of my penis when I urinate but it’s very, very little.
  • I still sit to pee. I have too much extra flesh around my penis and the urine sometimes comes out in a fan for a moment. Maybe in time I’ll be able to drop trou and urinate standing. Urinating through my fly won’t happen before the mons resection.

Doctors, Infections, and Stitches

If you’ve been following my recovery you know that I have had some yellow-colored discharge from the hole left at the end of the vaginal closure. I also had some stitches along that line which were relatively loose and knotted. I suspect those knots were causing some irritation and even a very tiny amount of bleeding.

E-mail exchange with Miro
I emailed Miro, my surgeon, and specifically mentioned the stitches and some swelling and discomfort I had a couple of days ago. I asked if it would be alright have the visible portion of the stitches along the closure cut away. He said that was fine. He also mentioned that while six weeks is enough time for capsules to form around the testicular implants, it is not enough time for complete healing of the scrotum. He thought the new swelling was caused by my activities a few days ago and wants me to continue to be careful while sitting, walking, and driving. I assured him I am doing so.

My Local Doctor
Yesterday I saw my general doctor about the stitches and the yellow-colored discharge. He cut away those loose stitches and the tugging made me pretty sore. He also took a close look at everything else and was happy with my healing progress (he last saw me 9 days previously). He told me that I needed to do a better job of cleaning the folds on and around my penis and to take care to keep them dry. I thought I’d been keeping everything clean but apparently not clean enough. And, frankly, there are folds and crevices I didn’t know about (I’m not a contortionist and it’s difficult to find and see everything while holding a mirror with one hand. I have, however, worked it out – I think – and am keeping things more clean and dry).

NOTE: There are a lot of details about post-op care that are left out by the surgical team. Typically we are very well-informed about the surgical procedures and risks – and I think they expect us to be just as well-informed about aftercare. The team also seems to have a general outlook of, “Don’t worry, it’ll be alright…” and they don’t worry about crossing a bridge until they actually get to a bridge. Sometimes getting information, especially speculative information, is challenging.

My doctor did not see any discharge until he dabbed a bit of gauze at the small hole at the end of the stitch line. It came away with a tiny amount of yellow fluid. While I was in the doctor’s office they also checked my urine for signs of infection (which has been a concern since the catheter came out). The urine test showed that I have a slight infection. Considering that and the yellow discharge from the vaginal closure my doctor prescribed more antibiotics (generic for Augmentin to take twice per day for seven days. I have been taking only one per day for the last several weeks). He also gave me a prescription to help avoid yeast infection (Diflucan). He asked if I liked yogurt and I told him I’ve been taking a probiotic on a daily basis. He was glad to hear it and recommended I continue (oh, and I bought more yogurt).

Soreness and Discomfort
Before my appointment with the doctor yesterday, which was at 1310, I stopped at the bank and a couple of stores. After the appointment I stopped for lunch and at a couple of other stores. All of the stops were relatively brief and didn’t really involve a lot of walking. But by the time I got to the last store it was about 1600 and I decided to skip it and go home. I’d become fairly uncomfortable by then and there wasn’t anything on my grocery list that couldn’t wait a couple of days. So I went home and about a half hour after I got there I took a Norco. I guess between the walking and driving, as well as the doctor pushing skin and tugging stitches, my scrotum was just over it. My pain level was at a 4, pushing a 5.

This morning I was alright and my discomfort was closer to a 1 on the scale. Naturally, I had high hopes of a good day and taking it easy. I left home about 1100 to drive 40 minutes to my grandmother’s house (she has an early appointment tomorrow and I’m driving her). I stopped on the way and picked up a couple of grocery items for her as well as my antibiotic prescriptions. By the time I got to her house I was becoming sore again. My mom joined us shortly after my arrival and we all had lunch and played dominoes. We were probably an hour into the game, about 1400, when I gave up and took a Norco. The pain had crept back up to what it was yesterday evening and I decided against ignoring it.

By the way, sitting at the dining room table wasn’t the problem. I was no more comfortable sitting in the recliner than on the dining room chair. It’s just the same old story of paying the price for activity the day after I’ve been moving around.

That’s it for the last couple of days. I’ll be out and about tomorrow until early afternoon. I have a feeling I’ll spend the remainder of tomorrow and all of Saturday on the couch. We’ll see.

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