How I Decided to Have Sex Reassignment Surgery—and What It Was Like

Gender-identity issues are quickly gaining some much-needed visibility. On April 24, Bruce Jenner revealed he’s a transgender woman in a groundbreaking interview with Diane Sawyer (according to GLAAD’s guidelines, we’ll refer to Jenner with male pronouns until he requests otherwise). He and his famous family are exploring his transition in a two-part special on E!, part of which aired last night. The other goes live tonight at 9 p.m. ET (the first installment is on again at 8 p.m. if you missed it). And on May 2, the all-women’s school Smith College announced it will admit transgender women in a landmark decision that further spreads the news that transgender women are just that: women.

When people decide to transition, they may have sex reassignment surgery for various reasons. It’s not an easy process, but the payoff can be worth it. Here, Rebecca Kling, a 30-year-old transgender artist and educator, opens up about life pre-gender assignment surgery, undergoing the process, and how things have changed since then.

I always knew being a boy was wrong for me, even though it took me a while to figure out what was right. The analogy I use, even though it’s imperfect, is that we’ve all had that experience of tossing and turning, trying to get to sleep. We know we’re uncomfortable, but we’re not sure how to get comfortable and get to bed. For me, this body and these social expectations were uncomfortable in a way that was a hard to put my finger on and vocalize, but nevertheless felt wrong on some deeply understood level.

One of the things that is pretty universally difficult about being trans is that it’s an experience that isn’t shared by family. You’re thinking, ‘How do I figure out who I am when the people in my life aren’t like me?’ I, like every trans person I know of my generation, found a lot on the Internet. The narratives that were online 15 or 20 years ago generally came from older trans people who very often talked about how miserable being trans was. To be very clear, being trans is not easy. However, a lot of the people who were talking online had had such universal rejection that they couldn’t picture a world where friends and family could be supportive. Fortunately, that didn’t match my own experience in many ways.
 

The idea of transitioning used to be everything all at once: You got hormones, surgery, and changed your name and presentation. Everything about you had to change, but that’s not how we make life decisions! In my twenties, I found a therapist who talked about the difference between the all-or-nothing model and the à la carte model. She’d say, “Okay, let’s talk about changing your name or having surgery or taking hormones. What feels good about it? What feels bad about it?” There’s a little bit of irony in that, ultimately, I did the all-or-nothing thing. I had surgery, went on hormones, changed my name, and changed my presentation.

I didn’t decide on it all at once, though—I chose to complete each step for reasons that felt right in that moment. For example, when I decided to have hair removal, I knew I didn’t like being hairy. I wasn’t yet sure if I’d want to go on hormones, or legally change my name, or have surgery. All I knew was that that specific step felt right. As it turns out, for me, so did all the other steps I ultimately considered. There are trans people out there who had a much better sense of what they wanted earlier and knew from day one that they absolutely didn’t want surgery. There’s no right or wrong.
 

Something that sucks about being trans is there is shit-all data on the best way to transition, both medically and mentally. The World Professional Association for Transgender Health has guidelines on how to treat trans people, like that if patients are of childbearing age, mental health professionals should be sure to discuss reproductive options with them before any genital surgery takes place. Most reputable doctors will follow those, but they’re in large part based on what’s thought to be best, not peer-reviewed science.

Generally, you receive hormones before surgery, but surgery can mean a lot of things. We usually talk about gender reassignment, but there can be a tracheal shave (shaving down the Adam’s Apple), facial feminization (surgically shaping the forehead, jaw, and width of cheeks), and breast augmentation. For transgender men, there can be mastectomies and hysterectomies. When I was starting this process, before I decided to go on hormones, I talked with my doctor and said I wanted laser hair removal first, which I started at 18 and continued for a number of years. I am an Eastern European Jew. We are a hairy people!
 

I ultimately did decide to go on hormones and started when I was 22. I was on estrogen, progesterone, and testosterone blockers. One of those tricky things is that a big part of how trans people figure out what dose works is by talking to other trans people. There’s not a medically backed, peer-reviewed “best” trans hormone policy. They can come in shots, pills, and patches. It’s likely that one of those is better than the others, but we don’t know.

I took pills. Because I was starting hormones at the tail end of puberty, there were a lot of things they couldn’t undo. I’m always going to be 5’10” and have the bone structure I have. As a performer, I have a vocal range I’m comfortable with, but my natural vocal range is a little lower than I’d like. My hands are a little bigger than I’d like. But what the hormones did, first and foremost, is make me feel better. Emotionally, I quickly felt like there was something shifting in me. Physically, I certainly liked growing boobs!

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After that, I checked in every so often with my therapist about surgery. It wasn’t my priority. One of the reasons for that—which, again, is different for different trans people—is that I never loved what was between my legs, but I was used to it. I understood how it worked and what felt good and what didn’t feel good. The idea of spending a ton of money to change it into something unknown was really scary. Then, as other things were feeling more comfortable, like the hormones and my presentation, and as my job was feeling more stable, I revisited those questions and realized I would like a vagina rather than a penis. There’s really only one way to do that. I’m a big researcher, so I started talking to doctors, meeting with surgeons, and talking to people who’d had surgery. I also read tons of online reviews of different surgeons.

The official name for the surgery I had is vaginoplasty. Most of the surgeons these days are performing the same broad technique, which is a penile inversion. What that basically means is they cut open the penis, take out the spongy erectile tissue, and invert it up into the pelvic cavity that everyone who is assigned male or female at birth has. They then create labia and a clitoris from excess penile and scrotal tissue.

Vaginoplasties run in the ballpark of $20,000. It can be a little more or a little less, depending on what surgeon you go to, and they usually aren’t covered by insurance, but that’s starting to change. The Affordable Care Act has some positive language about LGBT identity, and there’s hope that within the next couple of years, insurers will be required to cover it. My surgery was in the fall of 2013. All the insurance agents, lawyers, and doctors I talked to said 10 years from now, it’s pretty likely insurance will cover it, but I didn’t want to wait when there was really no guarantee—so I chose to have my surgery and paid for it out of pocket. I paid about $5,000 myself from savings and credit cards, was gifted $10,000-plus from generous friends and family, and I also crowd-funded $5,000 via a fundraising party and online donation drive. My surgeon, like most, required letters of recommendation from two different therapists. In addition, she required laser genital hair removal, which was very painful.

No insurance I know of, even the best one, would have covered my hair removal. If I were a cisgender woman (the technical term for most women, who are assigned female at birth and grow up to identify as women) with the amount of body hair I had, it almost certainly would have been considered a hormone imbalance and have been covered. There are gaps in what “trans-inclusive” and “medically necessary” mean.

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Because of the pain medication, I don’t have clear memories of when I woke up. My mom, who was there with me, said I seemed incredibly pleased with myself, repeating, “I did it!” What I do remember, as the pain medicine wore off, was less pleasant. I was certainly glad to get through it, but I was nauseous and in pain. It took me another 24 hours before I was able to get out of bed and weeks before I could walk without tiring.

I was in the hospital for, I think, five days, then an aftercare facility for another week and a half. It took me three months after surgery to start working again. Most of my post-care was like any other surgery: taking it easy, making sure to eat enough, trying to balance bed-rest and recovering strength. The biggest difference was the need to insert medical dilators multiple times a day to ensure my new vagina healed properly (a.k.a. maintained its new post-surgery depth). That was icky and painful for months, as my body figured out how to live with this new configuration.
 

Just recently, I was hanging out with a trans friend of mine who’s looking at surgery for herself, and she said she felt like it took me a full year to be myself again in terms of energy, attitude, and comfort in moving around. By six months, I probably would say I felt good, but I do agree that it probably took a full year before I was at 100 percent.

One of the things that’s weird about having the surgery is that, at the end of the day, most people don’t interact with my vagina. I don’t show it to most people! But then there’s crossing my legs and feeling that be more comfortable, or wearing yoga pants to work out and feeling okay in those, or going to the beach and wearing a bathing suit that I feel looks good and feels good on my body. As a performer and a writer, I hate not having the words for things, but it feels really right and really good. I f*cking hate the language “home in my body.” It’s so trite, but there’s something to that. I didn’t hate having a penis, but it didn’t feel right. Moving through the world feels better. And sex certainly feels better!
 

I was sexual before I had surgery, and one of the things that’s scary about surgery is they don’t guarantee anything about the ability to orgasm. But they’re using a lot of the same nerves, and everyone I talk to says if you were orgasmic pre-surgery—which I was, thank you very much— your brain understands how pleasure works. Your brain will figure it out. The first time I tried to masturbate after surgery was probably around two months in, which my surgeon had said was fine. It was still a little painful. I could feel the starting of pleasure, but it didn’t get me there. I backed off, waited a month or so, and lo and behold, was able to get myself off in a way that’s more rolling and full-bodied and yummy.

RELATED: 12 Ways to Show Your Vagina More Love Every Day

There’s this conflation of sex and gender and sexuality. I didn’t transition to have sex. I didn’t have surgery to have sex. But those are important parts of our experiences as humans. I neither want to over- nor understate that. I feel better in being able to be sexual in a way that feels more right in my body. That’s not why I had surgery or why I transitioned, but it’s a part of who I am as a person.

I identify as queer, although I generally lean toward more feminine people. I have made the choice, at least for now, to make sure any partner I’m with knows about my surgery beforehand.  For me, that feels both emotionally and physically safe. Even though it’s 18 months after having surgery, I’m still figuring out how my body works and what feels good.

That said, there are very real emotional and safety reasons why someone might choose not to disclose. In five or 10 or 15 years down the road, when this is less new, I may make a different decision.
 

I can’t speak for all transgender people. There is no one right way to be trans. My experience is my experience. The thing I fear most is someone taking my experience, talking to someone else, and saying, “You must not really be trans because Rebecca says it’s like this.” When asking questions of trans people in your life, I like to talk about reciprocity and need to know. We have a need to know with names and pronouns. But if you’re bumping into someone at Starbucks, you do not need to know their surgical status or hormones or old name or what’s between their legs. In terms of reciprocity, would the reverse question be appropriate?

Trans identity is often presented as this foreign and impossible-to-understand idea. At the end of the day, we all want to feel comfortable in our skin and respected in our identity. That’s not a trans trait, that’s a human trait.
 

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Rebecca Kling is a transgender artist and educator who explores gender and identity through solo performance pieces and educational workshops. Her multidisciplinary performances incorporate conversational storytelling, personal narrative, humor, and more. Kling takes the position that sharing accessible queer narrative with a wide audience is a form of activism, and that understanding combats bigotry. Her book, No Gender Left Behind, was released in 2013. For a behind-the-scenes look at her writing process, check out her blog.