Fistula Repair & Stage Two with Dr. Michael Safir

It’s official! I’m having my fistula repair and some stage two things done on October 3rd, 2018 with Dr. Michael Safir in San Fransisco, CA. I am only having one post-op appointment with Dr. Safir a week after my surgery on October 10th. My local urologist will take over my post-op care from there. Dr. Safir and I discussed possibilities to make this less financially stressful for me, but not sacrifice my quality of care or compromise his ethics. That plan is what we came up with.


I had two fistulas after surgery. There was a “welling up” from the middle of my scrotum at the base of my penis. Thankfully by July this had closed up and healed on it’s own. The fistula towards the end of my penis has not closed up on it’s own unfortunately. After months of trying to plug my fistulas with my fingers like Dr. Safir and my local urologist advised with no improvement, I finally gave up on it and just started sitting to pee again. While this was definitely a bummer and dysphoria inducing, the stress and mess of continuing to pee standing up was just not worth it to me anymore.

Dr. Safir and I spoke and exchanged videos two more times over the summer. During those conversations he was still pleased with how much urine I was voiding through the end of my penis and with the strength of my stream.

Both Dr. Safir and my local urologist feel that this fistula repair will be easy and normal and don’t expect complications with it. That is why Dr. Safir has decided to go ahead and do some stage two things during this surgery.

Stage 2

Stage two things that will hopefully happen during this procedure include:

  • Penile Lift
  • Majora Fold Reduction or “L-shaped incision”
  • Mons resection

I’m thrilled by the possibility of getting these things accomplished and am looking forward to feeling less dysphoria about the look of my package. The penile lift and mons resection will help lift things up and bring them forward, while the majora fold reduction should remove the “mud flaps” around my penis. (I stole the term “mud flaps” from another guy in a surgery group I’m in. I love the humor in the term.)

I will not be getting testicular implants during this surgery because of the fistula repair. That would put too much stress on my body while it’s trying to heal other things. Because an implant surgery is pretty routine and easy in the world of urology, I’m not really concerned about that. My hopes lie much more with the plastics part of this stage for dysphoria relief regarding the appearance of my package.


This trip has happened very quickly and as a result there was much less time to find accommodations and decent flight times. I discussed this with the Brownstein and Crane Surgical Services office and Dr. Safir multiple times. I know they try their best and are only trying to get me to feeling “whole” again as quickly as possible. I hate how “thrown together” this trip has felt though. I’m a planner by nature and like to have plenty of time to physically and emotionally prepare. It is what it is, but it will be interesting to see if that aspect of it will have any bearing on how I feel about this second experience.

Last time I had caregivers for the first part of my recovery and my mom for the second part. This time I will only have my mom, plus my dad. My father is as supportive as anyone can be about my transition, but has never been this closely involved with one of my surgeries. My mother has always experienced this on her own with me. It will be interesting to see how it will be having my dad around for surgery and directly after surgery.

As usual I’m excited and nervous for this next stage. Stay tuned!




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