Pre-Op Appointment with Dr. Safir – Fistula Repair/Stage Two

My folks and I arrived in San Fransisco on September 30th for my fistula repair and parts of stage two metoidioplasty. We spent the evening with my cousin walking along the bay and visiting, which was nice.

The apartment I secured this time through Airbnb is not as nice and is much further away from the surgery center and office. Since this surgery was booked with much shorter notice than first stage, it didn’t leave time to find very good accommodations. It will serve our needs, but is nothing close to the apartment I stayed in for first stage.

My dates for pre-op and surgery were originally October 1st (pre-op) and surgery October 2nd, but due to my insurance wanting it to take place at the surgery center, those appointments each needed to be moved back for a day. So in the meantime, my folks and I explored a little bit. We did Muir Woods, hiked the headlands to the coast and after my pre-op appointment on October 2nd, we saw 17-mile drive.

Pre-Op Appointment

It was great to see Dr. Safir again. He looked good and relaxed and welcomed me warmly. We talked through my questions while he examined me. He was very pleased with how well I’d healed, especially my scrotum. Dr. Safir was pleased at how symmetrical it was, that it had a good hang and was natural looking.

Here are the highlights from my appointment:

  • He initially discussed trying to do the penile lift during this surgery. Upon further inspection of my fistula he feels that trying to repair the fistula and do the penile lift together would put too much stress on my body and healing the fistula. The penile lift can be accomplished during the implant stage.
  • We discussed doing a monsplasty on me. He feels that I don’t have that much mons tissue. Of course dysphorically I feel like I have a lot. He showed me during the exam though with a mirror that pulling up the mons tissue wouldn’t really lift or expose my penis much. In the end, he feels the labia majoral reduction incisions will do more to unmask my penis and make it more visible.
  • The labia majoral reduction incision is something that Dr. Chen offers on his website. Dr. Safir has adopted this technique from Dr. Chen. During my exam, Dr. Safir did his best to show me how it works on my body. Below is a picture of this technique. By making the L-Shaped incision, it pulls up the majoral tissue from its anchor at the other corner, raising the excess tissue, thus showing him what he can remove.
L-Shaped Labia Majoral Reduction incision.
L-Shaped Labia Majoral Reduction incision.
  • Compared to stage one, he expects the recovery for this stage to not be as intense as the first. I will have a suprapubic catheter again and a stint in my penis for the first week.
  • I had a piece of granulated tissue that did not heal at the base of my penis/middle of my scrotum. He is going to cauterize it with silver nitrate.
  • My urologist at home will take over my aftercare when I return home on October 11th. I will be doing weekly appointments with her as I heal. Dr. Safir will be working in conjunction with her on this.

I am so ready for this and to be able to pee standing up! I’m a little anxious of course, but nothing like the first time. Can’t wait to update on the outcome!



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