‘Dr. Chettawut Tulayaphanich’

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YouTube and ‘SlimandMe’ script

Sahwdee kah and greetings to YouTube viewers.  This is my first immersion creating a YouTube post.  I do not have the wherewithal to do elaborate videography and editing with all the whiz bang gadgets and gizmos.  This will be a simple video shot in one take, for better or worse.

I am making this video as a companion piece to my web-site ‘SlimandMe.WordPress.com’.  Among the many topics on that site are personal stories and references.

Kapung kah.  My thanks to those who contributed their stories that allowed me to re-tell them in this composite essay.  Thank you to those who supplied their props for this video and web-site.

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I had to decide on a subject for the video.  I decided that this first video will be the general process of GCS / SRS through Thailand’s Dr. Chettawut Tulayaphanich.  He is one of the world’s best – his Chettawut Clinic is among Thailand’s ‘Big Three’ that also includes Preecha Aesthetics Institute (PAI) and Suporn Clinic.

Dr. Chettawut uses a surgery technique that is anatomically correct.  Allow me to encourage you to learn comparative anatomy during your transition.  You’ll come to know from that education and your ‘due diligence’ that few surgeons perform surgery that is anatomically correct; my personal opinion is that Dr. Chettawut is the world’s best in this category.

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Dr. Chettawut has a detailed web-site (‘http://www.chet-plasticsurgery.com’).  I encourage you to read and study its information.  Correspond with Dr. Chettawut if you have any questions.  Good surgeons will communicate with you and build a relationship so that you are fully aware of what you are about to do.  Surgery is a one-way proposition, there is no going back.  As one person said, ‘You can’t grow ’em again’.

Eventually you will choose your surgeon whomever he or she will be.  Many surgeons are booked months or years in advance.  If you are early in your transition, then you would do well to begin developing a list of surgeons, tell them you are early, and that you are planning your GCS / SRS at some time ‘x’ number of years in your future.  A good surgeon will work with you on this and will not demand a specific schedule until you are ready.

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Dr. Chettawut will set guidelines for you that you must meet.  These standards also apply pretty much across all of the best surgeons.

You must not be a drug addict, or an alcoholic, or a tobacco smoker.  These issues create complications in your life whether during your pre-op transition or your post-op recovery.

  • Certainly, if you are choosing Dr. Chettawut or another Thai surgeon, you must be aware that illicit substances are likely to get you in serious legal consequences at Thailand and nearby nations.  Indonesia recently executed a handfull of foreign tourists who used illegal drugs; they are preparing for another round of executions in another week.
  • Buying alcohol at Thailand is not as simple as in America when going to your local convenience store or grocer.
  • Tobacco smoking contains substances that can result in poor post-op results.

As far as my knowledge goes today, I personally know of no one post-op from any clinic or surgery center who is using illicit drugs or smoking. Those who imbibe do so with only an occasional glass of wine.

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You must meet health standards.

You must be neither over-weight nor under-weight.  Dr. Chettawut posts parameters to his web-site presenting acceptable weight ranges.  Obesity interferes with surgery and complicates your recovery.  You would do well for yourself to get out and get exercising to be in your best of health throughout your transition.  People in good overall health do well during recovery.

Medical illnesses and diseases may, or may not, impose special consideration on your eligibility for surgery.  Be very clear and open with your prospective surgeon.  I know of persons who had cancer and were accepted and others whose cancer denied surgery for them.  Some medical conditions require different methods of performing GCS / SRS; your surgeon must know of your specific circumstances well in advance of your arrival.  Last-minute surprises sprung on your surgeon will not do you well.

(2015 08 10) Chettawut Clinic Confirmation Letter - 25 Aug 15 - Name covered DOC052317-05232017173247-0001You must submit medical records to your surgeon.  These records will document your health status and fitness for surgery.  You must have blood tests, X-rays, cardiograms completed within a specified time frame prior to surgery – usually four to six weeks before your scheduled date.  Upon receipt, Dr. Chettawut will render his preliminary approval for your suitability for surgery and issue his approval for travel; he will not determine your final approval until your personal encounters with him at his Clinic.

Here is the approval letter that you want to receive.  With this, you are ready for travel.

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Preparing for travel and your travel day will arrive quickly.

You were directed to cease your ERT at least two weeks in advance of travel.  Hormones can create blood clots; surgeons take precautions that you do not develop blood clots while flying.

You’ll want to get up, walk around, exercise as much as possible if you are flying long distance from USA to Thailand.  Your flight from Los Angeles, San Francisco, Seattle, or elsewhere to Asia can last from 10 hours to 14 hours or maybe longer depending upon your itinerary.

*(2016 01 xx) Chettawut Clinic Introduction Instructions (full page) (3)

Dr. Chettawut will send his driver to meet you at the main Bangkok International Airport (BKK).

The driver will take you direct to your recovery residence (Baan Siri, Dusit, or Vertical).

Depending upon Dr. Chettawut’s schedule with you, the driver may stay with you as you check-in at your residence, take your belongings to your room, and return to the car to be driven directly to the Chettawut Clinic for your first appointment.
(2016 01 xx) Baan Siri Business Card (reverse)(2016 01 xx) Baan Siri Business Card

Dr. Chettawut and his staff will introduce themselves to you:  ‘Sahwdee kah’.  By now both Dr. Chettawut and you have been corresponding several months.  Your first meeting will go well.  Your nurse will direct you to change into your slippers, undress, put on his famous white cotton bathrobe, and attend to your first appointment.  Dr. Chettawut will examine you, he will discuss what he can and cannot do, he will ask you what you expect of him.

You will also complete any left-over paperwork:  present your medical reports, X-rays, and psychological evaluations, and make any final payments.

You will have one or two more pre-op meetings or consults with Dr. Chettawut before your big day.

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(2016 01 xx) PramRam 9 ID Card (reverse)(2016 01 xx) PramRam 9 ID Card (front) (obscured)

Of course you must submit at least two psychological reports from qualified counsellors.  This is no complication because you are already undergoing therapy.  If you do not present these two letters of recommendation, then Dr. Chettawut is obligated to comply with Royal Thai laws that mandate you present yourself to their government’s board of psychologists.  Dr. Chettawut will help you comply; he has privileges at regional medical centers such as Pramram 9 Hospital’s ‘Mind Clinic’ who will assess your eligibility.

Be yourself at your presentation, submit a written statement to them supporting your request for their approval for your surgery.  Answer all questions honestly same as you would with your home counsellor.  If your home therapist approved you, then it is quite expected that the Royal Thai board will concur.

You are now set for your final pre-op examination with Dr. Chettawut.  You will again discuss your expectations of your results and what Dr. Chettawut can do to meet your desires.  He is an excellent surgeon with years of training and experience; he can do only what is medically possible, not perform miracles.

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Wait a minute!  It is not all business.

Consider arriving at least one or two weeks before ‘business’.  Get to know the people, places, and events of Thailand.  Check their calendar – consider traveling during a time when they are involved with local or regional holiday activities – partake their culture.(2016 01 19) Wat Pho and Hua Mauk Tickets DOC040716-04072016202118-0001

You certainly want your excursion to this fine nation to be memorable for more than only your confinement for surgery.  See the temples and other Thai cultural sites.  Be respectfull – temples adhere to a dress code of modesty and expect proper comportment at all time from all visitors.

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Find time to meet and make friends with your neighbours – they may be all you will see in the coming days.  Be aware of patient confidentiality.  Your medical team are prohibited from disclosing the identification of their patients.  It will be your decision whether or not you permit your team to disclose your presence for others to find you; therefore, it is possible that you may have a next door neighbour (maybe in your hospital, maybe at your recovery residence) you will not meet unless both of you permit your doctor to release your information to another patient.

You can help your neighbours  while you are pre-op and they are post-op; you will need their help when you are post-op.

Share trips to go shopping and do errands.  You will need to stock on groceries before you are ‘confined to quarters’ during your peri-surgical days.(2016 01 xx) Tesco Cards (Discount, Meal)

There are many local shops and street cafes.  If you are not quite adventurous, then you can find universal fare at the Tesco, Max Value, and 7 / 11 stores near your residence.  Tesco provides a frequent-shopper discount card same as many stores in the USA.

Want more?  Go to Seacon Square Mall, Paradise Park Mall, Night Train Market, or Siam Center.

What is not within walking distance is available by local bus, train, or Sky Train.

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Dr. Chettawut requires that you remove all jewelry at least three days before surgery; no metal earrings, posts, or other piercing items allowed. He also requires you remove all traces of nail polish at least three days before surgery.

(2016 01 xx) U-Enema

Now it will be time to attend to your cherished pre-op days’ duty:  your cleanse.  Your bowels and bladder must be clear so that they do not contaminate your surgery site.  You must NOT consume solid foods and certain fluids during your three last days preceding surgery; your prohibition includes juice with pulp and dairy products.  Your cleanse diet allows only clear liquid and clear broth.  You might want to stock up on gelatin powder or clear drink mix.  You will also take vitamin pills to help compensate your nutrition during your cleanse.

Your three-day cleanse will also include a series of scheduled bowel evacuations.  You will administer your enemas during your last days.  Expect to park yourself at the throne three days until you are clear.

Practise your cleanse diet at home and this will be a breeze at crunch time.  Otherwise, you may experience the munchies and hunger pangs that disrupt your focus.  I tried this routine a few times limiting myself to clear drink mixes and broth for four days at a stretch; it got easier each successive time – and I lost a few un-necessary pounds in the process.

Again, Dr. Chettawut reserves the right to delay your date if you fail to complete this vital pre-op process.

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Your surgery date arrives quickly.

The morning of your surgery date requires one final pre-op obligation:  no drinking any fluids of any kind from 7 am – no water, no juice mix, no gelatin mix, NOTHING.  If need be, set your alarm for 6:30 am and enjoy your final pre-op drink of juice mix or water.

Be prepared at any moment.  Your time might be scheduled in the afternoon but Dr. Chettawut may send his driver to bring you to his Clinic in the morning.

You arrive at Dr. Chettawut’s surgery clinic, meet his team again, put on your slippers, go upstairs to your un-dressing room, strip, and don the famous white cotton bathrobe.  A nurse will lead you to your waiting room for one final pre-op medical exam.  You lie down on your bed (this will soon be your first post-op recovery bed); Dr. Chettawut will discuss his surgery plans one last time with you, ask you to present your final pre-op questions, and assess your prospects.  Perhaps this is your last chance to leave, but you’ve come this far and passed all the evaluations and scrutiny that make that decision extraordinarily remote.  You should no longer hold any doubts by now.

Certainly, this is major surgery.  That clock on the wall to your right will tell you how long you will be under the knife – six hours, eight hours, maybe more.  It will be among the first items you will see as you later scan the room coming out of anaesthesia.

Dr. Chettawut and his team will depart from the recovery room.  You are lying there on your hospital bed wrapt in your white cotton robe with your thoughts to your self.  All your years, all your experiences, all your family and friends (or lack thereof) will flood your emotions as you await Dr. Chettawut’s call to walk down the hall to his operating room.  Your final alone time will move both slow and fast – your last minutes seem to take forever yet Dr. Chettawut will summon you quickly once he and his team assure themselves that they have finalised the OR for you and that you are ready.

Take it all in as you depart this recovery room.  Your return in a few hours will be as post-op.

It’s time.  You walk down the hall to the OR.  Smile.  Your team greets you: Dr. Chettawut, your nurses, your anaesthesiologist.  They are there for you and only you during these next several hours. Yes, your life is in their hands.  They accept your trust solemnly.

Dr. Chettawut motions for you to lie down on the OR table; your right arm goes to the extension to hold it perpendicular to your body.  Your anaesthesiologist will receive your left arm to extend it to your left; he will slip the needle into your blood vessel.  Dr. Chettawut and his team instruct and encourage you one final time as you begin drifting into sleep.

  • ‘Take deep breaths.’

Absorb your environment and let go.

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Your mind is foggy.  You have no sense how much time passed.  Dr. Chettawut and his nurses encourage you to ‘Take deep breaths’ as you awake from surgery.

You notice that you are doing everything to breath but something is in your throat.  Relax.  This is the breathing tube that Dr. Chettawut inserted to ease your respiration during surgery.  You must demonstrate to Dr. Chettawut that you are alert enough and that you can resume breathing on your own before he will remove your breathing tube.

You ask Dr. Chettawut if the surgery went well, if it is complete, if you really are changed.  You may repeat your questions several times awash in your amazement.  He smiles and assures you.  Yes, all went well and you will recover well.

You survey your familiar surroundings inside your post-op recovery room.  There’s that clock on the wall to your upper right.  Yep, your surgery took that many hours.

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Dr. Chettawut will answer your questions as he instructs you of your post-op paces.

  • You must take your medicine at specific times.
  • You must get rest to heal properly.

Dr. Chettawut assigns nursing staff to attend to you without interruption.  They each take turns staying with you at your bedside just out of sight behind your left; they are there to care for you immediately if any emergency occurs.  They will assess your physical and mental recovery progress.

  • Nurses will check your ‘vitals’ at regular intervals.
  • You have tubes coming from your surgery site that your nurses will be inspecting.
  • You have an IV that your nurses must be certain is working properly.
  • Air bags wrap your legs and massage them to facilitate blood circulation; now is not the time for blood clots.

You are also under continual watch – there is that camera to your left in the corner above the entrance door to your recovery room.  This camera is there for you – Dr. Chettawut’s eye continually observing your well-being.

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Yes, that wrapping around your waist encloses your surgery results.  Nothing feels different down there.  The magic awaits its unwrapping in about a week to 10 days time – soon enough according to schedule.

Meanwhile, you notice one tube from your wrapping; it is your urinary discharge.  Your nurses measure your flow.  You must drink plenty of water to maintain production; Dr. Chettawut and his nursing staff will be certain you are drinking enough water every time they measure your output.

You eat your first meals a little at a time.  Warm soy milk.  Warm chocolate milk.  Miso soup.  Chicken noodle soup.  Crackers.  Simple Thai food.  Yum!  These will be a lasting memory.

Your nurses will wash you every day using a sponge bath.  This feels soothing.  They are there for you; they really care for you.

You will drift in and out of periods of sleep and awake during your first couple days.  You can watch TV during your recovery while you are awake.  You do need rest.  Your attending nurse will direct you to sleep if you are awake too much; she is both your best friend and your Sergeant-Major.

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You might be groggy when Dr. Chettawut presents your official GCS / SRS certificate to you.  It is a statement attesting that Dr. Chettawut’s surgical procedures comply with international protocols.

It may not be specific in all details if your operation required alternate procedures.

You may come to read your declaration a thousand times while you are recovering at the Chettawut Clinic; that’s okay if you spill, one copy is sealed in plastic.

Your certificate is suitable for framing.

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Two or three days in your post-op recovery room seem endless yet come swiftly to their conclusion.  Time now to move to your downstairs ground floor room; you will remain here another few days until Dr. Chettawut determines that you are well enough to return to your recovery residence.  Dr. Chettawut and his nurses will allow you out of bed for your first time since surgery.  It feels good walking.  Your nurses guide you – slowly – step by carefull step – sticking swabs of smelling salts into you nose so that you do not pass out.

This ground floor recovery room is a bit more accompanying.  You are initially still tethered to all the same hoses, wires, and inflatables.  The difference is that your time is short for them.  Dr. Chettawut will approve you to be disconnected from your vitals monitor, your leg massage, and your two ‘Redivac’ vaginal drains (ouch, that stings when Dr. Chettawut removes each one).

You are now more awake and alert; you will chat with the nurses as they attend to you.  You no longer require 24-hour nursing care as was at your first recovery room.  Dr. Chettawut’s all-seeing camera is your constant companion there above the door to your right.  Here you are permitted to use wi-fi to send e-mails and browse web-sites, you may watch TV while you are awake, you may receive visitors, and you must rest.

Dr. Chettawut will provide a special donut pillow for you to sit on.  Its design will help protect your surgery site.  Go to your nearby store wherever you are staying and buy a pillowcase for this donut cushion; you will prefer to be discreet with it at public places.  Your nurse will require you to sit on this pillow during your ride home to your recovery residence.  Use this pillow at your recovery residence, for your day at the Foreign Ministry office at the Chaengwattana complex, and on your long flight home.  You may be using this pillow for a month or two at home as you recover.

Too soon yet too long you will be ready to go home to your recovery residence; Dr. Chettawut patients usually stay at either Baan Siri (Bangkok Rama), Vertical Towers, or Dusit Hotel.  Baan Siri cottages are located closest to Dr. Chettawut’s clinic.  You are a little sore as nurses assist you walking slowly from your room to the car.  Be mindfull of your movement – you are still healing.  Sit carefully on your new Dr. Chettawut ring pillow.

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Your arrival home to your recovery residence marks another milestone.  You completed your Clinic days on restricted bed confinement.  Your nurses who accompanied you will instruct you to your proper recovery conduct:

  • bed rest,
  • minimum walking inside your recovery home and outside patio,
  • how to walk carefully as to maintain the integrity of your healing,
  • how to monitor and empty your bladder bag on your own, and
  • shower on your own to protect your surgery site.

Sri and Noi, Dr. Chettawut’s nurses, visit each patient on their daily runs, except Sundays.  They attend to all Dr. Chettawut patients at each of the three recovery residences and to others who may be located at a hospital.  Their nursing schedule varies.  You must be prepared for them at any time – as early as 7 am if you are their early stop to as late as perhaps 4 pm if you are their late stop.  You need not worry of surprises; they typically visit each patient at approximately the same time each day.  You will usually receive an e-mail or telephone call if they will be making their visit at a time different than their norm.

Sundays are odd.  You miss Sri and Noi’s visit, their attention to your healing, their company.  Their absence does provide the opportunity for you to prove to Dr. Chettawut your own attention to following his directions.

Dr. Chettawut’s nurses know when you are not complying with doctor’s orders.  They are highly experienced; they are checking your status and observing how you are, or are not, healing properly.

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Soon enough you arrive at the day when you get to see Dr. Chettawut’s results.  You will be un-bandaged within one week if you complied with instructions and self-care.  Your un-packing is worth a ceremony.  Unfortuneately, Dr. Chettawut does not allow you to be accompanied by your companion or any visitor; it is you and the nurses alone for this private, personal event.  Commit your un-packing to memory; it is a once in a lifetime experience.  Use your mirror to watch.

Nurse Sri will measure your inside depth.  Most Dr. Chettawut patients are rated from five to seven inches.  This is not immutable; many patients can extend their depth during their early course of dilation while their tissue is most flexible.  Of course, those who fail to maintain their duty schedule may lose depth and diameter.  You do not want to lose your big ‘O’ at depth.(2016 01 xx) Dr Chettawut Card (front)

Nurse Sri will instruct you at your first dilation.  She will observe you until she is certain that you know how to perform this requirement on your own.  She will check your progress with your dilation schedule.

Some patients might start with the candlesticks – yes, candlesticks wrapt in a condom.  This is for patients whose anatomy begins small.  Others with small post-op anatomy begin with dilator #0.  Most patients begin using #1 and advance from #1 to #2 by the time they are cleared for departure travel home.

Appliances #3 and #4 await your discovery at home.(2016 01 xx) Dr Chettawut Card (reverse)

Nurse Sri will make daily swabs of your new anatomy.  She is checking for proper healing progress and testing for presence of blood which could signal post-op complication or damage.  Dr. Chettawut provides correction surgery before you depart Bangkok.  That said, he has every right to demand each patient follow his instructions.  He has many years experience and knows what he is doing; he knows that his patient instructions will provide optimal results.  He should not be imposed by a careless patient who refuses to abide by his competent guidelines.(2016 01 xx) Q-C Lube

Your nurse will remove your bladder bag a day or two after your un-packing.  You will know when it is time.  Your bladder drugs are wearing off and your urinary system wants to get busy on its own again.  You know that you are ready to lose the bag when your urinary muscles over-ride the catheter tube and you are going normally again.  It may seem a bit sloppy but it proves your continued recovery to Dr. Chettawut and his visiting nurses.

If you have not already done so, now is the time to begin using the bidet.

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Gradually resume eating solid foods.  Remember, Dr. Chettawut required powerfull medicines to cease your bowel function during surgery and recovery.  You do not need to experience constipation that could strain your surgical region.  You are best to limit your intake to foods easily digested – fruits and vegetables.  Avoid heavy foods – bread, noodles, meats, fried ‘crispy critters’.(2016 03 06) Baan Siri Restaurant IMG_0295

You will have plenty of time to eventually resume your regular diet.  Of course you can use your time to consider a dietary adjustment.  Thai food served at your recovery residence or nearby cafes is quite nutritious yet you may very well lose weight.

  • Your free breakfast at the Baan Siri restaurant offers rice, entrees of seafood or pork or chicken, eggs, fruits (watermelon, papaya, pineapple), salad fixings (lettuce, cabbage, carrots, onions, tomatoes, etc.), toast, American-styled cold cereals, orange juice, and coffee and tea.(2016 01 xx) Tesco Cards (Discount, Meal)
  • The example of that Tesco meal card shows a main dish for 40 THB, a side dish for 30 THB, and a soup for 10 THB; a filling dinner for 80 THB (less than $3).  Hoagie sandwiches can be bought for 30 THB.

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Dr. Chettawut will conduct your final exam a few days before your scheduled departure date.  He may need to remove sutures that failed to absorb (ouch!, that can sting).  He may need to correct injury the patient caused by careless post-op behaviour.

Dr. Chettawut and his staff will make their final good-byes at the conclusion of your final exam.  It can be an emotional time for all – certainly for you the patient.  Your gender dysphoria consumed you for perhaps many years since childhood.  That is all gone.  You are no longer transsexual, you are now female plain and simple.

*(2016 01 xx) Chaengwattana Federal Center (map)(2016 02 17) Notary Payment Receipt (obscured)

One last stop before your departure travel day is your trek to the Thai Foreign Ministry office at the Chaengwatana federal center.  Start your day early – it is best that you arrive before their lunchtime closing (12 noon to 1 pm).  Check-in at the 3rd floor desk at the top of the stairs.  That agent will direct you to the correct window where another agent will certify your surgery letter.  The standard fee is 200 Thai Baht; request same-day service and pay the total 400 THB rather than spending time and Baht returning a day or two later.  You may need to insist upon same-day service with a supervisor if this window agent tries wrangling you to return another day.

Bring your Dr. Chettawut donut pillow – it could be a long wait on those hard seats.

Why must you certify Dr. Chettawut’s document?  It is one final step in this process to comply with Royal Thai law.  Your certified document can now be presented to your home nation authority as final bona fides of your anatomical revision.  You can now alter your status on legal documents that allow only this item to enact your change.(2016 01 19) Baan Siri - Hua Mak Map

If you finish early enough you have these choices:

  • explore the Thai federal center and sample food from the street carts or basement cafes
  • catch a taxi home to your recovery residence before the deluge of rush hour traffic.

Of course, you could also make one final day of touring the temple district before making your way home to your recovery residence.  Use caution!  You are still in early healing.  You certainly do NOT want to damage your surgical site.(2016 01 19) Bangkok Central Train Station (Ildi)

Pace yourself and your sight-seeing.  Be mindfull that the typical temperatures are 90 degrees Fahrenheit during the day and 80 degrees at night – with high humidity.  Bring plenty of drinking water with you for your excursions around town; bring snacks or enjoy Thai street food (‘crispy critters’, pork meatballs, fish rolls, egg and banana popover)

*(2016 01 xx) Chettawut Clinic Release (full page)

Your departure date is approaching.  Dr. Chettawut will issue his approval for travel checklist; later he will issue a travel letter that you will present to your airline explaining that you recently had a surgical procedure and require medical assistance.  Your airline will provide free attendant and wheelchair service; you will receive expedited attention through security check-points and allowed early boarding.  Your airline might provide a full row of seating for you rather than being scrunched between two passengers.  Of course, there is no guarantee that you will be free from that child who will be kicking at your back-rest during the entire flight across the Pacific Ocean.

*(2016 01 xx) Chettawut Clinic Post-op Instructions (3) (Dilation Schedule) (full page)

That’s it.  You are now home.

You are complying with your three-per-day dilation schedule.  Expect on a weekly  average to use one tube (4 to 5 ounces) of lube while in this early stage.  Too little and you will be dry; too much and you will dribble.  Experiment and determine what amount is best for you.

Your inaugural dilator (candlestick, #0, or #1) appears large enough at first; #4 seems quite huge.  By week 10, you will be ready for #4 and it will fit just right.

You will attend to your six-month and 12-month post-op exams.  The best place is a return trip to Dr. Chettawut so that he can directly assess your progress.  Barring that opportunity, perhaps your community has an LGBT health center that includes specialists who assess newly post-op clients for proper development.  Otherwise you will experience your own first gynecology appointment with a ‘normal’ gynecologist.  You’ll certainly need to tell your gynecologist that you are post-op; it would be bad form trying to pass as cis at your first event.

Do you know about the complete gynecological exam?  Perhaps you know the details having been married; then again, maybe your ex- was not quite descriptive to you about hers.  Your complete routine gynecology appointment should include both a breast exam as well as bottom exam (I can elaborate if need be).

If your ex- or others have not mentioned it, allow me to offer that you’ll want to bring your mirror to watch (in case your gynecologist does not provide one, though most do); some gynecologists attach a camera and you can watch on the large-screen TV monitor.  You’ll want to be certain she dips the speculum in warm water.  Request to keep your first speculum as your souvenir.

Please do not be afraid to ask questions or demand services of your doctor, physician’s assistant, or nurse.

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Your neo-vaginal anatomy may likely consist of three (maybe four) sets of muscles:

  • your entry muscle is of moderate strength,
  • your intermediary muscle is weak,
  • your deepest muscle is strongest.

Your deepest muscle may constrict and thus hinder your capacity to attain full depth.  Here is why you learn to practice deep breathing and relaxation techniques to proceed to depth.

Learn to tighten, flex, and flow your muscles as part of your climactic experience.

You may have a sensitivity at your entry muscle which can be quite orgasmic.

Depth also holds a reward.  Post-op can achieve their Big ‘O’ when their appliance touches at depth.

Align your device along the natural path of your neo-vagina:

  • apply steady pressure inward,
  • do not press against your bowel, that can disrupt normal reflexes and regularity,
  • do not press against your urinary tract, that can cause painful urination.

Use caution when dilating – no matter your experience level or to which appliance size you have advanced.  Steady pressure will usually be sufficient.  Dilation is not a painful experience; it is prescribed masturbation to familiarise you to your new anatomy.  Confer with your post-op specialist about actual pains and discomfort.

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All should be well as you live your new sense of normal.

Unfortuneately, no one otherwise guarantees that you will remain employed, financially stable, or retain family and friends.  You knew better going into this that you will lose.  As one frequently commented, her employer acted as if her surgery removed 100 points from her IQ score.  Nope, that’s your loss of ‘male privilege’.  Please read spirit friend Cara’s post:

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Up-date (20 Apr 17):

According to the statistics page, there has been heavy traffic to this ‘Dr. Chettawut Tulayaphanich’ (

Kapung khaf!

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