When Elise first heard of gender-affirming surgery—various types of surgical operations that help people physically transition to their gender identity—it seemed next to impossible for someone in her situation. She had not yet come out to her family and when she did, it took time for them to adjust and for her to feel comfortable going to them for support.
However, after a few years filled with research and conversations with her family about her gender identity, what seemed impossible became achievable.
Elise underwent a vaginoplasty, surgery to construct a vagina from existing genital tissue, at Massachusetts General Hospital in 2020, with a care team led by Milena Weinstein, MD, gynecologic surgeon, Anton Wintner, MD, urologist, and Jonathan Winograd, MD, plastic and reconstructive surgeon, Heather Parker, NP, and Leah, RN.
Discovering Her Gender Identity
Now a 20-year-old transgender woman, Elise says that she knew from a young age that something was missing, but she couldn’t put her finger on it right away.
“It wasn’t something I expected. Growing up, I was a boy and that’s how I was treated by my parents,” she says. “I didn’t know I was transgender, but mostly because I didn’t know that was an option. I was young and I didn’t hear about LGBTQ topics very much.”
Her realization, she says, was marked by the small things. When her cousins would play dress-up, she would put on a dress and try out makeup. When playing video games, she would gravitate toward the female personas, despite remarks from her family that she should select the male ones.
Elise recalls that it was in eighth grade when she first thought about what life would be like if she had been born a girl.
“I remember posting on social media that everything would be so much easier for me if I was a girl,” she says. “That’s when I really began to consider it seriously, or as seriously as someone who thought it was impossible could consider it.”
Elise began to make changes her in life to assert her gender identity. She sought regular guidance from a therapist, who quickly became a significant source of support when coming out to her family; she switched to female pronouns; and she changed her name.
Despite movements to find comfort in her own skin, Elise’s childhood and teenage years were marked by intense frustration and emotional conversations with her family. Throughout all of this, she persisted, and began hormone therapy as a junior in high school.
Upon turning 18 years old, Elise delved into research to learn about her surgical options. A year later, she came to Mass General for her vaginoplasty, a surgery to construct a clitoris, vaginal canal and labia from existing genital tissue.
Experienced, Affirming Care
Prior to her surgery at Mass General, Elise underwent an orchiectomy, surgery to remove the testicles, at a separate institution and was referred to Mass General for a vaginoplasty with a highly experienced and equipped multidisciplinary team.
She set up a consultation with the Mass General Transgender Health Program team to establish her medical support. Following this consultation, Elise met with her surgical team, which included Milena Weinstein, MD, gynecologic surgeon, Anton Wintner, MD, urologist, and Jonathan Winograd, MD, plastic and reconstructive surgeon.
“For best results, patients undergoing gender-affirming surgery at Mass General will work with a team of surgeons who are experts in each of their specialties,” says Leah, RN, Transgender Surgical Program. “They’ll receive medical support every step of the way. Also, we have a nurse and surgical coordinator dedicated to only the gender affirmation surgical patients.”
Elise attended her first few visits with the Mass General care team virtually. She had the opportunity to ask questions, complete a physical exam and learn about the timeline for both the operation and recovery.
“I was a little jaded from my past experiences, so I came to Mass General wary,” Elise says. “However, I could tell from my first meeting that they were more connected to my situation, which I really appreciated.”
While her surgery was originally scheduled for January 2020, due to the unexpected COVID-19 pandemic, it was rescheduled for March 2020.
“I was feeling a little bit of doubt before my first scheduled surgery. It’s a big surgery; it’s a big change to my body. I got some more time to sit on it when it was rescheduled,” she says. “When March came, I felt less anxious and more excited. I knew this is just what I wanted and needed to do for my wellbeing.”
She arrived at the Boston campus on the day of surgery, prepared and resolute. In the operating room, Elise recalls how the team put her at ease. The anesthesiologists, she says, were particularly helpful in making her feel calm and relaxed before administering her epidural.
Following surgery, Elise woke up in her recovery room, a new woman.
Elise recovered comfortably in her home while attending college classes virtually. As for post-operative pain, she says that she felt a manageable soreness for a few weeks, which she treated with ice packs and ibuprofen. Parts of the surgical site remained numb for a couple of weeks as the effects of the epidural slowly wore off.
Additionally, an important part of her new routine to help her body adjust to and maintain its changes is vaginal dilation, which helps to preserve the depth of the vagina, prevent tightening of its skin graft and improve the elasticity of vaginal wall.
All of this, she says, is nothing compared to the newfound confidence that she gained.
“For the first time, I can put on a pair of leggings and go to the pharmacy without worrying about someone giving me a weird look,” she says. “I don’t have to take extra steps to hide who I am.”
Elise says that she went into surgery knowing that it would not fix all of the anxieties and self-consciousness that had been built up throughout the years, but that it was an essential step to allow her to feel more like herself.
“I feel so much more confident and armed to have a conversation with anyone about who I am and about the sacrifices, the journey, the costs that I've made to be who I want to be,” she says.