I am scared and I don't really know what to do.
Background:
I went into surgery for vulvoplasty at Boston Medical Center on January 14th, 2025 believing that all of my scrotal skin was going to be used to make my labia majora. I believed this because that was what I had said I wanted, and Dr. Jaromir Slama, the plastic surgeon of the two co-surgeons, had previously told me on October 15th, 2024 that he would do so for me even though normally he just cuts off and discards most of his patient's scrotal skin because he thinks it "looks bad."
It was very important to me to keep my scrotal skin because it was a primary erogenous zone for me and I didn't want any of my genital tissue to be unnecessarily discarded.
Dr. Slama agreed to do this for me, akin to how he used to perform the surgery before deciding scrotal skin "looked bad," as I stated that I understood his aesthetic concern but I would actually prefer the aesthetic of having my labia majora fully made of scrotal skin instead of mainly just groin skin. I also stated that I was comfortable with the likelihood that it would make the procedure take a little longer, as Dr. Slama would be creating my labia majora by himself rather than have Dr. Munarriz do part of them as they normally would, since Dr. Munarriz had never performed this version of the surgery. I asked if there would be any additional difficulties for him doing it this way, but he said no, that it was actually very simple, basically one cut instead of two. He said he would put a note in the system about this for me for when I scheduled for surgery. He also told me that if I changed my mind, I should just specify that I wanted the scrotal skin removal during my consent form signing.
When I scheduled for surgery soon after, the scheduling person told me they had no way to note that
my vulvoplasty (which Boston Medical Center calls "genital remodeling") would not be performed the standard way that Dr. Slama performs them nowadays. They could not find a note that Dr. Slama had left about it. It was put into the system as genital remodeling, as it had been before I came to this agreement with Dr. Slama. But they scheduled me to have a new pre-operative consultation with Dr. Slama to confirm the surgical plan, followed by a separate appointment to sign the consent forms for surgery, followed by a pre-operative consulation with Dr. Ricardo Munarriz, the urologist of the two co-surgeons, who BMC staff had neglected to have me meet with for the entire year I had been seeking genital remodeling there. All of these appointments would be on the same day to help streamline the process for me, for which I was grateful.
Two days after these appointments were officially scheduled and confirmed, on October 30th, 2024, I received a phone call from Nurse Pamela Klein, who is the primary patient contact for BMC's GenderCare Center. She was confused that I was now scheduled for surgery, as she had only just been informed that I had cancelled my previous scheduled surgery on October 15th to seek a consulation for vaginoplasty elsewhere. The more exact reality is that on that day I had expressed my desire to consult about peritoneal vaginoplasty with another surgeron in the future. Dr. Slama had come to me and told me that he thought I should cancel my scheduled genital remodeling to consult with the other surgeon first. We had a lengthy discussion about it, during which I reiterated several times that I wanted to proceed with undergoing genital remodeling first before possibly looking further into peritoneal vaginoplasty in the future, because as far as I knew, there were no surgeons would performed full peritoneal vaginoplasty with vulvar aesthetics I liked who I could afford to go to.
That's when Dr. Slama had brought up a supposed risk (which he said had been proposed to him by Dr. Munarriz) that internal scar tissue created during genital remodeling would prevent me from having vaginoplasty later if I wanted to. I did not understand why that would be, as I had never heard or read anything like that. I asked him to explain futher, which he did, but following his explanation, I expressed that I did not think the risk was very significant and I would still like to proceed with genital remodeling that day, especially since Dr. Slama had confirmed that he could create my labia majora himself using all of my scrotal skin, which is the main thing I had wanted in the first place. But rather than leaving it at that, I asked Dr. Slama if he thought I should still cancel my surgery in spite of my convictions, and he said yes. So I agreed to cancel, because I did not feel comfortable insisting on him performing my surgery that day if he was so unsure about it. I confirmed with him that I could still reschedule as soon as I wanted to, and that he would still perform my surgery using all of my scrotal skin as we had discussed, which is when he said he would be putting a note in the system.
I had actually attempted to reschedule immediately that same day, as I had no desire to wait. I had confirmed within a couple hours of agreeing to cancel that the scar tissue thing was a non-issue, that I could definitely have peritoneal vaginoplasty in the future if I wanted to, but also that it would actually be a year before I could consult with the other surgeon.
It made no sense to me to wait more than a year to reschedule when I had a surgical team I trusted already available to perform the vulvoplasty I wanted, which was much more important to me than vaginoplasty anyway. I even sent a message to Dr. Slama's office on MyChart to state that I still wanted to have vulvoplasty with him, that it was very important to me, and that he was the only surgeon I wanted for it. But I had difficulty getting anywhere with the scheduling team for a couple weeks, as they were apparently not expecting me to reschedule so soon, which I thought was weird because my husband (who had been with me for the discussion with Dr. Slama in the pre-op area that day) had literally asked if we could reschedule for the next week and we had attempted to reschedule at the office before we left the hospital that day.
I explained all of this to Pam Klein, who expressed that she understood. But when I described that nature of the surgery I had discussed doing with Dr. Slama and had rescheduled for, she told me that I was just describing his normal genital remodeling method. I told her that Dr. Slama had told me he normally cuts off and discards most of the patient's scrotal skin, but she insisted that was not the case, and that using all of the scrotal skin to make the patient's labia majora was the norm at BMC. This was confusing to me, so I asked if there were other options I was not aware of that I may have accidentally opted into before without knowing. But she said that the only other option offered at BMC was penile inversion neovaginoplasty, which I explicitly did not want since I did not want to have a canal lined with hair-growing skin. I had already confirmed earlier that week with the electrologist I go to that I was nowhere near close to done with genital hair removal, due to the fact that my remaining body hair is almost entirely blonde and both difficult to see and resistant to removal, so even if I had wanted penile inversion, it would not have been a reasonable option. I insisted once again that I did not want a full vaginoplasty for that reason, just a minimal depth vaginoplasty. Pam then said that minimal depth vaginoplasty is considered synonymous with genital remodeling at BMC. So, I confirmed that I wanted genital remodeling with all of my scrotal skin used to make my labia majora, which she again said would be the norm. I asked if I could still confirm this was the case with Dr. Slama himself though. She saw that I had a scheduled appointment with him and told me I could check with him then.
In the meantime, I recieved a call from Meghan McGrath(?) who was a social worker at BMC. She wanted me to give her my therapist's contact information so that she could discuss with my therapist whether I was ready to have surgery. I was confused about why this was necessary, as I had already had my support letters resent, and a phone call with my therapist had not been required before. I gave her my therapist's contact information. They proceeded to play phone tag for a few weeks, until Meghan called me again and told me that she was leaving BMC, so some new person named Micha Martin would now be the one who needed to speak to my therapist. Again, I was very confused why any of this was necessary, as was my therapist.
When I arrived at BMC's Plastic Surgery office for my scheduled pre-operative consultation with Dr. Slama at 11:00 AM on December 26th, 2024, I was surprised to be met not by Dr. Slama, but by a Nurse Practitioner named Marlene Putnam. She told me that Dr. Slama was too busy to meet with me, and that she would now be doing my consent form signing with me. I told her that I actually already had a consent form appointment scheduled with another practitioner named Paul later that day, but she said that was not the case. I checked my MyChart, and saw that the appointment was now gone from my list of upcoming appointments, which had not been the case when I checked the week before. This change was made without anyone informing me. My current appointment was still listed as being with Dr. Slama though.
I decided to proceed with the appointment anyway, since I knew what I wanted and had no plans to change that. But Marlene started off by saying that I was there for vaginoplasty, which immediately threw me off. I told her that, to my knowledge, while the surgery I was there for was technically a "minimal depth neovaginoplasty" it had another name at BMC, though I was not 100% sure what that name would be since it was not the typical way Dr. Slama performed the surgery. She seemed confused and offered to check with someone, but I asked her to wait and let me check my MyChart to confirm that nothing else had been changed without my knowledge. It still said I was scheduled for genital remodeling on January 14th, which was a relief to me. I told Marlene that the surgery I was there for was called "genital remodeling."
I further clarified that that I did not want penile inversion vaginoplasty, since I wanted all of my penile skin to be used to make my clitoral hood and labia minora and all of my scrotal skin to be used to make my labia majora, as I had discussed with Dr. Slama. I told her that I did not want any of my genital skin to be used inside me or discarded. She said that she had been told that I previously cancelled my surgery because I wanted vaginoplasty. I told her that wasn't true, that I had not wanted to cancel that day and only agreed to it because Dr. Slama insisted on it. She asked me to confirm that I understood that I would not have a canal, which of course I did. She put away the consent form for vaginoplasty, and instead just gave me a general consent form for surgery to sign. I read it over to make sure nothing appeared incorrect, and then signed it. I asked her after if there was anything else I needed to sign to have my surgery that way I had described it. She said she would check, left the room, and than came back and told me that they did not have a specific consent form for genital remodeling, just the general consent for surgery.
Marlene then said that she would send down an order for me to have routine pre-op bloodwork again, so that I could have that done before I went to my next appointment with Dr. Munarriz. I agreed that I would still like to confirm the details of my surgery with Dr. Munarriz since Dr. Slama was unavailable, but I was confused because Marlene stated my appointment would be later in the afternoon at 2:00 or 3:00 PM rather than at 1:00 PM as I had previously been told. She insisted that my chart said the appointment would be the later time. I thought maybe this was another last-minute change that BMC had not informed me about, but when I checked my MyChart, I saw that my appointment with Dr. Munarriz was still listed as 1:00 PM. I told Marlene this, but she insisted that was not the case on her end. Then she asked me about my birthdate, which confused me. I did not give a clear answer since I was confused, but my husband (who always attends medical appointments with me now as my healthcare proxy and so he can double-check things medical staff say to me) told her that what she had stated was wrong.
So Marelne turned the computer screen she was using around to face us, revealing that she had been looking at a different patient's chart. The patient in question was a woman named Kathy who was 44 years old at the time and was born in 1980, and was apparently scheduled to consult with Dr. Munarriz about vaginoplasty later that afternoon. I express those details only to make clear that this was a very obvious HIPAA violation, as Marlene effectively gave us a buncch of private information about another person's healthcare. I intentionally did my best to forget most of what I saw, including the patient's surname. At the time, we both immediately told Marlene that it was not my chart. She switched to my chart and said she must have just clicked on the wrong patient when checking my upcoming appointments. She confirmed that my appointment with Dr. Munarriz was at 1:00 PM, which meant we actually had only about an hour to get the bloodwork done.
We rushed down to the blood lab, but when we arrived they told us that there was no bloodwork order for me. I told them that we had literlaly just been with the person who sent the bloodwork order and watched her type it in, but they insisted there was nothing. They said they would call up and asked us to wait. After waiting some time, I went back to the front desk and asked if anything had come theough. They said no, but they would trying calling again. We waited some more, with me becoming increasingly frustrated with all the issues, last-minute changes, and lack of communication. Finally, I went back up to the front desk again and asked if we should just go back up to Plastic Surgery ourselves to ask, and they told us that would probably be best since they weren't having any luck getting through. When we went back up, the front desk there confirmed that no bloodwork order had been put in for me. They said they would call Dr. Slama to have him put in the bloodwork order. That confused me, because I had been told that Dr. Slama was too busy to meet with me for an important appointment that had been scheduled for two months, but apparently he was not too busy to send bloodwork orders for me that should have been someone else's job. I was going to ask if I could speak with him, but then they confirmed the order had been sent down, and we had to rush back down since I was running out of time. This time the bloodwork order was actually received, though they had no explanation for what the problem had been before. So I did that quickly so we could leave for Urology. I only realized afterwards that the explanation was obvious: Marlene had not actaully just switched to the other patient Kathy's chart at the end of my appointment as she said. She had been on Kathy's chart the whole time and had sent the bloodwork order in under her name instead of mine.
When we arrived for my appointment at Urology, I was relieved when Dr. Munarriz actually showed up to meet with me as planned. He also confirmed that I was there for genital remodeling (though I realized later that was only because of the short note that Marlene provided from my appointment with her). He went over the specifics of the surgery with my husband and I. Much of it was familiar to me, but some of it was not. I got the sense that Dr. Munarriz explains things differently than Dr. Slama does. When we got to the part about using scrotal skin for the labia majora, or rather, not using some of it, I explained that I wanted to have all of my scrotal skin used to make my labia majora. Dr. Munarriz reiterated the "aestethic concern" that Dr. Slama had previously discussed with me, and I expressed that I understood that, but I still wanted as much as possible of my scrotal skin to be used to construct my labia majora and not discarded.
I explained that this was something I had already discussed with Dr. Slama, and that I was already rescheduled for surgery on January 14th. Dr. Munarriz said he had no knowledge of any such plan, that as far as he knew I was not scheduled for surgery yet, and that he had not even known I had this appointment with him until that day. All of which was extremely confusing to me, because again, these appointments had all been scheduled for the past two months, and Dr. Slama had told me he'd put a note in the system for me, and no one else had expressed that there were any issues until now. Dr. Munarriz said that as far as he knew, I showed up distraught on October 15th and said I wanted to cancel my surgery. I was upset hearing this, because I had already clarified the situation multiple times. I reiterated what really happened yet again to Dr. Munarriz, and I asked why he had thought the scar tissue from prior surgery would was such a big risk in the first place. But he told me that he actually did not think it was a very significant risk at all, especially from genital remodeling, and that he actually had no experience with it occurring - it was an entirely hypothetical risk. I told him that Dr. Slama had told me to cancel based solely on this supposed risk, and he again prodessed to have no knowledge of that, only that he saw me looking distraught when he passed by (which was when Dr. Slama had told me that he thought we should cancel ny surgery). My husband and I reiterated that having the genital remodeling as I discussed with Dr. Slama that day was very important to me, but Dr. Munarriz refused to discuss it more and left us with the impression that all of it was still undecided.
A day later, on December 27th, 2024 I messaged Pam Klein on MyChart and expressed to her that I was frustrated with all of the last minute changes, staff confusion, and lack of direct communication with me about what what happening with my surgery. I attached a letter I had written with a complete retelling of what happened on October 15th when I agreed to cancel my previous surgery. In it, I also reiterated the reality that I had always said that I wanted vulvoplasty, and I stated that the continued confusion over what I wanted was unreasonable, especially because everyone involved was insisting on talking to my therapist instead of listening to what I was saying. I even mentioned the fact that I had PTSD from prior medical malpractice I had experienced and that it had been a big deal for me to trust the team at BMC so much, and they were now making me worried by being totally unprofessional and uncommunicative. I ended by saying that if Dr. Slama or Dr Munarriz or anyone else had issues with providing my vulvoplasty as I had described it, then they should reach out to me directly instead of sending other people to talk to me or reaching out to my therapist. I asked Pam to give the letter to whoever needed to receive it, and she expressed that she understood my frustration.
On October 30th, Micha Martin called me about connecting with my therapist. I made sure they had each other's contact information. Sometime in the following week, the two of them finally had a phone convversation. My therapist checked with me beforehand what my surgery was called, and I comfirmed that while we had been previously calling it a "minimal depth neovaginoplasty" the proper term for it at BMC was genital remodeling. She later told me that she hadn't even needed to provide that kind of info, that Micha just wanted her confirmation that I was ready for surgery.
On January 6th, barely over week before my surgery date, Pam Klein called me again. She said that the team would be meeting to discuss my surgery later that week, but that there had apparently been something missed during my consent form signing. This made sense to me, since Marlene had been all over the place But then Pam said they needed to know if I wanted scrotectomy or not. I asked her to clarify what that meant, and she told me it meant removal of the scrotum. I told her what I had always said before: that I did not want any of my scrotal skin to be removed and discarded, that I wanted all of it to be used to make my labia majora. She told me again that that was the norm for genital remodeling, which was not what Dr. Slama and Dr. Munarriz had previously told me. I said that I wanted to have genital remodeling without the removal of any of my scrotal skin. She said that would just be normal genital remodeling then. I asked her why I was even being asked whether I consented to scrotectomy then. She told me that it was apparently a new consent thing they were doing for the surgery, to make it clearer to patients that they would not have a scrotum afterwards, since the description of genital remodeling on the GenderCare Center site does not specify that. I thought that sounded a bit weird, because how would the surgery be performed without involving the scrotum? I pointed out that scrotectomy means "removal of the scrotum" and I wanted my scrotum to be used, not just removed. She in turn pointed out that the surgery description lists penectomy, but still involves using the penile skin. I asked if it was because that scrotal skin would normally be used for part of the vaginal canal, and agreeing to scrotectomy meant agreeing to the understanding that you would not have that skin available for vaginoplasty since it would already be used. She agreed that was probably it. But she kept referring to the alternative as "normal genital remodeling" which I thought would make it sound like I wanted scrotal skin removed, since that's what the norm really was. I agreed that I understood I would not have a scrotum after surgery, and that I would not be able to use my scrotal skin for vaginoplasty later, but I wanted all that skin to be used for my labia majora. Pam kept saying that she needed me to specifically say yes or no to scrotectomy. I asked if there was a way she could clarify which option was which with Dr. Slama. She said she could try, but he wasn't available that day, and it might not be possible for her to get back to me with that information until after the team would meet that week to discuss my surgery, which would mean it would be too late and my surgery would need to be rescheduled again.
I kept trying to make sense of the question because to me, normal genital remodeling at BMC involved the removal of scrotal skin, which would be scrotectomy. But Pam was saying that wasn't the case, and yet was still asking me if I consented to scrotectomy after I had already told her I didn't want any scrotal akin removed. I asked what the difference would even be, and she thought that if I said no to scrotectomy it might mean they couldn't operate on my scrotum at all, and my surgery might be cancelled. I didn't want that, so I consented to having my scrotum operated on, explitly for using the skin to make my labia majora, but I asked her to confirm with Dr. Slama that this was the same plan I discussed with him on October 15th. She said she would. She then gave me some other information about consent forms I'd need to sign on the day of my surgery, and reconfirmed with me that I was ready for surgery and had supports. Before she ended the call, I asked her to also confirm what the offical name of my surgery was, since there had been confusion about that.
A week later, on January 13th, 2025, Pam Klein called me again. She confirmed that the team had approved my surgery, that my surgery was set for the next day, that it was the same plan I had with Dr. Slama last time, that the surgery was still called genital remodeling, and that the extra consent request had been just a new formality they were doing. We both agreed that it was unnecessarily confusing. She asked if I had any other questions, and I said no, but I asked if I could still speak to Dr. Slama anout my surgery to confirm the details with him. She said I would be able to speak to him in the pre-op area before my surgery like usual.
On January 14th, 2025, I arrived for surgery with my husband and two friends there to support me. I confirmed with the staff that I was scheduled for genital remodeling. I insisted on my husband being allowed to come into the pre-operative area with me from the start. We first checked in with a nurse, who asked me to confirm what surgery I was there for. I said what Pam had told me to say. After that, one of my friends was allowed in to join us. We then met with the anesthesiologist. I was doing consent forms with him when Dr. Slama arrived. I tried to acknowledge him and finish up quickly. My husband also said hello to him. But he basically just nodded and then turned around and left without saying anything. I finished with the anesthesia consent forms less than a minute after he left. I asked the anesthesiologist if Dr. Slama would come back so I could speak with him. He told me that he surely would and was probably just checking on other things.
Then Dr. Munarriz came to speak with us. He went over some of the urological risks that he had not discussed with me during the pre-op consultation, some of which were really alarming to my husband. But I had expected them, so I was not perturbed. I did ask Dr. Munarriz though why Dr. Slama had still not spoken to me about my surgical plan, since it had been three months. He said it was probably because these genital remodelings are a much simpler surgery (which fit with what Dr. Slama had previously told me about my surgical plan on October 15th). Still, I asked if he could let Dr. Slama know that I was waiting to speak with him. He said he would not, because if Dr. Slama had been there earlier, then he would probably be back soon. My friend who was with us is trans and has has had vaginoplasty herself, and she was annoyed on my behalf that one of my surgeons wasn't speaking to me.
More time passed, and then a group of staff arrived. They said that they werr there to take me to surgery. They asked if I had seen both my surgeons yet. I told them that while I had technically "seen" both of them, I had only had the opportunity to speak to Dr. Munarriz, while Dr. Slama had left without speaking to me. I said again that I really wanted to speak to Dr. Slama to confirm that he knew what the plan for my surgery was, since I wasn't sure everyone else had been communicating with him about what I wanted. The staff told me that Dr. Slama definitely knew the plan for surgery and what I wanted, and said again that it was time for my surgery, so he was probably already in the OR waiting for me. At this point, my first friend has seitched out, and my other friend, her partner, was witnessing this part.
I agreed to be taken into the OR, expecting that I would have the chance for a quick word with Dr. Slama. When I was brought in, someone asked me to confirm what surgery I was there for. I told them that I was told to say I was there for "genital remodeling," but asked them to confirm that meant that all of my available scrotal and penile skin would be used to make my vulva, not a vaginal canal. I believe they confirmed that was the case, but that's where my memory gets fuzzy. I had already been given painkillers and antibiotics. I remember looking for Dr. Slama in the group of masked faces. I thought I had the sense of speaking to someone else after that, but soon after I was told to count down and then unconcious.
When I woke up about a half hour after my surgery ended two hours later, I immediately felt like something was wrong. I was in the PACU, and I asked the nurse attendant if I could speak to Dr. Slama. She said he was busy doing other surgeries, but she would let him know that I wanted to speak to him. I got my phone and let my husband know I was awake. He had just gotten a call from Dr. Slama less than an hour before confirming that everything went well and as planned. He came to wait with me in the PACU. The nurses kept trying to make him leave, but I kept saying he was my healthcare proxy, and we kept refusing to let them make him leave until they gave up. He brought me my meds because I was overdue and it took 6 hours for them to get anything after I first requested it. Around that time, Dr. Slama came to meet with us. EDIT: My husband was not in the room for the whole encounter though - he had left to use the restroom just before Dr. Slama arrived and came back during the conversation.
EDIT: I realized that doubting my memory of any part of this does not help me. So here is what I remember from that conversation:
I was nervous, and immediately asked Dr. Slama: Do I have labia majora fully made from my scrotal skin? He said that my labia majora were partly made form my scrotal skin and partly from my groin skin. I asked why, and he said there hadn't been enough left to use. I had hoped that was just because I didn't have much to begin with, but when I asked, he clarified that he had removed some of my scrotal skin because I had said I wanted that by agreeing to scrotectomy. I told him that was not true, that I had said I wanted to keep all of it, and that Pam misinformed me what agreeing to scrotectomy meant. He countered that he had aready explained it to me himself in October, and that I could not have answered unknowingly, even after I described again how Pam had been giving me contradictory information the whole time and had said she confirmed this with him. I also pointed out that I had not agreed to scrotectomy during my consent form signing with Marlene and when meeting with Dr. Munarriz, but he said neither of them had noted that. I asked if there was any way to get my scrotal skin back and reattach it, but he said it was too late to change my mind and it had already been discarded. And I told him again that I had not changed my mind, that Pam had written down the wrong thing because she didn't understand what she was asking me - I had told her I did not want any of my scrotal skin to be removed. He insisted that I should still be happy regardless because his other patients were happy with him doing this. I asked if I still had full labia majora, and he said that I did - which I interpreted to mean that the remainder of my scrotal skin still covered the area of my labia majora.
It was at this point that my husband returned from the restroom to find me in conversation with Dr. Slama, emotionally distraught and asking him a series of other questions: Do I have a clitoral hood? Do I have a clitoris? Do I have labia minora? He confirmed that I still had these various aspects of my anatomy, and said that I should stop worrying about it and just focus on resting and recovering. Then he left.
I did not explain to my friends that this had happened, partly because I effectively dissociated away from the trauma of it and partly because I believed that what I had undergone was still a "typical" vulvoplasty, the way most other surgeons would perform it. I thought that while some of my scrotal skin had been removed, I still retained the majority of it as my labia majora. For that reason, I spent the first week of my recovery looking at photos posted here by other people who were only a week or two out from surgery, to get used to what I should expect to see when the bandages came off. And between my dissociation and all the painkillers I was on, I managed to convince myself that I had nothing to fear. I had surpressed some of my memories. Others grew fuzzy.
A week later, on January 21st, I went in for my first post-op appointment, which was with Pam Klein because both Dr. Slama and Dr. Munarriz were unavaiable. I got my catheter and bandages removed, and I got my first look at the surgical result. I immediately knew that something was wrong. There was just too little tissue. I asked Pam about it, and she said swelling could disguise a lot of things, but that didn't make a lot of sense since sweeling would make things seems bigger, not smaller. And also she had just noted a moment before that that I had barely any swelling at all. But I tried to put it aside and be patient like I was told.
But after another week, the bit of swelling had gone down significantly, and things looked worse to me, not better. I had my second post-op with Dr. Munarriz and asked him why the scars on the outside of my labia majora had been placed so close to my labia minora. He said they were able to do it that way because I was skinny, and it was ideal because it looked more like natal female anatomy. It did not look that way to me at all. I asked him what I could do about the scars, and he suggested Vitamin E oil, which I had read was actually recommended against because studies show that it doesn't really help and in some cases makes scarring worse. The whole thing was very confusing.
Within a couple days, I started having emotional breakdowns. I knew this was not the surgery I had thought I'd be undergoing that day in January. I knew Dr. Slama had not followed the plan I had discussed with him. But I had already supressed the memory of him confirming this to me. I called Pam to tell her that a lot of my scrotal skin was missing, but she just made me even more scared and confused when she said that some of my scrotal skin was used to make my labia minora and clitoral hood, which made me think maybe some of my penile skin had been removed instead. I called her again about that a few days later, more frantic, but that was equally unhelpful. I then called BMC Plastic Surgery and got a call back from a PA named Alicia Hanau, who looked through my surgical notes and confirmed I'd had a typical genital remodeling / minimal depth vaginoplasty, but said there were some errors or discrepensies in the surgical notes.
None of what I was being told made sense or made me feel less confused. I was sure that I had somehow been opted into the wrong surgery, but Pam had said the only options were genital remodeling and neovaginoplasty. I did not agree to surgery believing that a large amount of my genital skin would be cut off, and Pam had said that skin would be used for neovaginoplasty, which for a few weeks made me believe that I had been meant to have a "minimal depth" (but not "zero depth") vaginoplasty and had messed up the consent form appointment somehow.
Alicia had set up an earlier appointment with Dr. Slama for me, so I saw him that week on February 6th, 2025. By then I was convinced that I had somehow ruined the plan Dr. Slama made for me by saying the wrong surgery name. But when I met with him, he said that neovaginoplasty wouldn't have even been possible with my amount of skin, and that I was indeed supposed to have genital remodeling. He confirmed that my penile skin was intact, though he had some difficulty telling me exactly where it ended and my scrotal skin began. But then he told me they had discarded most of my scrotal skin, and that I had been told this would happen beforehand. I immediately dissociated again from the stress and just went along with it like everything was fine. I was very apologetic and went home trying to be okay with the fact that I had obviously made some terrible decision.
But within a few more days, I was sure that I had not knowingly agreed to this, because I remembered all the previous conversations and confirmed with my husband that he remembered me saying I wanted all of my scrotal skin used for my labia. He had been telling me that he thought it was all there, but I told him that Dr. Slama had told me that most of it was discarded, and showed him the notes Dr. Slama put in my MyChart for the appointment that day which said so. I told Pam this over the phone on February 26th, 2025. I asked her if she could remember the details from the phone call she made to me on January 6th, because I was sure something she had told me had led to this, but she said she couldn't recall and thought it was better that I stop trying to remember past conversations and instead look into revision options.
On February 27th, 2025, I met with Dr. Slama for my fourth (and third original) post-op appointment. Had I not requested for him to speak to me after I woke up from surgery and had Alicia not scheduled the extra post-op for me, I would have gone without speaking to Dr. Slama once in the entire time from October 15th, when he pushed me to cancel my original surgery, to February 27th, a month and a half after he performed my rescheduled surgery. I spoke to Dr. Slama about how upset I was about having nearly all of my scrotal skin removed, and how I needed it fixed somehow because my dysphoria was crushing me. But he just insisted that this had always been the plan and that I had agreed to it.
To "prove" this to me, he showed me photos from the first 5 years of his work from 2017 through 2022, to demonstrate how bad all of his patients looked after he used their scrotal skin to fully make their labia majora. I thought it was kind of fucked up for him to use photos of other people he had operated on to try to convince me to accept what he'd done to me, while also basically insulting those people's bodies. But I said that I actually thought some of them looked pretty good, more akin to what I wanted than what he did to me. He kept talking at me like I was crazy for not agreeing with his personal idea of what a vulva should looked like, and saying over and over how bad they looked. A resident doctor was present during all of this, and Dr. Munarriz was brought in partway through it, too. I said that it looked to me like the issue wasn't the scrotal skin itself but more the way it was placed and the lack of supporting tissue underneath. When I suggested a few of the things that I knew other surgeons did to avoid those issues, Dr. Slama just said that he didn't know how to do that. Which seems to be his response to a lot of things - saying that he doesn't know how to do it, or, sometimes, that no one does it, which I've often found to not be true.
I asked Dr. Slama again why he had retained so little of my scrotal skin when he knew how important it was to me. He just said that he performs the surgery exactly the same for every patient. I in turn showed him other photos I'd found online (some on here) of other more recent patients of his who clearly had a lot more of their scrotal skin left after surgery. Most of them he just said were "bigger" than me, and thus needed more skin. Which just sounded backwards to me. That those with less tissue get to keep less of it while those with more tissue get to keep more of it. Also, it felt like I was being blamed for being skinny. And it was clear that they don't just retain the exact same amount of tissue for every patient. Dr. Munarriz chimed in and said that I probably had more scrotal skin that I would have if I'd have vaginoplasty, to which Dr. Slama made a face and said something like "Ehhh, maybe..." which I took to mean that it absolutely was not so and Dr. Munarriz had no idea what he was talking about. But Pam Klein had told me the same thing - that doing genital remodeling meant more/all of my scrotal skin would be used to make my labia majora. I asked about a future revision again, but Dr. Slama said I should just give up on changing it and accept what I had.
As always, photos/videos will be first, then stories at the bottom.
