NOTE: As you are reading this, please note that I am older, but in very good physical shape. I am an avid trail runner. I could go out and run 18 miles on the drop of a hat like it's nothing. I also have a high pain tolerance and am emotionally very strong. Not too much phases me. So, your experience might be a little different.
I am 54 and have been on HRT for 20 months. I switched to monotherapy with progesterone after 10 months. I had FFS with Facial Team at 15 months. At 16 months I started to consider gender reassignment surgery (GRS). I live in the USA and so I first pursued a surgeon recommended by my primary care provider. However, his specialty is the PIV procedure, and the earliest I could get for a first consult was 1 year out. I wasn't super happy with that, although I knew that it would require a lot of laser hair removal that I could start in the meantime. I made the consultation appointment while continuing to look for alternatives. I had my FFS with Facial Team in Spain in June 2025 and had a very good experience with them. I started looking for GRS surgeons in Spain. I came across Dra. Ana Rodriguez Vega (Dra. RV) during my research. While I found some good information about her practice online,
I think what really sold me was reading a subreddit post on a trans woman's experience having GRS with her. It convinced me to schedule a video consultation, which was in early August.
Dra. RV works with Safe Rebirth to market her skills. Safe Rebirth markets for Dra. RV, as well as other doctors around Spain. My first contact with Safe Rebirth was with Aida. Let me first say that she is wonderful to work with. Aida acts as the liaison between the patient and the doctor. She and her partner Oscar work to help make the process smooth and the experience a good one. Aida helped me set up my video consultation. That included providing instructions on taking pictures for the doctor to evaluate prior to the consultation.
In my case, my pictures showed that I did not have enough elasticity to do a PIV procedure. The doctor recommended a colovaginoplasty. I had read other posts on the
r/Transgener_Surgeries subreddit about colovaginoplasty, and they had me concerned. We did talk through some of that, and the doctor answered my questions and concerns. I felt better after the consultation. And, I did do further research.
The next step was to confirm that I wanted to do the surgery. I again worked with Aida throughout this process. I put down a deposit to hold a spot for my surgery on November 14, 2025. I also started the process of scheduling the pre-surgery tests that were needed. There was bloodwork, an EKG, and a chest x-ray. For me, I am in very good shape. I typically have a resting heart rate in the low 40s because I'm an avid runner. When I did my EKG, my lower-than-normal heart rate of 37 triggered a e-consult with a cardiologist. Since I'm an athlete and had no symptoms that come with a heart rate that low, I was quickly cleared. There was no permanent hair removal requirement for this procedure since it was a colovaginoplasty.
I remember throughout the process,
the gravity of what I was doing didn't really sink in at first. It started to hit me around 5 weeks prior to surgery. The "oh my, things are getting real" feeling set in. That continued for about 3 weeks. I think I finally found peace with my decision then and had no doubts. Deciding to do GRS is a big decision.
Anxiety will likely be there, but you need to trust in the homework you did on choosing your surgeon and in the procedure, you are getting, and trust in your decision that this is what is best for you.
In preparation for the colovaginoplasty, I needed to stop E a month ahead of time. I also had to be on a low residue diet for a week prior. The diet is stuff like scrambled eggs cooked using butter, turkey breast, mashed potatoes, apple sauce, maria cookies, etc. It wasn't as bad as I thought. However, I normally take a fiber supplement and that was prohibited. Not taking that was the toughest. I did have to pack a bento box of turkey and mashed potatoes, and maria cookies for the flights to Spain. You can't rely that the plane is going to have stuff allowed on this diet.
I left for Spain on November 11th and arrived on the 12th. I stayed at the Atiram Tres Torres Hotel that is a block away from the clinic where the surgery would be and where I would spend a week recovering. I would be returning to this hotel after my hospital stay for an additional 10 days. I took the opportunity to get to know where things were, relative to the hotel. I walked over to the clinic. It's just a block away. I walked to the nearby grocery store that is a block away from the hotel, but in the other direction. I walked down towards the main roads. There were some additional grocery stores there, one or two Farmacia stores, and some cafes. This exploring was all on the 12th.
I checked out of the Atiram hotel on the morning of the 13th and checked into the clinic around noon. Oscar met me at the reception of the clinic to walk me through the check in and take me up to my room. Aida joined us shortly after. Geri also stopped by to introduce himself. Geri works sort of as a liaison for the clinic. I think he has a nursing background. He was on communications with Dr. RV, and if you're having problems, then he can help get those resolved. Anyway, the afternoon was quiet. I had a liquid diet for lunch and fasted for dinner. However, in the afternoon, they started giving me some stuff to drink to clear out my colon. There were 2 bottles in the late afternoon and another 2 later that night. I ended up needing a 5th bottle just because things were not quite where they needed to be.
On surgery day (the 14th), I fasted. I did have to take an enema. Around late morning, I showered one last time. I figured I wouldn't get to do that for a while. My surgery was scheduled for 3pm. A nurse came to get me shortly before that and wheeled me down in a bed to the recovery area. Once there, a nurse added a port to my hand. At some point later, a 2nd port was added to my arm but I'm not sure when. The anesthesiologist came by to introduce herself and asked some questions. Shortly after, Dra. RV came by to see me and how I was doing. Shortly after that, I was wheeled into the surgical suite. I shimmied over onto the operating table, and the anesthesiologist began positioning my arms and setting up what she needed to monitor me during the surgery. Shortly after, she started the IV and I was out like a light.
I vaguely remember being wheeled into my room. Once there, the nurses began the dance of keeping stuff flowing into my IV; fluids because I was still fasting, pain meds, and antibiotics. On Saturday and Sunday (days 1 and 2 post op), I spent the days and nights flat on my back and fasting. Surprisingly, fasting didn't bother me. But lying flat on my back did. That was the hardest part. I had a compression bandage that was mostly for my colon incision. It included some kind of underwear like bandage that covered up my bottom. The catheter snaked out one of the leg openings. It was mostly comfortable. The pain meds worked very well.
Throughout the recovery in the hospital, I had no pain. It is worth noting that I have an extremely high tolerance to pain. More on this later.
I spent Monday (day 3 post op) still in my bed. I was able to raise the head end of my bed much more than the 2 previous days. I was conservative on raising it though because it does put pressure on the underwear bandage which put pressure on the surgery area. I was able to start having a liquid diet. Breakfast was just water as I was getting used to having something in my stomach again. Lunch was water, broth, and apple juice. Dinner was more liquids like lunch. This was also the day where they let me put on a night gown instead of a disposable hospital gown.
Tuesday (day 4 post op) began solid foods. Like Monday, they were introduced slowly. Each meal I had more choices. Tuesday was also the first day I was allowed out of bed. The nurses helped me out of bed in the afternoon and I was allowed to sit in a chair on the donut cushion I had brought. If I haven't mentioned it before, I highly recommend a donut cushion. The surgery area is going to be swollen for a while. I'm currently 4 weeks post op and things are still a little swollen. Anyway, I had purchased the cushion on Amazon. It was a rectangular cushion with a round cutout in the center and a depression running front to back. Mine was some kind of foam with a cover that you can remove and wash. Sitting in the chair was great after being in bed for so long. It gave my back a rest so later when I had to get back in bed, my back no longer hurt.
Geri came to see me on Tuesday. He came to take the compression bandage and the underwear bandage off. He had to carefully cut them off. It felt good to get those off. He also checked on the vaginal packing, which remained for the time being. I could now wear underwear with a maxi pad to catch any discharge. The catheter remained and I was instructed to alternate underwear leg holes that it snaked out of each day.
On Wednesday (day 5 post op), I could begin getting in and out of bed by myself. I could also start walking in the hallway on my floor. The floor was not large, so I did laps. I would do 5 laps up and back and then rest for a while. I repeated that several more times that day. It was good to get some exercise and to get the blood flowing after being immobile for so long. Also, on this day I was eating stuff from the regular hospital menu. The food was quite good.
Dra. RV came to see me on Wednesday night. She came to take out the vaginal packing and to instruct me on the first dilation. She was very thorough with the details and answered all of my questions.
I won't lie. The first dilation hurt a lot. This is normal. The process is to inject a mix of saline and betadine solution twice. Then do the dilation using the smaller of 2 dilators the doctor provides. They are some kind of reinforced glass like material and are 7.5 inches long. I use a water based lubricant with some betadine mixed in. The first dilation was just a few minutes. And after the dilation I inject the saline and betadine mixture twice more. All of this is done on the medical equivalent of a “puppy pad”. It keeps the mess to a minimum. Dra. RV provided supplies for doing the dilation during the remainder of my stay. If you do run short on supplies, there is a Farmacia a few blocks from the Atiram hotel that has saline and betadine. It’s only open at night during the week.
On Thursday (day 6 post op), I continued with the hospital food for breakfast and lunch. I also walked several more times. This was also my first time to dilate on my own in the morning. I set everything up like the doctor had showed me and started.
I am woefully deficient on female anatomy, and specifically where the vaginal canal was exactly. I guess I didn't pay enough attention the night before. This was totally on me. Finding the right spot the first time was more difficult than I thought it would be. I kept thinking I found it and was wrong. I eventually found it. Afterwards, I cleaned up and took a shower (after first clearing it with the nurses). That was much better. I did not mention it above, but while in the hospital, the nurses came by and gave me sponge baths every day. So taking a shower was felt so good. After the shower I got dressed in regular clothes. Today is my discharge.
I was discharged in the afternoon. Since I was here for GRS by myself, I had 2 rolling suitcases and a backpack and purse. At discharge, I decided not to wait for help. Oscar volunteered to help move me, but it would mean waiting until 5:30 - 6pm to leave. I was ready to leave right away (around 2pm) if I could. Since my suitcases were rolling, I got discharged and rolled my stuff the block to my hotel. It was not bad at all. I then checked in for my 10-day recovery stay. Once in my room, I unpacked my smaller suitcase and rolled it back to the clinic. I had left the supplies from Dra. RV in my room. I loaded up the supplies in my suitcase and walked out again. I did say goodbye to the nurses this time. I saw many of them on multiple days during my 7 day stay. They were great and I was well taken care of! Many of them speak some English. Some are better at English than others. Communication was never really a problem though. And if there is something you are trying to communicate and you just can't communicate it well enough, the nurses usually can lean on a colleague who is better with English. This is something that impressed me with this visit and my previous visit in June. Language is not much of an issue. It doesn't hurt to learn some Spanish sayings or even just some common words before coming here though.
Once I had all my stuff at the hotel and in my room, I first went to the grocery store a block away for some groceries. I got stuff like bananas, protein yogurt, protein yogurt shakes, cartons of pre-cut fruit (blueberries, pineapple, melons, etc.), salads, maria cookies, lunchmeat, bread, etc. It wasn't fancy stuff for meals, but it will do if you don't feel like going anywhere or ordering in. I bought enough for 2 days at a time. The hotel has a small fridge. The freezer didn't work the best, so no ice cream. I learned that the hard way. The store does sell a roll of 30L trash bags. I used these for two things; first for the trash that the dilations generate and second, I put two down on the bed (overlapping) underneath where the "puppy pad" is put. More on that later. I also bought paper towels to help clean up during dilation. At one point, I also needed more maxi pads. I think the brand was Evax (or Evo) Liberty, and they are like the Always foam #2 maxi pads you can buy in the USA. I had brought Always pads with me, so I was looking for something similar.
After grocery shopping, I set up my bed and space for dilations. I had a room with a queen bed (might have been a king). Since I was the only one there, I set up one half of the bed for dilations and the other half was for sleeping. On the dilation half, I put the 2 x 30L trash bags overlapping a little. The "puppy pad" goes on top of that and you do your dilation with your butt in the center of the pad. I then took one of the nightstands and set up my supplies for dilation. That includes a bottle of saline with betadine mixed in, a box of dilators, a bottle of lube, a tube of betadine gel, and a large 60ml syringe with a thin tube that fits on the end of it. Dilation goes something like this. Put on a pair of latex gloves. Inject 2 x 40-50ml syringes of the saline/betadine mixture into the neovagina. I then leave it sit for 20-30 seconds and then squeeze it out onto the "puppy pad". Take the smaller glass dilator and coat the end with lube/betadine mixture. Put lube on a finger and massage the opening of the neovagina while trying to relax your muscles. It takes some time to get used to it. Try slowly inserting the dilator. I have to put a little pressure on the muscle going across the opening of my vagina. It is still a little tight. I then back off and repeat several times. Slowly, the muscle loosens up, and I can push past it. This has gotten easier over time. I'm now at 4 weeks post op and it takes me about 1-2 minutes of massaging with a finger and then about a minute until I can get the dilator fully in. I'm supposed to dilate for 20 minutes minimum. I've gone as long as 45 minutes, and that was just because I was bored of lying there. I definitely could have gone longer. After dilation, I do another round and inject 2 x 40-50ml syringes of the saline/betadine mixture into the neovagina. I squeeze it out again. And finally, I clean up everything. The "puppy pad" works well to contain the mess that is mostly from the saline/betadine mixture. It does also capture any lube you drop and any secretions from the neovagina. I had a trash bag setup on the floor next to my bed where I was doing the dilation. It made cleanup easy. Every morning, I put the rest of my trash in there, tied it up, and put it out for housekeeping.
Dra. RV provided the dilator kit with two exceptionally good high quality glass dilators. I am on the smaller one now. After 3 months, I move up to the larger one. The doctor also provided a kit of dilation supplies including saline, betadine solution (liquid), betadine gel, medical grade "puppy pads", and a box of latex gloves. I was one bottle of saline short for my stay of 10 days, and so I purchased one additional bottle of saline and a tube of betadine gel from a Farmacia that was 3 blocks in the same direction as the grocery store from the hotel. They were only open in the evenings though. I thought having the supplies was very helpful. It not only gave me what I needed while in Barcelona, but it showed me what I needed to order (from Amazon) so that I had the supplies once I got home. Luckily, I had someone who could receive the supplies at home while I was away.
Dilations did get easier over time. I had playlists on my phone to help pass the time during the dilations. The hotel towels and sheets and blanket are all white. I was super anxious and careful not to get anything on them. I was mostly successful. There were a few leaks here and there. Early on in the 10 days, I did also use a trash bag under my butt when I was sleeping. The maxi pads did a good job, but occasionally, I had a leak. That was mostly from not squeezing out all of the saline/betadine mixture after a dilation. As the days went on, I got better control of the muscles around my neovagina and was able to squeeze it all out. No more leaks.
While at the hotel, I took advantage of the breakfast buffet for an additional cost. It was a little different than the breakfast foods I am used to in the USA. They did regularly have fruit juices, scrambled eggs, bacon, and some kind of sausage. There was also fruit, cheeses, meats, sometimes salmon, toast, sometimes mini waffles. It was very good and the attendants kept the various foods well-stocked. There were also some really good Nespresso coffees. It was difficult to sit since everything was still swollen and hurt. It did get better over time but was never really comfortable. I guess I could have brought my donut cushion with me, but I didn't feel like it.
Since leaving the hospital, I did have a catheter. I brought a gray catheter bag I had purchased on Amazon so I could walk around with it more discreetly. It was nice to hide the catheter, and I could usually curl up and hide most of the tubing in the bag. I'm not sure if it was necessary though. I used it for 5 days before the catheter was removed. The catheter was in for a total of 12 days, 7 in the hospital and 5 in the hotel. I guess it's a judgement call whether it is worth having it. I did feel better with it when I walked over to the shopping area to buy some clothes and to have lunch. I wasn't self-conscious about it. I think it was worth it for me.
Having the catheter out was awesome! It does take a little getting used to peeing. I do spray some. It was less about learning how to hold it and more about learning how to relax the muscles to pee. Apparently, learning how to relax the muscles is a more common thing to have to learn. I do smile now when I pee because everything just feels right. I now have the right equipment.
My time in Barcelona went pretty quickly. I did get a chance to walk the 20 minutes down to the L'llia mall. It's a large 3 floor mall with all kinds of stores. And they are good stores. I wanted to do more shopping, but was limited by the room I had in my suitcases. It was worth the walk, and I spent 3+ hours out and about on that excursion. If you have the energy, it is worth it.
On my departure day, I packed up my stuff and loaded everything into my cab. I used Welcome Pickups for my cabs for my arrival and departure. It was an option available when booking my stay at the Atiram Tres Torres hotel. It made everything go smoothly. On my arrival, I did get nervous that I was going to miss my pickup as the passport control line was long and slow. I did make it. Looking back, I would give myself extra time. If you miss your pickup, either you must pay more for the driver to wait or you have to find another cab. The service does a very good job with the drivers communicating with you before the pickup. We were using WhatsApp to do so, and I was able to keep my driver up to date and vice versa on everything. The cabs were also nice and clean. My departure went smoothly. I flew from Barcelona to Philly (USA) and then to Indianapolis. My connecting flight in Philly was delayed due to it being the end of Thanksgiving holiday weekend.
Also, a lot of people in the Philly airport were sick; runny noses, coughing, etc. Looking back, I should have worn a mask during my trip. I eventually arrived home. I had been "up" for 25 hours at that point.
Not wearing a mask did get me sick. I’ve had this cold now for 1.5 weeks. The coughing has been annoying for dilation. Every time I need to cough, I have to take the dilator out so I don’t hurt myself. It makes dilation take longer. Thankfully, I am now starting to get over it.
At 4 weeks post op, I had my first video checkup with Dra. RV. I send pictures weekly to the WhatsApp group her office setup for me. At 4 weeks, I am now going from 3 dilatations per day to 2 dilations per day. If the latest pictures show that everything looks healed up, I can stop using betadine. She did say I could also then stop the saline and use tap water too. I have a supply of saline that I stocked up on, so I'll probably go through that before I switch to tap water. I should also be able to go from 2 injections before and after dilation to 1 injection before and after. In another month, I get to drop to one dilation per day. The month after that, I get to move to the next size dilator. I’m a little scared of that next dilator.
Overall, my experience was an very good one. I was surprised about how little pain I had, and excited about how my new equipment looks and works. Prior to the surgery,
I was a little on edge about messing with my colon. It ended up being a non-issue. The colon incision area was a little tender during the first week but otherwise was not a problem at all for me. Similarly, the vaginoplasty was also not as bad as I thought it would be.
I am still a little numb and swollen in spots, but that is going away. I had a small patch of skin that was bruised and was expected to be lost. It is not uncommon. It is now growing back and should be fully healed up shortly. The stitches are starting to dissolve/disappear. I am looking forward to things tightening up and smoothing out a little as it continues to heal.
I am not an expert on what everything is supposed to look like down there, but I am happy with my results. I am starting to get some sensation back, and am looking forward to it all coming back. By Valentines day, I should be able to test things out.
I can feel my scrotum tho and the one testicle I have.
i’m scared that nothing can be done about it
still having bottom dysphoria post op is so awful i thought it would get rid of it.
