The Bottom Surgeon (aka The Dick Doctor)

The doctor's surgery was about a block from Regent's Park. He's in private practice and the office was incredibly posh. The waiting room had what looked like 18th century prints, in four colours and several nice sofas. I felt under dressed compared to the furnishings.

The sign in form asked for my credit card details and insurance information. I told the receptionist I was on the NHS and she told me to fill out the other parts of it. I overheard the patients before and after me saying the same thing, so maybe Friday is NHS day.

I went up to the doctor's office, which was smaller and had two oil paintings hanging behind the desk of what looked like impressionistic Parisian street scenes. Rather clichéd art, alas, but hardly the focus of why I was there.

The doctor was a big man and spoke in a relaxed manner. He asked me my height and weight, my allergy information and what musical instruments I play. Have I had any previous surgeries? I told him about the benign tumour I had many years ago and he examined the scars on my wrist. "This is important for this kind of surgery" he explained and then asked if I was right or left handed. "So you want to get a phalloplasty." I said I wanted a meta and asked if I was in the right place. He explained that he calls them all phallos.

I didn't take notes and I wish I had, so some of this is not in the same order as it actually happened. My impression that a meta is only one operation was in error. It's actually three operations, depending on what happens. He said that 2/3rd of people who get it are unhappy later. Skinny people do have the best results, as it sticks out more. He told me about how they move everything they can away from it, to increase the sticking out. Natural dick growth happens over the first four years people are on T. I've only been on it for 3 years. The people who have the biggest dicks starting out will have the biggest dicks at the end.

In the first op, they do a hysto, if the patient is having one, add the waterpipe, move stuff around and build a scrotum. They start out giving the patient two catheters, one through his belly to his bladder and one in his new dick. They take out the one in the dick after a week, because it's irritating, and leave the other one for three weeks, to give the waterpipe a chance to heal before sending wee down it.

There's a 30% chance of developing a leak, either at the tip, which can split or at the base. If there's a leak, they give it a while for the patient to otherwise heal and then try to fix the leak. I've heard elsewhere that this is difficult and doesn't always work the first time.

Then finally, they add in silicon prosthetic bullocks. He opened his desk drawer and pulled out a bag of ovular, squishy balls. He showed me one about the same size as the end of my thumb, above the top knuckle. He said it would be that large and then pulled out another, clear ball and said it would be made of the material in the second ball. The first one seemed small, but it's not like I have a lot of experience with how big they normally are. He said they had to use small ones or it would dwarf the meta-dick.

I gave the material a squeeze. Again, not much basis for comparison, but it seemed kind of firm. If I sat down hard on something, I might bounce a bit. He emphasised how durable the material was, "You can pierce it with a needle or stab it with a knife, and it will be fine," listing several things I hope never happen to me. He took another, much squishier one from his drawer. "I used to use these. They're nice and squishy, but I kept having to replace them when they sprang leaks." I said I appreciated durability.

If I got a hysto at the same time, it would be two days in hospital, assuming that was done lacroscopically. However, the lacroscopic surgeon he works with isn't in London, but a hospital out in the country. I wondered if it was similarly posh to his offices, but didn't ask. That hospital is just off the main line from Paddington, which does not sound like it would be a fun commute while one has a catheter protruding from one's abdomen.

Then, back to work shortly afterwards. All the wounds are in the same area, so that apparently makes things simpler. He talked some about complications, but I've got them all jumbled in my head now. Apparently, smokers have the worst ones. So he's quit operating on smokers. Fortunately, I do not smoke.

He also said that skinny people have the best results, since it sticks out the most and many (but not all) skinny people can wee through their fly. The rest cannot. Which is probably related to the unhappiness factor. This truly makes a very small dick, which is not considered usable for 'normal' sex. However, it is my understanding that it's a dick that has normal spontaneous erections and, provided, one sleeps with yoga practitioners, it's possible to manage to stick it places.

He was generally fairly negative about the meta, so I asked about the normal phallo.

That used to be 4 operations, but they've got it don to 3, he said proudly, contracting his earlier statements about how given the complication rate, one shouldn't get to caught up on the number of operations.

They take skin from the patient's arm or belly and use it make a shape like a sausage roll, attach it to the existing blood supply and hook up nerves. He showed me some photos of post-surgical penises, that he had on his blackberry. They were on the large side, but they looked just like any other dick. (Again, not much experience, although one does see them a bit in pron.) The first was an arm one and the second was a belly one.

Of course, if you use the belly, you don't get any erotic sensation, he explained. "So the belly is out," I said. "Everyone says that!" he said.

He drew some pen marks on my arm, one of which intersected my tattoo. They would take one of two sets of veins and arteries leading to my hand and two sections of skin, leaving only a narrow strip. They would shape the donor skin "like a sausage roll" and sew it on, connecting up my existing blood supply and connecting nerves. They take some of the nerves from my existing dick and connect those up also, so most people get a mixture of erotic sensation and normal sensation. The existing dick can be stuck sort of under the new one, left out on it's own or taken off completely, but that's an extra thing and makes everything somewhat more complicated.

My tattoo would end up part of the waterpipe and not be visible. They replace the arm skin with skin from the patient's bum. "So it comes with a free bum tuck" he said. "I'm 9 stone, I don't need a bum tuck." He said if there was not enough skin on my bum, they could peel the surface off of my thigh and do a thinner layer of skin. Other surgeons do it that way routinely and it can also have a good result. He showed me a photo of a skin-grafted arm.

"Oh, I forgot about the head!" and explained how they built that, but I was thinking of half-peeled thighs and feeling alarmingly like crying, so I don't recall what he said.

He looked at my left arm and tested the blood flow to see if it would be good enough for me to sacrifice half of it. He said it would be fine. They had one patient, about ten years ago, who's hand died, but that guy was a heavy smoker and that probably wouldn't happen to me. Most blood flow problems happen to smokers. Some of them lose their entire penis. He's stopped operating on smokers because of the complications.

He took out a BMI chart and looked up my BMI and said it was a bit low. The layer of fat under the patient's arm skin was what provides girth for their penis. He told me I should try to put on a stone or two. "Not, muscle; fat." Once they made the penis, it would be "diet-proof" but eating more fat wouldn't make it get any bigger either.

He asked if I had a partner and when I said no, he asked if I was looking. They don't do the final stage until the patient has a partner or is looking. He took two devices out of his desk drawer. They were like those fat, ergonomic ball point pens, but half again as long as those normally are. One device just had one of those things and the other had two. He pointed at the single one and said they would use that for me, as I'm thin. Also attached to the devices were small squishy pumps and a bulb, maybe 10% bigger than a kiwi fruit.

The phallic portion would go in the phallus, the pump in a bullock and and the bulb somewhere in my abdomen where I wouldn't feel it. He squeezed the pump a few times. Water comes from the bulb and goes in to the phallic part to make it stiff. When one is tired of being stuff, they squeeze another part of their bullock to release the seal and squeeze the water back into the bulb.

A dick that reliably gets hard and stays hard as long as you want isn't all bad, really. He said the infection rate for adding these devices was 10%. I said this sounded high. He explained this was an achievement compared to the previous rate. The infection can take up to a month to become apparent. After that, one's body forms a protective shell around the devices and starves the bugs of food. they give antibiotics for a few days after the operation and then wait to see if an infection develops.

The devices are fairly complex and fail at 1-2% a year. This is why they don't do that part until the patient has a partner or is looking, he said.

I asked how long I'd be unable to work and he said it would be a month before I could use my left arm again. I don't know if that means actually a month or is like the "two weeks" my last surgeon told me.

He told me to go think about it. They don't want to force people to have operations. Patients need to be sure of what they want. I asked if I called back tomorrow and said I was certain, how long it would be until I would have the operation. "3 to 6 months" he said.

I could have a willy in 3-6 months.

I thanked him for his time and said I would call him after I'd thought about stuff and then went looking for fatty foods, feeling completely freaked out.

. . .

It took me many weeks after the last operation to regain my mental focus, so if I got an operation in the next 3 -6 months, the chances of me actually graduating are quite low. I've already made some sacrifices for this stupid PhD. In for a penny, in for a pound. It would be really stupid to bullocks it up (so to speak) in the home stretch.

If I do not graduate, my plans to stay on in the country are not going to work out very well (unless I could get married, but I suspect a bandaged wiener may impact my ability to find somebody to marry). So I would have to have the operation and then bugger off right afterwards. Given that I'm entitled to NHS coverage on the basis of being a student, taking this and then leaving without even graduating seems more than a little morally suspect. Assuming that I could get all the operations finished before my visa ran out, which seems unlikely.

If I'm trying to get a job right after graduation, which seems wise, it might be problematic to take sick leave right away. My next likely break where I could lay about recuperating is the summer of 2012. Of course, by then, with the cuts, my NHS funding could evaporate. And the massive cuts in university-level arts education may mean that I can't find a job and I have to leave anyway. So a planned delay may well mean starting over in another country or it could very easily mean never. I strongly suspect it means never.

I am literally sacrificing my right nut for my PhD.

And my left one.

The next time I'm in a pub's bog, in a cubicle with no latch on the door, hoping nobody notices that I'm sitting down to wee, I'll be sure to think how fucking awesome my PhD is.

. . .

I feel completely freaked out. Indeed, even if my PhD weren't at stake, and I was certain exactly what I wanted to do, I'm not ready for another round of surgery. My chest still hurts and last week a blob of pus came from what I had thought were healed scars. I need 6-8 months for my chest to settle down before I can call it healed. I know some men do move this quickly, but arm, bum, chest and bits is a lot of things to be healing all at once and my uneducated guess is that this probably increases the chances of complications. An infected dick would be disconcerting, but a numb dick would be a personal tragedy.

Whatever I do, it's a few months of pain and then I'll have the results of it for the rest of my life. I think that provides a useful perspective. I should take time to think, but really, I know what I'm going to do and it's terrifying. However, step one is to wait.