Reflection activities worksheet - HE1286
The full resource:
Gender Affirming (genital) Surgery Service
Reflection Activities Worksheet
Acknowledgement:
The primary source of information for this support booklet has been derived from the patient information from Trans Care BC and the Gender Confirmation Centre.
Note: Please remember the information provided here does not replace the information you receive from your surgeon which will be tailored to your individual needs. Recovery time depends on the progress of your recovery and the type of work you do. The estimated duration is given for informational purposes only. We will refer to the Gender Affirming (genital) Surgery Service as “GAgSS” throughout this resource.
Starting Considerations for Reflections
Decisions about having surgery are really important and take time. They take a lot of careful thought and consideration.
We have created this worksheet to help provide some guidance for this process. We suggest you either use this worksheet or copy it into a journal and use it to help create a map of your decision-making path.
Which procedures do I want to consider?
We encourage you to take all the time you need when considering your options and to think about all of the following information. These are big decisions.
Below is a list of strategies that can help you make a decision you feel more confident about. Choose any strategies you like.
Be clear about my options: Identify what surgeries are available.
The GAgSS is able to provide the following surgical techniques:
- Full Depth Vaginoplasty
- Minimal Depth Vaginoplasty
- Metoidioplasty with or without urethral lengthening
- Phalloplasty with or without urethral lengthening
Use the Gender Affirming (genital) Surgery Service (GAgSS) website: this website provides surgery and other patient information resources. The Gender Affirming (genital) Surgery Service – Health New Zealand | Te Whatu Ora
Talk: with whānau, trusted friends, your counsellors and your GP or gender care doctor, and be clear about whether you want them to be a supportive listener or give advice.
Make a pros and cons list: Consider the advantages and disadvantages of each option. (GAgSS website: patient resources and information- Surgery types provided and FAQs)
What-is-minimal-depth-vaginoplasty.pdf
What-is-Phalloplasty-without-Urethral-Lengthening_2023.pdf
FAQs-Phalloplasty-Frequently-Asked-Questions_2023_.pdf
Identify what matters most to me:
- What surgical outcomes are most important to me?
- Thinking about risk, what am I willing to tolerate?
Note: This risk may not be the same as the risk a surgeon, anesthetist or the GAgSS is prepared to undertake.
- What do I understand the risks to be?
- What other factors will influence my decision? (See Choosing your Caregiver and Support people and FAQs for Caregivers and main support people - GAgSS website)
- What changes am I expecting to have in my life if I were to have surgery?
- What do I know won’t change in my life after surgery?
- In what ways is my decision influenced by how others may see or treat me?
- Is there anything else that might be impacting on decision making that I want to further explore or to have some support around?
- How can I help myself to cope if my expectations are not met?
- Are there any procedures that I am now thinking I may want to consider eliminating?
My current genitalia feels to me like (select one):
- The most important aspect of who I am as a person
- A somewhat important aspect of who I am as a person
- Only a small aspect of who I am as a person
- Totally irrelevant to who I am as a person
- What might it be like to go ahead in life without having genital surgery?
Use my skills for managing stress: Draw on my positive coping strategies for dealing with uncertainty or unexpected news. (See “Self-care Activities and Tips for Anxiety” in our Caregiver resources on the GAgSS website and see below “What is within my control –my circle of influence”)
Choosing-your-Caregiver-and-Main-Support-People-Gender-Affirming-Genital-Surgery-Mar-2023.pdf
FAQ-Sheet-for-Caregivers-and-Support-People-Mar-2023.pdf
Gather the facts: Get answers to my questions from the GAgSS website, and my local healthcare providers.
Using overseas sources such as medical tourism websites and relying on anecdotal stories does not provide clear or accurate Aotearoa/New Zealand facts that are relevant to those in New Zealand considering a referral for publicly funded surgery or accepted onto the GAgSS waiting list for a First Specialist Assessment.
Visualize each option: Look at pictures of surgical results, focusing on looking at pictures of people who have a similar body type (and ethnicity and age) to yourself when you are trying to envision this. Imagine what my life might be like with each option. Remember that surgeons in the private sector tend to post photos online of only their best work and results. The picture’s you find online may not provide you with accurate or realistic expectations for you or your body type. (Visualizing life after surgery -see reflections below)
Name my emotions: Check in with myself around my feelings throughout my decision-making process. This helps me take care of my needs. (Naming my feelings -see below)
Talk to myself like a trusted friend: Use encouraging and kind self-talk. Be patient with myself while I make these big decisions.
Journal: Writing in a journal can help clarify our thoughts, questions, hopes, and fears.
Consult with healthcare providers: Share my hopes. Find out what surgeries are recommended for my body morphology*, expectations and goals.
*Body morphology means your own individual variation of physical features and traits due to genetics, aging and lifestyle. This also includes the external appearance of your body, including your body’s shape, size and skin texture, and the internal structures including muscles and organs shape.
Are my expectations realistic that take into account my current medical and mental health and my psychosocial situation?
Ask questions. Share concerns. Listen to information and advice based on medical expertise from within Aotearoa/New Zealand.
Mindfulness: Mindfulness/meditation is a way to feel calm and focused. It can involve quietening the mind by focusing on the breath, body sensations, senses or listening to guided imagery. A calm mind can help us feel grounded when making decisions. (Consider downloading and using a free mindfulness app such as Calm, Insight Timer or Headspace)
What is within my control? What is beyond my control? What is my circle of influence?
Surgical expectations, outcomes and results are impacted by many factors. Some factors are within our control, or inside of our circle of influence. Other factors are beyond our control, or outside of our circle of influence.
Being aware of what’s inside and outside of our circle of influence can help us be more mindful about what we focus on and how we use our time and energy. Here’s a list of factors that can impact surgical expectations outcomes and results.
Circle any that might impact your surgical expectations, outcome or results.
- Genetics
- Current health conditions
- Communicating my hopes or goals for surgery
- Current shape and size of genitalia
- Weight
- Having a medical, mental health, or addiction issue
- Engagement with treatment for managing a medical, mental health or addiction issue
- Wait times for assessments
- Time off work or studies to attend assessments and appointments
- Starting a new job or important study commitments
- Choice of surgeon
- Expressing my questions and concerns
- Reading or writing difficulties
- Wait times for surgeries
- Wait times for other medical/health appointments for progression consideration e.g. diabetes management, hysterectomy, urology.
- Sleep
- Reaching out for support
- Who my supports will be during this process
- Who my post operative caregivers and supports will be at home for 3 months if I have surgery
- Location of the hospital for my surgery
- The amount of money I have for surgery-related expenses
- Requesting financial assistance
- Taking the recovery time off from work or studies
- The finances I will need to cover my ongoing living costs while I am off work or away from studies
- Hygiene
- Nutrition
- Procedures a surgeon will perform
- Rest
- Physical activity
- Having to have hair removal
- Time off work or studies to regularly attend hair removal appointments (for about 1 year+)
- Additional hair removal and other costs and expenses that I have to cover myself
- Following post-op instructions
- Having post-op complications
- Following medication instructions
Look at the factors you’ve circled above. Are they inside or outside your circle of influence? Sort them into the following circles:
-
- Me – things I can directly control through my thoughts, words and actions.
- My circle of influence – things I can’t control but can influence these with what I can control
- Beyond my control or influence - concerns of which I have no control or influence over the outcome
What personal resources can I draw on - what are my strengths and coping skills?
What have I identified as concerns or difficulties for myself?
What are my expectations of the time frame? Are they realistic?
Visualizing life after surgery
When you visualize, you make a picture in your mind of how something might look and feel. Visualizing can help with thinking through decisions about surgeries. Imagine how you might feel for each of the procedures you are considering. Imagine what life might be like.
Here are some scenarios you may want to visualize for each of the procedures you’re considering:
- The travel required
- Visits to the surgical hospital clinic for check-up appointments (post operatively follow up in person appointments continue at regular intervals for 1 year)
- Recovering from surgery in the first 3 months
- The appearance of my vagina as it heals
- The size and shape of my penis as it heals
- Having complications related to peeing as I heal
- Dilating regularly
- Managing a catheter during healing
- Having complications related to peeing that don’t resolve on their own (phalloplasty and metoidioplasty)
- Managing a long-term catheter due to complications from urethral lengthening (phalloplasty and metoidioplasty)
- Numbness in my donor hand or wrist (RFF patients)
- Having visible scars
- Numbness or hypersensitivity in my genitals
- Loss or change in sensation
- Difficulty walking during recovery
- Having less energy during recovery
- Recovery taking longer than expected
- Asymmetrical genital appearance
- Feeling satisfied with appearance and depth of my vagina
- Feeling dissatisfied with the appearance and depth of my vagina
- Feeling satisfied with the size and shape of my penis
- Feeling dissatisfied with the size and shape of my penis
- Needing unexpected revision surgeries
- Managing the post-operative blues
- How I’ll feel in my underwear
- How I’ll feel naked
- Using bathrooms and toilets
- Being in open change rooms
- Being physically active (running, riding a bike, playing sports, etc.)
- Feeling aroused
- Masturbating
- Being sexually active with others
- Adjusting a penile implant or external device
- What else do I think will change in my life after surgery?
- What else can I think of that will not change in my life after surgery?
How do the options compare?
Reflection activities
Naming my feelings.
Making decisions around genital surgery can bring up all kinds of emotions. Feelings are information from your heart and your body that can help you decide what to do. Naming emotions can make them feel less overwhelming. Talking to other people about what you’re feeling can also bring relief and help you cope better.
Reflect on the emotions you’re experiencing as you explore genital surgeries.
Anger Anxious Belonging Blame Curious Disgust Disappointed Embarrassment Empathy Excited Fear/Scared Frustrated Gratitude Grief Guilt Happy Humiliation Hurt Jealous Joy Judgment Lonely Love Overwhelmed Regret Sad Shame Surprised Vulnerable Worried
This list is based on the List of Core Emotions by Brene Brown (2020) Available from: Resources | Brené Brown
Pick a feeling that’s hard for you. Consider the following questions in relation to genital surgery. When I feel ______________________________________________
- Where in my body am I physically feeling this?
- What do I notice?
- What’s the first thing I want to do when I feel this way?
- How can I show myself empathy and compassion when I feel this emotion?
Closing reflections
After considering everything, do I still want surgery?
What procedures do I now want to eliminate?
What are my biggest hopes about surgery at this time?
What are my biggest concerns about having surgery at this time?
Timing is also an important consideration for surgery.
You may be heading off to school, starting a new job or have other important life events. Commitments like these make it difficult to accommodate the down time (with associated financial costs) to recover from surgery. Picking the right time for surgery is just as important to your recovery as managing and maintaining your physical and mental health and wellbeing.
When is the right time, should I decide I want surgery?
Looking over what I have written, Is now the right time?
What would it be like if now is not the right time - what changes do I need to make to be ready for surgery?
How do I see it impacting my wellbeing and daily life if surgery doesn’t happen at this time?
What are my coping skills and strengths that starting now I can begin building upon even further, to additionally strengthen my resilience and stress management?
Do I have any other concerns, questions or thoughts?
We hope you find this reflection worksheet to be a useful tool. We are constantly working to update and improve our resources to better suit your needs. We welcome any feedback you wish to provide.
Gender Affirming (genital) Surgery Service Team National Specialist Services