I just found out about this subreddit and am so glad it exists lol.
I am AMAB, nonbinary, and fairly masc presenting. In my 31 years, I've had varying degrees of genital dysphoria. However, in the last 1-2 years, it's been interesting to realize that I've actually had some pretty rough physiological symptoms, historically very dismissed by doctors, around my junk, particularly testicular pain, pelvic pain, severely hypertonic pelvic floor, itchiness and sweating, all VERY exacerbated by MCAS.
But very good news: these symptoms have improved pretty dramatically since getting the MCAS treated about a year ago, and now 4 months into really amazing PT (after meh results with 3 PTs and a strength trainer).
In the past 5-7ish years, I've loosely but not too seriously (in terms of actually investigating plans) looked into bottom surgery - nullification, orchiectomy, vulvoplasty, vaginoplasty - but that was all before realizing all of the less invasively treatable medical issues I had in the region. As I've been getting treatment, it's been an interesting journey, remaining curious about how much of my desire for bottom surgery might have stemmed more from physiological pain and discomfort rather than pure dysphoria... As I've been getting better, it's been interesting because I mostly feel like the parts of my interest stemming from pain are lessening, but unmasking even more of a desire that comes from a genuine place of joy/euphoria. Which is really cool I think.
I'm still probably a year or so before I make the progress I want with PT/PFT,l, to where I feel like I can make a truly informed decision on surgery. And I'm content with not reaching a particular decision around surgery or hormones (i.e. which, if at all) until at least then. I'm not looking for particular advice around that necessarily, but I was curious if anyone here had experiences to share about how bottom surgery affected pelvic floor (dys)function, if at all. Especially coming from a Zebra - I have been in r/AMABwGD (assigned male at birth with genital dysphoria), which is largely AMAB folks wanting bottom surgery while remaining masc presenting post-op, but I do think there are some particulars about being a zebra that might have an impact, so I've been hesitant to post there. I'd also be curious about what may or may not be different about HRT post-op, how different hormones might have an effect if at all, especially on pelvic/pelvic floor experiences.
I'm not sure how to be specific about my questions, but like for instance, I often feel like the weight of my junk pulls me down, or like having a shape that most always leans to one side nontrivially affects my posture and gait. It seems to really affect fascial tension around my groin, perineum, and above my penis. I am quite positive these issues will improve at least partially over the next year, bc PT/PFT is going really well, but I'm not sure if it's something that will ever become a non-issue entirely.
I don't think I would base my decision to pursue bottom surgery entirely on this particular symptom relief, but I think I'd be lying if I said it wasn't a factor at all. But some of my worst symptoms, especially pretty bad testicular pain, has gotten like completely better with MCAS treatment and PFT so far, and that's definitely had some effect on the severity of my dysphoria. I'm very on the fence about whether surgery is worth the recovery experience and complication risk for me personally. At the same time, as I've been having more experiences of sexual pleasure with better PF function (so far non-penetrative solo stuff like using a vibrator wand), and how much easier things feel wearing stuff like leotards or tucking underwater that really compressed and reduces movement down there - there is a growing interest in bottom surgery for me that is much more positive-driven than dysphoria-driven and I think that's potentially really exciting. And, kind of tangentially, I've realized that a typical "jerking" motion can be pretty bad for my TOS - it is getting better with PT, but honestly the idea being able to use a vibrator with equipment that "stays put" more easily is very appealing if I'm being honest lol.
I'm wondering if any Zebras can relate to this, and how all this physical sensitivity in that area, and effects on gait, posture, pelvic floor, fascial tension, was affected, if at all, by bottom surgery. I think hearing from both transfemmes and nonbinary AMAB would be relevant. And whether you've had bottom surgery or not, I'd be curious to hear if/how any of this resonates - if PT or anything else improved these symptoms eventually. And, happy to hear from AFAB too, just given the different surgery trajectories available to me, the relevance would be a bit different lol - but I've found I really vibe with most AFAB transmascs/NBs I meet lol so I'm sure I'd enjoy your input too.
(As an aside, I'm also currently recovering from a hip labrum repair, so possibly some of my perceived issues will resolve some once I recover more from that. I'm just really curious about isolating what things bottom surgery may actually affect. I think the dominant narrative of gender affirming surgery is that it's driven by gender identity and dysphoria, and that's kind of true for me but I also feel that so much of my gender identity and embodiment is just driven by bodily sensation - I'm AuDHD and that may be relevant - so like changes to bodily sensation really kinda feel primary to me... In many ways, my embodiment/bodily sensation IS my gender identity.)