Their new "vagina" isn't a stretchy, naturally moist mucosa structure, it's inverted skin from the penis. So it wants to shrivel up like any skin tag. Every day for about half an hour, a dildo-like thing has to be inserted to stretch this skin. But it will never stretch like a real vagina or be self lubricating. And fistulas, little eroded tunnels, are frequent between this fake hole and the rectum and urethra. This leads to gross infection and the constant smell of poop. It's a well-known nightmare aftermath and a mercy for this guy that he can't feel most of it.