Yep. Because the massive tomahawk wound right in the taint is an unnatural injury which pretty much is the same as what would happen if one took a circular saw to that area. The body tries to heal open wounds by releasing large amounts of clotting factor and B/T immune cells to fight off potential infections into the area, causing inflammation and swelling as the cells try to figure out how to close this unnatural monstrosity. However, for these people, their wounds are not allowed to heal because it is suposedly functioning as a "vagina". So every day, they have to take a tool resembling a spoon and a small lint roller and forcibly remove any clots, scar tissue, and newly formed bits of flesh developed by the body trying to heal that axe wound, scraping, forcing it open again, and flushing blood into the bathtub with lots of water. As you can imagine at this point of reading, it is EXTREMELY painful, uncomfortable, dangerous, and extremely high risk for septic bacterial infections. And on top of all that, they realize too late that this "vagina" gives them NO sexual pleasure during the act, because they are still male, but their male genitalia had been removed, and this artificial "vagina" simply does not have the natural nerve endings and other things required for sexual stimulation that a natural, biological female vagina has. So they are basically trying to keep a gaping, bleeding, painful, and festering power tool injury open and spending every day at extremely high risk for a rampaging and fast moving septic infection. The stress, excruciating pain, humiliation, and self loathing from having to undergo this hour long procedure of mutilation and torture every single day, for the rest of their lives, also greatly weakens their immune system, making their risk of fatal sepsis even higher.