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Jazz Jennings didn’t exactly have a barrier-free, effortless journey to her final gender confirmation surgery.

The 19-year-old trans rights activist and star of TLC’s I Am Jazz had her first bottom surgery in 2018 after spending many years on puberty blockers. But serious complications required her to get not one, but two corrective procedures afterward.

On the season premiere of I Am Jazz Season 6, fans saw Jazz get her third, and what she hoped was her final, gender confirmation surgery.

But after her surgery with Dr. Marci Bowers and Dr. Jess Ting, the young reality star had another scary complication that led her doctor to suggest yet another procedure in New York. On the season’s second episode, “The Ex-Factor,” a terrified Jazz frantically asked her mom, Jeanette Jennings, for help when she discovered a problem.

Jazz Jennings
Jazz Jennings | Vivien Killilea/Getty Images for GLAAD

The 19-year-old noticed a complication a month after her third surgery

About a month after her third bottom surgery, Jazz seemed to be healing well. Surgeons had corrected the placement of her clitoris, as well as debilitating scarring and other complications.

But one day, Jazz noticed something was off…very off. “Mom! Come up here! Something’s wrong!” she exclaimed as Jeanette bounded up the stairs. “I want you to look at something for me,” Jazz told her mom.

Jeanette seemed just as scared as her daughter. “Your urethra’s supposed to be, like, this tiny little thing,” she told her. “I don’t see a vaginal canal, then, Jazz.”

The women agreed that a “giant bulge” seemed to be blocking her vaginal canal, making both of them worry something was going wrong in the recovery process.

Needless to say, Jazz was more than a little concerned about the strange bulge. “This is freaking me out, because my mom is confused about my urethra, my vagina, and that’s not a good sign to me,” the young advocate told I Am Jazz producers.

Dr. Bowers said she needed another procedure in New York

Luckily, Jazz and Jeanette were able to send a photo of the alarming potential complication directly to Dr. Bowers, who got in touch right away.

“I’m trying not to panic,” Jazz’s mom said, but she admitted she had no idea what could be going wrong. “I have no idea what I’m looking at right now.”

Dr. Bowers said it looked like more tissue needed to be removed. “For me, it looked like there’s some type of bulge or bubble,” she told the I Am Jazz star after examining the photo. “That’s some of the residual erectile tissue. And I think the urethra, you know, that should be a little bit smaller.”

That’s when she had to break the news: Jazz would likely need a fourth surgery in New York City to correct the problem. “If you can stand it, another round of surgery,” she told a shocked Jazz and Jeanette.

The I Am Jazz star was understandably disappointed by the news, especially since she was slated to begin college in a matter of months. “I really thought that after this third round of surgery, things would be smooth sailing, but no,” she lamented. “I was feeling so much more confident in myself and that labia minora would form.”

Jennings’ parents weren’t thrilled by the news

Like her, Jazz’s family had hoped this was the end of the road in terms of Jazz’s journey to a completed gender confirmation surgery. She got the surgeries as early as possible so she could head to college without a second thought.

But Jazz’s mom had to admit that might not end up being the case. “If she needs a fourth surgery right now, I really hope there are smelling salts on the wall, because there’s a good chance I might go down,” Jeanette confessed.

Jeanette broke the news to Greg Jennings, Jazz’s dad, who wasn’t any happier than the rest of the family. The biggest concern for him was Jazz’s education, as the teen had recently been accepted into her two top choices: Harvard University and Pomona College.

“We’re not going to interfere with her education,” he said. Jazz did end up getting a fourth surgery to correct the complications. But it looks like the teen was satisfied with the results in the end. She recently announced she couldn’t be happier with the ultimate outcome of her procedures, despite the obstacles along the way.