What is colpocleisis?

Many FTM’s will undergo removal of the ovaries, tubes and uterus including cervix.  A subtotal hysterectomy means the cervix has not been removed and really should before one can proceed to colpocleisis.

Colpocleisis involves the removal of vaginal epithelium and subsequent imbrication (sewing together) of the vaginal muscularis (wall).  The vagina is not removed, but the intent of this procedure is to close the cavity, which is helpful to reduce complications from urethral extension following metoidioplasty, namely fistula formation.  The lining of the vagina or mucosa is cauterized ultimately leaving a raw granular surface which is approximated internally with a helically applied suture placed in a purse string like manner. .A drain is left within for several days to avoid fluid collections.  The raw internal surface being approximated adheres together obliterating the cavity.  Complications can include bleeding, infection and conceivably injury to adjacent structures although in my experience this has not happened.  Colpocleisis should be considered an irreversible procedure in that a normal vaginal cavity may never again be regenerated.

Harold M. Reed, M.D. FICS
Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
Founding Member Sexual Society of North America

305-865-2000

What is metoidioplasty?

For construction of a penis, there are 2 approaches: metoidioplasty and (full-scale) phalloplasty.   Metoidioplasty is the simpler and least expensive of the two.  Metoidioplasty is taken from the Greek words, meta meaning toward oidion meaning male organs, and plasty to form.  A metoidioplasty is based surgical release of a clitoris which has been primed on testosterone.  You may reasonably anticipate the outcome based upon the length of the clitoral body and size of your glans clitoris pre-operatively.  In other words, anticipate a juvenile sized phallus at best without ability to penetrate.

 Metoidioplasty with a stand to void urethra has the advantage of being more economical $12,500 (in our practice).   A complete phalloplasty with penile implant providing the wherewithal to penetrate requires several stages and the likelihood that all stages will proceed without any complication or produce a perfect result without an occasional revisions is remote.

Harold M. Reed, M.D. FICS
Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
Founding Member Sexual Society of North America

305-865-2000

Should a suicidal patient undergo sex change surgery?

October 12, 2014

 Dear Dr. Reed,

Hi! I’m Carmelita, i have been born in a mans body and am seeking financial assistants for hormones and a breast job. I have been suicidal and in manic depressed state for my hole life, I am 29 and still living with my parents! I really need assistants with moving forward and being liberated by becoming my natural self. This year of 2014 i claim my life back and my happiness and dreams can be a reality and not a far fetch dream! I almost committed suicide two weeks ago and i’m to the max tired of living a lie, i have an abusive father and a mother from a small town…which comes with small town thinking! If anyone can help me.

Carmelita

Good afternoon Carmelita,

Thank you for your interest in what we do.  Mental stability is essential for patients undergoing major surgery.  Most patients sail on through without any heightened emotions other than gladness.  Some are clearly stressed complying with all the recommendations and discomfort which lasts for a few days and bladder spasms secondary to an indwelling catheter which can last for 12 days (until the catheter is removed).  Medication usually controls this fairly well.

An extreme example of instability is a psychotic break in which rational  patient communication is not working and psychiatric hospitalization is the only remedy.

An example of this occurred in my practice about 8 years ago.  The patient was intent on discharging me from her care, but of course no one else was  able to assume responsibility.  The resolution came when her mother came to the hospital.

My mother had a doctoral degree from Columbia is psychology  and the take home message was, “the best psychologist is an understanding mother.”

With psychiatric meds and Mom by the bedside the patient “came to” and apologized  with baby-like innocence, but that was no fun.  As it turned out she had a brother who was institutionalized for schizophrenia.

I would need to confer with your psychiatrist to confirm your candidacy.

After reading the attached, if you believe I am the doctor  for you, please initiate a consultation over the phone with our office  by sending us your name, address, and telephone number in an envelope along with a check for 250.  We’ll  get started ASAP.  We’ll have a lot to talk about.

This coming year, 2014, we are re-vitalizing our Grant with a slogan  similar to one a few years ago (“the first 10 in 2010″).  Now it is  “the first 14 in 2014.”   So far 3 positions were filled this past month.
October is a promotional month.

Our fees may be slightly lower in that we own our  facility, but that should not be your foremost consideration.  In our office Anne our amiable manager is the brains  behind pa and the maker of deals.  She has my full encouragement without  conferring with me to be extremely generous.

Cordially,

Harold M. Reed, M.D. FICS
Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
Founding Member Sexual Society of North America

305-865-2000

Colonic vagina prolapse (red stop light sign) is not a turn-on

October 12, 2014

Dear Dr. Reed,

Had a colonic vagina MTF sex change in the Far East and yes, have the “red stop light” sign you have mentioned.  Wasn’t told to expect that.  Have enclosed some photos.  Can this be revised?

Melissa

 

Good morning Melissa,

The colonic vagina has a place, I think for revisions where good well vascularized tissue is needed.

As far as lubrication,  followup of our patients has shown most of them have lubrication although no one is saying as abundant as with natal aroused 20 year old female.  However, colonic mucosa does not provide that level of lubrication either, otherwise doctors would not use jelly when doing a rectal exam.  There is also some “foreign” odor down there, not fecal but not vaginal either.

Have looked at your photos and what I see is of course the red stop light sign and also some prolapse (dropping down) of your colonic vaginal wall.  This doesn’t help either.  Are you straining to have BM’s because of chronic constipation?  Frequent coughing or lifting heavy objects.?  Just a thought.

I believe the prolapse has to be resected and hopefully we can bring labial tissue inwardly to minimize if not remove the redness altogether.  We will do our best.  We like happy campers.

Cordially,

Harold M. Reed, M.D. FICS

Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
Founding Member Sexual Society of North America

305-865-2000

Therapist with doctoral degree in Iowa is needed

October 3, 2014

Hi Dr. Reed,

I live in Iowa and our LGBT counselling center is staffed only by LCSW’s, no one with a doctoral degree is there.  I know you said 2 letters one of which is signed by a therapist with a doctoral degree for a sex change operation.

What does a poor girl do in Iowa, where corn stalks out number therapists with doctoral degrees by 10,00 to 1.

Katy

Good afternoon Katy,

Not to worry.  Chances are your therapist knows of a colleague with a doctoral degree even though the therapist is not formally at the center.  What you need to do is once your have the LGBT Center letter, have it faxed to the other therapist so she/he  doesn’t have to reinvent the wheel.

This is  a letter of concurrence not an invitation to put you on the couch for 3 months.

Also look at Dr. Becky Allison site:  http://www.drbecky.com/therapists.html  She has a very organized site with therapists in most countries in the world, and for the States all alphabetized , divided into major cities Therapists abound.  In Iowa I am seeing 3, one in Marshaltown, one in Sioux City, and another in West Des Moines (didn’t say Mons).

We also have a list of 15 therapists in South Florida all with doctoral degree who will do teletherapy.  You can call them to check on fees.

You’ll be fine,

Harold M. Reed, M.D.
305-865-2000

Long work list, but no longer requires vaginal depth

 

From 4 to 6 inches

10/16/2013,  Alicia writes

Hello I am a post opp transsexual. (sex change, done elsewhere).  I have four inches of depth and would like more what options do you offer.
Alicia

On May 5th, 2014  Alicia writes

Hello,  i am including some photographs of my vaginoplasty results for your revision recommendations. As you can see I greatly need more definition of the labia manora and majora as well as creating the complete”diamond shape with them, if you know what i mean.   My largest concern however is the protruding skin below the urethra. This gets worse when aroused.  Also some possible scar removal. What are your recommendations for me to achieve a more aesthetically appealing vagina as well as the cost.

I am no longer wanting the vaginal deepening we had discussed before. Through diligent dilation I have acquired six inches of depth.

Thank you very much,

Alicia

What does this tell us.  That post op MTF’s who diligently dilate with gentle pressure can deepen their vagina.  Good for you Alicia.

(Pretty please, aim for the umbilicus “belly button” do not push down towards the rectum).

Harold M. Reed, M.D. FICS
Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
Founding Member Sexual Society of North America

305-865-2000

10 G offer still exists

Good evening.  The possibility that this offers is almost too good to believe!  I’m fortunate to have a very supporting family, but as the sole breadwinner, there has been no way to save up the necessary funds. I have been trying to stash a nest egg, but as a Mom, the family always comes first.

This would provide a lot of peace for our entire family.  Please consider me, if at all possible.

Biggest hugs,  Lorna

 

October 1, 2014  4 PM

Good afternoon Lorna,

Thank you for your interest in what we do.  Sounds like you are well on your way.

After reading the attached, if you believe I am the doctor for you, please initiate a consultation over the phone with our office  by sending us your name, address, and telephone number in an envelope along with a check for 250.  We’ll  get started ASAP.  We’ll have a lot to talk about.

At this time the 10G vaginoplasty is still available.  The phone has been ringing off the wall.  Consultations with prospective patients are just starting.

You have a dream, we have a mission.
Cordially,

Harold M. Reed, M.D.

1111 Kane Concourse, Suite # 311
Bay Harbor Islands, Florida 33154
305-865-2000

I stand still for hugs, and usually am the last to let go.  Appreciate someone who writes intelligently (like you).

 

 

Will I be moist after surgery

October 1, 2014

Congratulations on your grant for the 10 G vaginoplasty sex change.
My concern is will I be moist down there?

Gabrylle

Dear Gabrylle,

Most of your patients report some to sufficient moisture.  Oral sex before coitus can be helpful as is some lubrication.

We have learned in the past few years, that estrogen receptors are present in penile and scrotal tissue.

For those for wish to achieve even more moisturization, the use of estrogen vaginal creams
may be helpful as it does for older natal women with atrophic vaginitis.  This should be medically
prescribed.

Vaginal moisture is a transudate or product from the capillary bed just under your vaginal skin.
Estrogens enhance capillary development and flow.

Hooping this is of help,

Harold M. Reed,. M.D.
305-865-2000

Can I stay at a friend’s home rather than a hotel

October 1, 2014

 I am planning to have my MTF sex change with you this January..  Do I have to stay at a nearby hotel for 7 to 8 days.  Have friends and family  in Miami.

Scarlett

Good morning Scarlett,

For the first 3 to 4 days after surgery, I would like you to be at a hotel 5 to 10 minutes from our office.  Daddy O is one block away.

If you sound the alarm I need to see you ASAP.   Even just to monitor your vital signs, good idea to see you daily.  Surely if you are stable, out of bed, walking around without difficulty, you can  join your family and friends, and return to our office for followup visits.  That would be a savings to you, and provide a lot more comfortable environment.

We have been allowing this for years.   As we approach the “season” for Miami Beach (the cooler months) make reservations early to get your best prices. Work directly with the hotel and mention my name for a discount.  Be sure to tell them your departure date may be flexible.  They’ll understand.

With every best wish,

Harold M. Reed, M.D.
305-865-2000

Had a metoidioplasty, would like to void standing

October 1, 2014

Dear Dr. Reed

My metoidioplasty was done elsewhere and for reasons of economy did not consider the “stand to void” option.

Is it possible now to upgrade that.  Don’t need all the bells and whistles, but that would be a big psychological boost.

Oleksander

Good morning Oleksander,

Yes we do  stand to void metoidioplasty revisions..  Our approach is to use a buccal graft taken from the inside of your mouth  (side of your cheek).

These procedures always work better if your vagina has been closed (colpocleisis). Has this been done?

Potential complications include fistulas and strictures (seen in about 20% of patients), and this may require secondary repair,  which we would do gratis.

Cordially,

Harold M. Reed, M.D. FICS
Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
Founding Member Sexual Society of North America

305-865-2000