June 6, 2013
Hello, my name is Maria  I’m a 22 year old girl from Naples in October 2010 she underwent an operation of RCS, unfortunately with bad results both aesthetic and functional. The work to which I have agreed to be subject was unusual and I was presented as a novelty in the field of gender change, even if I agreed with little security.  The technique consisted in taking a small part of the free edge of mucosa from the inside of the mouth and allowed to rise once in the laboratory be put on the walls of the vaginal cavity. The result is little depth, exaggerated secretions, blood loss, risk of closure, if not held in the opening with a brace of rubber always inside, and with adjacent stenosis. So to solve this problem I wanted to be subjected to an intervention with rectosigmoid colon that I know that you made, and together, tweaking the aesthetics of the vagina. From a visit with another doctor are aware of some shortcomings of high severity present in the aesthetics and functionality of my vagina, in fact I was told that he had still remaining corpora cavernosa which are the cause of an unattractive and unfeminine swelling when they are excited, and the urethral meatus in position with respect prefixed to his home and then I was shown and recommended an intervention ileovaginoplastica with contextual ectomy of the urethral bulb, the residues of the corpora cavernosa and urethroplasty, correction of vaginal lips to give to the newly vagina a more harmonious and natural.
I have some basic questions to ask you regarding the operation:
- How long can the intervention?
- How many days is the hospital stay?
- After surgery of the colon remains permanent swelling in the abdomen?
- The danger of this intervention?
- With the intervention of the colon there is risk of closure of the vaginal cavity?
- How deep can you do?
- I’ll have to use mentors in the post-intervention?
- The scar in the abdomen as it is long and wide (cm)? You can disguise via tattoo or even better with laser removal? Exactly how much is hidden from the slip?
- I could send photos of vaginal tweaks done to her?
- There are significant consequences after this surgery?
- The hole of the vagina can be moved higher?
- How much is the price of the intervention?

June 7, 2013

Good afternoon Maria,

Was in Rome a few months ago, also Florence,
and in Arezzo at a medical meeting.  Did not make Naples.
I am not a “lover” of colonic vaginas as there will
be an abdominal scar.  Often one sees
a red “stop light sign” in the perineum which is
colonic mucosa, and there is some peculiar odor.
It has a role as a last resort, and surely I would recommend
it under extreme circumstances.
You also have a very high riding posterior introital lip
rather than a “straight shot” into your vagina.
Yes, we do surgery for vaginal stenosis.  Please see
http://srsmiami.com/photography-m2f.html
example # 15/1-3  The attached is a letter we send
to prospective MTF patients which may be of interest.
The natal female pelvis has many suspensory ligaments and intra-peritoneal
features designed to maintain patency and suspension of the vagina.
The male pelvis does not, and nature abhors a vacuum. Dilation ideally
several times a day are advised if you are not sexually active.
Our novel approach has been done so far on 9 patients
with generally good results, but with one notable surgical
site bleeding complication.
We create the space, pack for one week, remove packing
and allowing your skin to re-epithelialize the space
extending your vagina inwards.  All the time you must be very
diligent with stent dilations to maintain the space and build
upon that.
Other approaches include:
A. The McIndoe procedure (creating a vagina with a skin graft).
B. The Vechietti procedure
A semi-surgical method that takes advantage of laparoscopy to accelerate dilation.
An olive-shaped device, placed at the vaginal opening, is connected
with sutures to a traction device on the lower abdomen. Under
laparoscopic guidance, the traction device is tightened daily,
gradually pulling the olive-shaped device inward to create a vagina.
This takes approximately one week. The device is then removed
and further manual dilation performed).
C. Colonic augmentation.
Requires an abdominal incision and removes part of your bowel
to become a vagina.  May have some unpleasant odors and can
have narrowing at the junction or a red stop light sign in the vulvar area
that will raise questions.  Colonic mucosa is more red than pink.
Lubrication varies, but most doctors who do a rectal exam for
other medical reasons put lubricant on their gloves.  Some patients
swear by it (like it).
Please see http://www.mayoclinic.org/vaginal-agenesis/treatment.html
Each has its pros and cons.
Our fees are 300 for consultation which can be initiated over the
phone.  9000 for surgery to include closure of anterior commissure
if that needs to be done.  Included is use of the facility,
anesthesia and any followup care we provide.  In the unlikely event
of hospital transfer I will provide care there gratis, but you may expect
a bill from the hospital and any consultants who may participate
in your care.
You will be required to purchase 500 worth of medical grade
vaginal stents.  If you are not sexually active you will need to
dilate after wound healing several times a day to maintain
your vagina.   This is also true for MTF patients who never have
stenosis.
Plan on staying at an nearby hotel (the Baltic or Daddy O’s
for a good 10 days post op, so we can start stent dilations
in the office after removal of your packing.

Best wishes and have a productive week,

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