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Long work list and disappointment following vaginoplasty

Dear Dr. Reed,
Had a vaginoplasty elsewhere about 7 months ago and post-op had a hematoma on the left side.  The skin over it, became frail and sloughed off.  At this time I do not have a clitoris, nor is that area erogenous.  Can induce orgasm after 20 to 25 minutes working much lower.

The urethra swells upon arousal, and my doctor said if that swelling is removed I’ll have urinary incontinence.  The urethral opening seems quite high.  I have hair growing out of my vagina, so dilations are painful.  Lastly I have a noticeable scar where the left labia should be.  Please advise.   Marcia

Dear Marcia,

I am so sorry to hear about these problems.  Most important is your ease of being orgasmic.  This is almost an entitlement if you were orgasmic before surgery.  There’s a saying “peripheral nerves will often regenerate” but this takes several months to sometimes over a year.  If you are making any progress, this is encouraging.  A neo-clitoral bud can be reformed, but without innervation it will not be orgasmically sensate.

If you look at an anatomic profile of a man versus a women, a man’s anatomy is about 30% elevated compared to a woman.  So unless penile skin is released by undermining the pubis, it will tend to want tor return from from where it came and any structure installed in there such as a clitoris or urethral opening will also migrate upwards.

Knowing this, we sometimes offset these structure a little lower and for sure make sure the penis skin is not inverted into the vaginal space under tension.

The potential for bleeding can occur with any operation even with a venapuncture stick for a blood test.  The best time to address bleeding is before surgery with advisories of medications not to take such as aspirin, Advil, vitamin E, herbal medications (Ginkgo biloba, etc), Some doctors prescribe Arnica montana and Bromelain to reduce bruising (about 50% of plastic surgeons I have encountered as do we).  However, If bleeding is noted the best place to stop bleeding is in the operating room.

If oozing occurs after surgery, a figure of 8 or criss-cross Elastoplast or Tensoplast) compressive dressing will usually do the trick.  The purpose of drains is to evacuate blood collections under the skin as this added volume compresses normal blood flow (impairs wound healing) and is a potential breeding ground for infection/abscess.

Bulging of your urethra above the vagina is called a urethral spongiosum rest. Spongiosum refers to the erectile tissue which normally surrounds the male urethra.  A rest is a term referring to a patch of tissue which no longer belongs there. This tissue is definitely distal to the external and internal urinary sphincters so removing it will have no consequence on urinary continence.  With our primary vaginoplasty cases we plicate (place tight circular stitches) on the underside of the urethra to reduce that flow and may do some mild cauterization. This still can be done when your doctor does a revision.

As the scrotal removal results in an excisional scar on each side, some scar is to be expected, but should heal fairly inconspicuously or can be revised.

Hair removal should be done before vaginoplasty. I can send you a picture of a patient done in Thailand with hair growing out of her vagina.  Scraping in the operating room is not always reliable.

So again, I am sorry to hear of all of this this but can relate.  Experience is good especially if we learn from it, or better yet training with a doctor who shows an oncomer what could happen and how to avoid.it.

Please provide a followup.

Cordially,

Harold M,. Reed, M.D.
The Reed Centre for Transgender Surgery – Miami
1-305-865-2000

vaginal-hair

Vaginal hair after simultaneous scraping and vaginoplasty, painful during sex and dilation

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