Archive for May, 2008

Should orchiectomy be performed if later anticipating MTF vaginoplasty

Thursday, May 29th, 2008

Hi Missy,

Thank you for your interest in orchiectomy on behalf of a friend.

We do orchiectomy on MTF patients several times a month.  Contrary to what you may have heard, prior orchiectomy does not impede vaginoplasty later on.  The scrotal skin is very elastic and if you visit our web-site
http://srsmiami.com/photography-m2f.html and look at photographic examples 6/1-5, you’ll see exactly how we shape the graft into a tube and apply that tube to inverted penile skin to form a deeper vagina.  On this particular patient, looks like a total length of  7 1/2 to 8″ inches was achieved.

Should a patient having had an orchiectomy later schedule in for vaginoplasty, we will apply 50% of what they paid as a credit to vaginoplasty.

So in effect they had an orchiectomy for $1,250.  I am not sure why some doctors charge so much for orchiectomy, but given that we own our facility could explain the difference in fees.

Just so you know, we do require 2 letters of therapy clearance which can be arranged in Miami initially by tele-conferencing, as this is irreversible surgery.

All the best to both of you,

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

Douching after MTF Vaginoplasty

Wednesday, May 28th, 2008

Douching after vaginoplasty is required and also fun, as it feels good to be clean.  The mechanical aspect of injecting fluid with a reasonable spray that can mechanically remove collections of secretions, devitilized tissue, and bacteria is highly desirable.

Jelly also accumulates in your vagina from stent usage and should be washed out at least every 3rd day or so, once you have healed sufficiently, say 2 to 3 months post surgery.  Those who have had scrotal graft extensions take somewhat longer than simple penile inversions to heal properly.   Suture fragments which do dissolve need to be irrigated out as well.  Many histologic studies comparing the lining of a vaginoplasty to that of a natal vagina show the cell formation is different and while douching may be optional for natal women, my bias is to be a little more directive for post-surgical patients.

We use a dilute solution of warm water, 3 or 4 parts to 1, of a  50/50 mixture  of hydrogen peroxide and betadine (povodone iodine) solution.  Surely if you are allergic to iodine use an alternate product. At the end of the first week, the packing is removed and the first douche is given in the office.  Verbal and written instructions follow. We supply a sterile Toomey 60 cc syringe which can be kept clean and reussed and a sterile 15 French red rubber catheter which can  also be reused.   We recommend douching every day for the first week after packing is removed, then every other day, for a week or so, then every 3rd day thereafter.

If after wound healing is complete and you detect an odor, try a douche.  If odor persists, of course see your doctor.  Having sex?, take a douche sometime afterward to get the semen out of your vagina as it is very antigenic (may cause allergic reaction).  (MTF)

Harold M. Reed, M.D.

Vaginal stenosis after feminizing vaginoplasty

Wednesday, May 21st, 2008

A patient who had vaginoplasty about one month ago, returned complaining of difficulty dilating. Intraoperatively she had a girth in excess of 1 1/4 inches.  EMLA cream was applied for 20 minutes.  A Q-tip size applicator was all she could accept initially and over 1 hour, she tolerated a 5/8″ stent and in the course of the next 3 days will be taken up to 3/4 to 1″ and the rest to be done at home.  Learning how to use the stents and USING them as directed is so important. 

Patients who complain of pain assuming the stents are being passed correctly should start on EMLA cream or Xylocaine 2% jelly ASAP, otherwise atrophy and shrinkage of the canal is predictable.

Harold M. Reed, M.D.

The American Urological Association meeting May 16, 2008

Saturday, May 17th, 2008

In Orlando and already the lecture series has started.  Friday, how to administer testosterone and its safety in older men and in men who have had prostate cancer.

Looking for conferences on vaginoplasty, metoidioplasty, and transsexual surgery in general  but thinly represented at this meeting.

Variant MTF patients

Wednesday, May 14th, 2008

Feminizing vaginoplasty is not always performed for those who clearly wish to leave all vestiges of maleness behind. A few times a week we receive inquires from prospective patients who simply wish to have a vagina. Our approach is in that this is not conventional surgery, and bisexuality is well recognized, 2 letters of clearance are required written by 2 licensed therapists both with doctoral degrees, ideally one being a psychiatrist. (MTF)

Lady had breast biopsy and requests silicone implants

Sunday, May 11th, 2008

Difference between ultimate size is 50 cc. You can do that with today’s implants, as they are not sold in pairs but singly. After any breast implant, the patient under anesthesia is sat up on the table and everybody stands by her feet an offers an opinion as to symmetry and position.

The time to make augmentation mammoplasty right is in the operating room.

Harold M. Reed, M.D.

4 penile implants this past week

Sunday, May 11th, 2008

This past week, 4 inflatable penile implants were installed. Two were the AMS 700 model with inhibizone coating and new MS pump (one touch button begins inflation) and two were Mentor Titans.

All 4 patients have been discharged and will be followed in the office this week. The oldest patient is 91 and very active and passed his cariac evaluation with flying colors, the youngest was 47, who had already 2 MI’s and stents. All patients of course are medically cleared and truly these cases should only be performed in a hospital setting with cardiac fellows available all night long and of course an overnight stay.

Two patients were explant-implants, one had a fluid loss and the other an overly long prosthesis (not my patient originally), one a radio-oncologist.

Harold Reed, M.D.

All four patients are doing well as of 5/21/2008

Which is better a metoidioplasty or phalloplasty

Sunday, May 11th, 2008

Kristina from Macedonia writes:
Dear Kristina,
A metoidioplasty is a lot less expensive and
is very satisfying for many especially those who do not
desire penetrable sexually relations.
Your sensation should be preserved 100% which is
not always true for phalloplasties as there will
need to be a neural hook up. Also with phalloplasties
there is a disfiguring harvesting scar either
on the forearm, or back, or lower abdomen.
But if all works well, you wind up with a normal
adult sized phallus.
If you have a metoidioplasty, this could be later
converted into a phalloplasty, but better to go in the
right direction from the start.
Your call.
Harold Reed, M.D.