Do u do currective work if it was done out side us and how much is it and is it worth going thru all the pain and surgery again?

Carla

January 20, 2012

Good afternoon Carla,

Yes, we do.  Consultation fee is 250.

Start to prepare a work list with photos.

Thank you for your interest in what we do.
Hope you like what you see.

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

Dear Dr. Reed,

What procedures are you doing for the MTF patients that would like look better in the neo-vulvovaginal area? 

Kaitlin

Good afternoon Kaitlin

Thank you for the clarification.  I owe you.

Internet service down for a few hours, sorry.

Patients usually enter with a work-list of complaints, to which I supplement recommendations to be done at the same time.  After all these patients show and tell to each other (or to a physician) and a good result will inevitably be an asset.

Problems include:  skin laxity which needs to be reduced, an open anterior commissure which needs to be closed, elevated posterior introitus, elevated urethral meatus, meatal stenosis, retained spongiosum urethral rest, lack of sufficient fullness to labia majora, a desire for broader (more leafy) labia minora (which I cannot provide as this is usually a result of not using available penile skin with the initial procedure, an approach I do not do),   adjusting the introitus for a more posterior entry, incising a ring like contracture at the junction of the inverted penile skin and scrotal graft extension, reducing clitoral size, hooding the clitoris, revising labial scars, inadequate vaginal depth, etc.

Hope that gives you some idea.

Sincerely,

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

i require revision of unsuccessful prior attempt…i would like to primarily address improvements in function and appearance of the external genitalia, at this time. also, what forms of payment do you accept?
Specific_Questions: i have developed problem with ‘priapism’ with competent oxygenation, past several years, near to post-surgical period, there was a loss of whole tip of clitoris, from which some tissue was banked. could phalloplasty technique, and banked tissue, ironically be adapted to reconstruct a clitoris upon remnant penile root inside? do you use methylene blue injection for priapism? i can’t wear any of my jeans, nor my wetsuit… although i’m 57, i don’t appear to be, and i have no issues with bp, cholesterol, diabetes, etc. although i do have fibromyalgia. what would be the cost of such a novel procedure, and what would it be called…?

Muriel

Good afternoon Muriel,

While we do revisions, for tissue banking and regeneration, perhaps write to
Dr. Anthony Atala at Wake Forest Institute, Winston Salem, NC.

Hope he can help with that.  For other aspects of your revision or perhaps
a simulated clitoral body, please confer with us.  In this area we do have
some experience and please see some of our revisions.  http://srsmiami.com/photography-m2f.htmlThere are medications to control the necrotizing effects priapism.

Intracaverous injection of  mehtylene blue certainly has been reported (vide infra)

Response from Allen D. Seftel, MD  http://www.medscape.com/viewarticle/440468

The penis is innervated by both autonomic and somatic nerves. Sympathetic and parasympathetic fibers in the cavernous nerves regulate blood flow into the corpus cavernosum during erection and detumescence. Erection begins with transmission of impulses from parasympathetic nerves and nonadrenergic, noncholinergic (NANC) nerves. This neural stimulus leads to the release of nitric oxide from the NANC nerves and possibly from the endothelial cells. Nitric oxide increases intracellular levels of cyclic guanosine monophosphate (cGMP) in the cavernosal smooth muscle, which relaxes cavernosal tissue, perhaps by activating protein kinase G and stimulating the phosphorylation of proteins that regulate corporal smooth muscle tone. The actions of the parasympathetic nervous system, nitric oxide, and cGMP permit rapid blood flow into the penis and the development of an erection. As pressure within the corporal body increases, small emissary veins transversing the tunica albuginea are occluded, trapping blood in the corpus cavernosum. The erection is maintained until ejaculation, which usually leads to detumescence, via the sympathetic nervous system inducing contraction of the corporal tissue via adrenergic nerves.^[1]

Priapism is a pathologic condition of a penile erection that persists beyond or is unrelated to sexual stimulation and typically involves the paired corpora cavernosa. Priapism is an important medical condition that requires evaluation and may require emergency management.^[2]

Priapism has 2 forms; the most common is low-flow priapism, commonly known as ischemic priapism. It is clinically characterized as a painful, rigid erection absent of cavernous blood flow. Ischemic priapism beyond 4 hours is identified as a compartment syndrome that requires emergent medical intervention. Potential consequences are irreversible corporal fibrosis and permanent erectile dysfunction.

Standard therapy for ischemic priapism includes injection of an alpha-agonist, such as phenylephrine, directly into the corpus cavernosum, to produce contraction of the smooth muscle tissue and achieve detumescence.

Recent studies have shown the efficacy of injecting methylene blue intracavernosally to achieve detumescence. Methylene blue inhibits the activity of guanylate cyclase, thus preventing cGMP formation. This may reverse the prolonged penile erection. Portillo and colleagues^[3] reported on 12 men with priapism, 10 of whom were successfully detumesced with 5 cc of methylene blue solution. Thus, methylene blue may be a first-line option for ischemic priapism.

Happy Memorial Day weekend,

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

Greetings Dr Reed, My name is Velishea.I had SRS in 1981 with a doctor in New York city at the age of 21. Immediately after having had my surgery I had 7 inches in depth. The dilator in those day was a pencil shaped plastic cone and the last inch was tapered. Even though I dilated as instructed, I lost depth. I currently have 4 inches in depth and intercourse is very painful. I went back to my Dr several years and he thought that 4 inches was adequate and I have consulted other Dr here in Houston that tell me the depth that I have is adequate yet intercourse is very painful to the point that I have not had intercourse in over 10 yrs. Aesthetically. the surgery is satisfactory ( it was a two stage) and I am orgasmic. But the depth is a problem one that at my age of 50 yrs old is time for me to resolve it now or accept it. I had a friend that had primary surgery with you and was very happy, and said you were a very honest and talented man, so thought perhaps you might be able to help me. Apart fr

Velishea

Good afternoon Velishea.

Thank you for your kind words.

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.

Yes, we do surgery for vaginal stenosis. Please see

http://srsmiami.com/photography-m2f.html

example # 13/1-3 The attached is a letter we send
to prospective MTF patients which may be of interest.

Our novel approach has been done so far on 8 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

Vecchietti 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 250 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

January 22, 2011

Good morning Cassandra,

We no longer have grant funds to dispose as testicular research was
suspended as few years ago.  Patients who are destitute do not do well
as they have no funds available for continuity of care and they try to skimp
on our recommendations with often disastrous results.

Perhaps here is some good news.  This April as posted on our web-site
http://srsmiami.com/ we are having a promotional offer if you stay at the Baltic Hotel
for your convalescence.

We have noted that 50% of our patients come in with a sponsor.  Could be
a spouse, loved one even Mom and Dad, friend, business partner, or
church group.

For a line of  Medi-credit, please try

Reliance Finance Company, LLC
http://www.reliancemedicalfinance.com/
800-322-6377

orChase Health Advance, USA only
www.unicornfinancial.com

SurgerylLoans.com
1-888-502-8020

or

or,  Canada only.
http://www.medicard.com/

Medicard Finance

or

www.carecredit.com
automated phone application #  is (800) 365-8295

Please be advised any service fees deducted from our check (often 3 to 5%),
will be passed back to you for pre-payment.   Some firms do, and other
do not.   Or think the fee for surgery will in that case be somewhat higher.

This April we are having a promotional offer for those who schedule surgery
during that month and stay at the Baltic Hotel.

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.

Cordially,

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

Very Kind Regards, Skyler

Thank you for returning my email.
 
Yes, I agree that I have unique set of circumstances. I am trying to better understand and get my arms around the reasoning for obtaining written clearance letters, as my GRS was performed 6 years ago and what I am seeking, is corrective surgery to improve the appearance of this area.
 
Please advise if this is still a requirement as I am prepared to move forward with scheduling the telephone consultation with you.
 
Thank you once again for your prompt response and have an enjoyable weekend.
 
Very Best Regards,

Skyler,

November 13, 2010

Good afternoon Skyler,

I am puzzled by your transitioning back which of course happens as there is a 3% incidence of remorse.  Many of these patients lambast their doctors for not using better judgment and rushing them.

We do have prospective patients write who are genetic males, do wish to continue to be regarded as men but wish a vagina. I have not yet operated on such a patient, but typical letters come in usually once every 2 weeks.

Despite letters of clearance for surgery, I find that not all patients under stress are emotionally stable.  In that your life style is a departure from “traditional” transgender patients before I get involved I would at least like concurrence of professional opinion that I am doing a productive and worthwhile surgery.

Will you be using your vagina sexually with an intimate or is it just for autogynephilia (self pleasure to know it is there)?  Why have you lapsed back outwardly into manhood?

Somewhat baffled,

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

This technique is working for us and documented on our web-site http://srsmiami.com/photography-m2f.html See photographic examples…

Vaginoplasty (Male to Female)
Example #13: 13/1-13/3
Patient presented with vaginal stenosis. Her depth was only 1 1/2″. This was recovered with a suburethral approach restoring the pelvic space, and allowing skin to epithelialize in. Her responsibility: frequent dilations to keep the space open for several weeks until new skin could re-line the vaginal vault.

A well known but seldom serious post-operative complication of feminizing vaginoplasty is a vaginal-rectal fistula or perforation of the low anterior rectal wall.

We have closed several intraoperatively and all have healed without incident.

Of those noted post-operatively following stent usage, everyone on conservative management also has healed without the need for diverting colostomy.  One patient did seek surgical consultation
in Missouri, her home state, and colostomy was performed and taken down (reversed) 3 months later and she did well.

Our belief is that if you seek surgical consultation, most likely a colostomy will be proposed as this is a time honored and conservative approach.  If you do elect consultation with a surgeon, please
advise and I will cheerfully confer with your chosen specialist.

My bias is… if you are not septic, or in pain, or do not observe any findings to suggest an abscess or intra-abdominal process, you may do very well with the following conservative measures:

1.  Please cleanse any fecal material noted with a gentle vaginal douche as described in your post-operative discharge instructions. To be repeated as needed.

2.  Stop stent usage unless I can personally see you at the office and review dilation technique. Seeing you at the office is recommended.

3.  Have a bathroom scale at home and take your weight every day or so, and chart this.  If you are losing appreciable weight, conservative treatment will no work, as patients in poor protein balance do not heal well.

4.  Stop all solid foods to reduce any stool formation.  Do ingest a minimum of 3 quarts of fluids daily.

5.  You should consider taking 10 cans of Ensure or similar protein shake everyday, throughout the day.  You can consume anything in the fluid family except alcoholic beverages. Ice cream and jello are also encouraged along with beef and chicken consomme.

6.  You will need to be on about a 2500 calorie diet. 

7.  Additionally, visit a nutriontal  store and get protein powder supplement.  Strive for 175 grams to 200 grams of protein daily.   Please advise if you have any kidney malfunction.  Protein granules may be whey or soy based.  Try a GNC store.

8.  Continue on Vitamin C 500 mg 3 times a day.

9.  Take Zinc supplements.  Zinc sulfate 125+ mg  tablets (or 45 to 60 mg of elemental zinc) 3 times a day

10.  Take arginine supplements which may be helpful.  2 to 3 grams, 3 times a day.

11.  The healing process, typically is first absence of stool in the vaginal area, then passage of vaginal gas only and finally no passage of vaginal gas whatsoever.

12.  Once this end point is achieved, wait an additional al 3 to 4 days, and start a low residue diet which does include some solid foods.

13.  Please  call me whenever concerns arise and periodically to update me on your progress.
Harold M. Reed, M.D.

 My name is Cheryl. I’m new here and exploring options. I transitioned in 2003 and had SRS with Dr xxx in 2004.  I’ve been happy with every aspect of my transition except for losing the “love” of my family and what I consider to be complications immediately upon arriving home following surgery. I called Dr xxx and spoke with him on the phone,  but he was somewhat dismissive and said I just needed to keep dilating and everything would be okay. I’ve been pleased with the aesthetics and I am orgasmic (yay!).

 I continued to dilate, even more than recommended, but the problem never improved. It got to the point where  dilating would cause swelling, which in turn made urinating difficult. I even saw a local urologist who was pleased to take me as a new patient, but he’s unfamiliar with SRS techniques. He found no problem except that I wasn’t able to void my bladder completely. It wasn’t until about a year I made the connection between urinating problems and the sdwelling due to dilation.

 One doesn’t realize just how much they like to pee until they can’t do it well. I eliminated the largest stent from my routine and that seemed to help.   Then some days, the next to largest stent would hurt and cause difficult urination. Eventually, about 24 months post op, I’d given up entirely on dilating. I should mention that at 11 months post op, I met a man, fell in love. He didn’t know my “history” until after we had fallen in love and I told him. I don’t know where I found the courage. That was a tough moment in my life. In any case, he didn’t care, but expressed concerns about “the plumbing already being done.” lol

 A tougher moment in my life was when we discovered, we couldn’t achieve intercourse. Tougher still was the break-up. We tried to remain friends, but it was just too much… mostly for him.

 Anyway, that’s all history. Now, my problem is constriction of the vagina and to make matters worse… my urologist discovered hair growing inside. You can just imagine what this all does for my psyche. Once again, urination is difficult and there’s inflammation around the urethra opening. Why? I don’t know. I’ve been waiting for a week and a half for Dr xxx to return a call.

 It isn’t like you can talk to your neighbor for advice on how they handled these problems. Any thoughts or suggestions would be much appreciated.
Cheryl

Good morning Cheryl,

Thank you for joining our group and your very informative post.

Your report of hair following vaginoplasty and those from Thailand as well is why we have patients get electrolysis before surgery.  “Scraping” in the operating room is not uniformly successful to say the least.

The hair could probably be removed with a few sessions using a vaginal speculum or long beaked nasal speculum and electrolysis. Pulling or teasing with a Kelly clamp might not work permanently and is really not my cup of tea.

You may consider as a conservative approach for vaginal girth enhancement, 2 lateral incisions, avoiding the urethral area, and then yes, you must dilate 6 times a day or more for than 15 minutes until that area is relined with normal
skin.

Glad you are lubricious and orgasmic. Let’s hear what some other savvy members of our group offer.

You will meet many Mr. Right(s) in life, if you are pleasant to be with and can give and receive spiritual love,

Wishing you the best,

Harold M. Reed, M.D.

Brenda

Hi Brenda,

Sorry, I do not believe that information is correct.  An aricle to the contrary was presented at the WPATH meeting in Oslo where biopsies were taken of
neo-vaginas versus natal vaginas and the tissue is still very reminiscent of skin.  In fact there is concern  that estrogen creams are not practical for the
neo-vagina as these cells do not have estrogebn receptors.

None-the-less many doctors will prescribe estrogen creams to treat tissue atrophy problems.

All the best as always,

Harold Reed, M.D.

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