Just a penectomy without vagina

June 30th, 2010

Hi, Harold! I am planning on scheduling a phone consultation with you in September. We had an email exchange regarding a cosmetic SRS procedure without the vaginal canal. I read your attachment, but I still have some questions regarding what I need to submit before the consultation. I am attending counseling right now and dealing with some non-gender related issues, but it has been two-and-a-half years since my last surgery and all the legal gender changes, so I already fulfilled all the necessary H.Benjamin requirements in the past. Will I need to a change in my current diagnosis from the medical one of “endocrine disorder” to the psychological one of “GID”? That would make no sense to me because I’m already a woman, legally, hormonally, and appearance-wise, and there’s nothing psychologically abnormal about a woman wanting to be like all the other women out there. It would offend me a great deal, but for this surgery I would do anything that needs to be done. Maybe I should let my counselor call you about this? I hope I’m not coming off abrasive, I just want to make sure that I have “all my ducks in a row”, and I also want to protect my psychological peace of mind (I will need it for the surgery :-)   You mentioned something about a psychological evaluation last time. Is that something you still would want me to get done? Please let me know what I need to submit, considering my individual situation, so that we can at least get this process started.

Thanks

Virginia A.
June 30, 2010

Good morning Virginia,

Presently I am in the Carolinas, but we have had on this computer alone about 8 E-mails, a few of which are posted below.

Especially for  unconventional surgery, involving penectomy to conform to a female appearance, 2 letters of therapy clearance are required, one of which has to be written by a therapist with a doctoral degree, as this is irreversible surgery.

This is not to say you need therapy.  Surely your feminine lifestyle is only that much more reassuring.  If you need help finding ualified therapist, we have a list of very experienced therapists who may elect to do the initial evaluation over the phone, to be confirmed by a face to face meeting when you are in Miami.
Sincerely,
Harold M. Reed, M.D.
305-865-2000

 Hi, Harold! My name is Virginia. I first contacted you back in 2008 regarding a possible post-orchi “cosmetic SRS” procedure, without vaginal depth. You were very helpful and accommodating, and you agreed to perform this procedure for me. However, I wasn’t ready to have it done due to financial reasons and, frankly, I wasn’t ready for it just yet. I needed some time to really figure out if it was something that was going to make me happy in the long run. I am ready now, and I would like to get this procedure done sometime in February of 2011.
       Last time, your price quote for my procedure was $10,000, and you said that you would make this a one-time procedure, with a possibility of a touch-up later, if needed. I hope that your current price is similar to the quote you gave me.
       I briefly described my situation to you before, but I don’t expect you to remember any of it :-)   I am legally female (post-orchi), and I am not seeing any counselors right now. I did get extensive counseling therapy for non-gender-related psychological issues while I was attending Boise State University. My current medical diagnosis is “endocrine disorder, unspecified”. So this SRS procedure will be purely cosmetic and it will not have any legal implications, as far as gender change, etc. You did mention last time that in my case, I would be needing a psychological evaluation and 1 counselor letter. Is that something I would still need to provide? If so, what information are you looking for in the counselor letter? My main focus of therapy was childhood trauma, so I’m not sure how that would relate to my surgery. Also, I’m not sure if any of my previous 3 counselors are still working at Boise State.

I would like to get more info on how much I will have to pay for my deposit and the whole timing thing, as well as your availability in February of 2011.
       Thanks,

Virginia

July 27, 2009

Good morning Virginia,

Understand what you would like, but the most sensual appearance will be achieved if you have cleavage between the labia. This can only be achieve by making some vaginal intrusion. You don’t need to have lots of depth.  Even a few inches will work. Of course it is easy to say if you are not planing on penetrating sex, then having hair down there is a mute point, but again, you will look better if you have electrolysis.  In natal women, there is no hair over the clitoral body.

We will attempt to make this a one stage procedure, but if you are seeking an extremely good cosmetic result, there may be a need for a touch up, which we do at no added charge as long as this is done under IV sedation and local.

All the best,
Harold M. Reed, M.D.
305-865-2000

Posted in Feminizing vaginoplasty, MTF, no vagina, orchiectomy | No Comments »

Orchiectomy requested

June 30th, 2010

hello my name is Myrna I am 22 years old, I live in Arlington Virginia, living as a woman since i was 20, I have taken female hormones from i was 20 two years now, i would love to removing the tests. out, and I would like to know the costs and all the information about it, thank you, sincerely, Myrna Lopez

June 30, 2010

Good morning Myrna,

Many thanks for you interest in what we do.

Our fees are 250 for consultation which should be initiated over the phone and also includes your first visit at the office, 2500 for orchiectomy which includes local anesthesia and IV sedation, and my post-operative care and daily visits at the Baltic Hotel.

We recommend you stay there for 2 days afterwards before returning to Virginia.  If you leave with your compression dressing on, you will be quite comfortable.   Typically after orchiectomy, you can reduce your estrogens by 1/3rd
and discontinue spironolactone if you are taking that medication now.

Two letters of therapy clearance are required (one written by a therapist with a doctoral degree) as this is irreversible surgery.  You may also wish to consider sperm banking (just a thought).

We can help with the therapy letters if needed.

Have a pleasant and productive day,

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

Posted in Feminizing vaginoplasty, MTF, orchiectomy | No Comments »

Sh– Happens

June 30th, 2010

Vaginal Rectal Fistula

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.

Posted in Feminizing vaginoplasty, Recto-Vaginal Fistula, Vaginal--Rectal Fistula, Vaginoplasty, Vaginoplasty moisture, Vaginoplasty revision, sex change, vaginal stents and dilators | No Comments »

Labiaplasty and cosmetic vulvar vaginal procedures for natal women

May 26th, 2010

Female genital plastic surgery, a relatively new entry in the field of cosmetic and plastic surgery offers sexual and functional enhancement along with cosmetic improvement for women.  Are the procedures labial plasty and clitoral hood reduction delivering the promise.  Michael Goodson and colleagues report in a large mutlticenter outcome study of female genital surgery in the Journal of Sexual Medicine,  2101; volume 7, page 1565-1577.    258 women and 341 separate procedures were reviewed. including 104 labiaplasties, 24 clitoral hood reductions, and 49 combined procedures.The reasons women give for surgery are 53% to look better, and 32.7% to enhance self esteem, 31% to feel more normal, and 75.7% have discomfort with sex, clothes, or sports, especially chaffing.  Overall satisfaction rates are 97.2% with labiaplasty and 91.2 with labiaplasty when combined with clitoral hood reduction and vaginal tightening (anterior or posterior repair).

The satisfaction rate with linear resection is 96.4% and with modified wedge 95.l7% were nearly identical. Enhancement of sexual function only was in the range of 64.7% and 35.7% of their consorts.  However, enhanced sexual function was for many patients not the primary reason for having the procedure.

Photos of some of our labiaplasty patients and results can be seen at  http://srsmiami.com/photography-f2f.html

Harold M. Reed, M.D.

Reed Centre for Cosmetic Genital Surgery

Posted in Labiaplasty, Vaginoplasty | No Comments »

Hair in Vagina and Contracting Girth

May 25th, 2010

Hello everyone,

 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.

Posted in MTF, Vaginoplasty, Vaginoplasty revision | No Comments »

MTF Vaginal Tissue Becomes like natal?

May 25th, 2010 
Dr Reed there was a study I read about were in they discussed how the inter wall of the neo vagina changes over time and becomes more like that of a genetic
vagina are you familiar with this study if so do you know were I can find it.

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.

--- >

Posted in Feminizing vaginoplasty, MTF, Vaginoplasty, Vaginoplasty moisture, Vaginoplasty revision | No Comments »

How long hormones before breast implantation

May 25th, 2010

Specific_Questions: i would just like to have brest for now.do i have to be on hormones for a year in order do have them?

Rhoda

May 25, 2010

Good morning Rhoda,

The longer you are on hormones the better, at least for 2 years to maximizer your “home grown” results.  As a rule,
you should be one cup size smaller than your mother or sister.

Implants always look best when covered by a sufficiency of estrogen produced breast mass.

If you believe I am the doctor for you, please initiate a consultation with our office by sending us your name, address, and phone number in an envelope and you will receive a call ASAP.  We’ll have a lot to talk about.

There is a lot of information we need to put out to you, as well as answer your all questions and concerns.  This fee provides for followup discussion and covers your first visit at the office excluding laboratory work.

Anticipate we will show you every courtesy.

With kindest regards,

Harold M. Reed, M.D.
305-865-2000
1111 Kane Concourse, Suite # 311
Bay Harbor Islands, Fl 33154-2041

Posted in breast implants | No Comments »

Needs MTF vagina only, possible?

May 25th, 2010

Was wondering if its possible to only get one part changed, i only want to go male to female between the knees you could say, is that possible?     Jeremy

May 25, 2010

Good morning Jeremy,

We receive requests like yours almost daily.  Why not a vaginoplasty?  Will you be sexually active?

If you believe I am the doctor for you, please initiate a consultation with our office by sending us your name, address, and phone number in an envelope and you will receive a call ASAP.  We’ll have a lot to talk about.

There is a lot of information we need to put out to you, as well as answer your all questions and concerns.  This fee provides for followup discussion and covers your first visit at the office excluding laboratory work.

Anticipate we will show you every courtesy.

With kindest regards,

Harold M. Reed, M.D.
305-865-2000
1111 Kane Concourse, Suite # 311
Bay Harbor Islands, Fl 33154-2041

Posted in Feminizing vaginoplasty, MTF, Vaginoplasty | No Comments »

My brother is transgender, is he moving too fast

May 25th, 2010

Hello:
I have a brother that is transgender. He will ultimately undergo vaginoplasty sex reassignment surgery (SRS). He has been on hormones since October 2009. He has only been in therapy since Feb 2009. I am looking to understand if he is moving too quickly along this path or if he is moving about average,  and if it is according to an acceptable protocol or timeline within the medical community for such a transition.
 
1) I have heard that transitions take several years. First the individual undergoes extensive psychoanalysis and therapy. Then that person lives as the intended gender for a period of time. Then hormone therapy is introduced and finally, SRS completes the physical transition. What is the recommended time frame for all of this?
2) How long does a transgender individual have to be on hormone therapy before surgery takes place?
3) Is there a website that I can go to to get more information on the entire recommended transition process? From how long the person needs to be in therapy, to how long hormone therapy should be, to how long to live as the intended gender, to how long and how many surgeries are required to complete the transition?
 
So basically, I’m looking to find out what the general guidelines are for transgender individuals considering SRS? I want to know what is standard practice for physicians. What do physicians require from their transgender patients considering SRS? Do you look for certain things – like how long they’ve been living as their intended gender? What prevents a physician from allowing someone to just jump right into SRS? Like i said, I’m worried that my brother is moving way to quickly and that he will jump into surgery before he is 100% sure that it is right for him. I just want to make sure that he does the transition carefully and correctly. Can you help me?
 
Thank you,
Phyllis

May 25, 2010

Good morning Phyllis,

You concerned is appreciated and shared.  The purpose of WPATH (World Professional Association for Transgender Health) is to establish guidelines for an appropriate transition and is widely respected in the United States, often in Europe and perhaps inconsistently in the Orient.

Minimum requirements are to be living 24./7 in the chosen role, “RLT”  (Real Life Test) for 1 year, but truly most confirm their intentions with a lot more time in grade than that.  The incidence of remorse is about 3 per cent, but could be a lot less with good therapeutic evaluation.

Our office is available for consultation.

With best wishes,

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

Posted in Feminizing vaginoplasty, MTF, Vaginoplasty | No Comments »

Vaginoplasty, how is it done?

May 25th, 2010

Question: Dr. Reed,

MTF vaginoplasty, how is it done and what is the cost.

Roslyn,

May 24, 2010

Good morning Roslyn,

Thank you for your interest in what we do.

We employ the technique of penile skin inversion with scrotal graft extension for added depth (in about 80% of our cases).

Our fee is 13,500 and inclues surgery, use lof the facility,  followup care,  your private RN, ACLS qualified,  an overnight stay, and my followup care.

If you believe I am the doctor for you, please initiate a consultation with our office by sending us your name, address, and phone number in an envelope along with a check for 250 and you will receive a call ASAP.  We’ll have a lot to talk about.

There is a lot of information we need to put out to you, as well as answer your all questions and concerns.  This fee provides for followup discussion and covers your first visit at the office excluding laboratory work.

Anticipate we will show you every courtesy.

With kindest regards,

Harold M. Reed, M.D.
305-865-2000
1111 Kane Concourse, Suite # 311
Bay Harbor Islands, Fl 33154-2041

Posted in Vaginoplasty | No Comments »

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