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Two patients done last week are doing well.  Each quite attractive,  youthful and with responsible and mature (mentally)boyfriends.  Both had vaginal augmentation with scrotal grafts.  Without that, they would have not easily been able to have penetrating sex.  When a patient starts to ask me as soon as I walk into the room, how am I doing, rather than the other way around, I know she’s well on the road to recovery.  The first on her 3rd post-operative day is already walking aorund the neighborhood.  Told her to slow down, but she is very energetic and aside from a dressing, hard to tell she had quite a bit of surgery.   Also a very subtle observation, she looks and sounds even more feminine than before surgery.  Can’t explain that, but the way she relates to her boyfrioend, I can see clearly this is a woman.  Wish you could be here to see it as I do, but the difference is unmistakable.  Did she have an MTF sex change or did I merely remove some trappings that didn’t belong to her?

Harold M. Reed, M.D.

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, deviltilized 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 afterwards to get the semen out of your vagina as it is very antigenic (may cause allergic reaction). 

Harold M. Reed, M.D.

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.

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.