Dr. Reed, Had a male to female vaginoplasty elsewhere and my urinary stream seems to go up not down. I find myself leaning over to keep the urine in the toilet bowl. Jocelyn
Following a male to female vaginoplasty an upward deflection of the urinary stream occurs more frequently than you might imagine. When consulting on the phone with a prospective patient done elsewhere seeking a vaginoplasty revision, I always ask about deflection or upward trajectory of the urinary stream. In a natal female the urinary meatus (urinary opening) is below the pubic bone. Unless the distal male urethra is completely released and brought down to this position it will tend to rise upwards especially if the vaginoplasty technique is penile skin inversion. The penile skin which may be brought down with tension wants to return “from where it came.” On side view external female genitalia are about 30 degrees lower than for a male.
The remedy is fairly simple, open the urethra on the underside so that the opening is below the pubic bone, and flare the opening so that the flow is not constricted. Please see our website srsMiami for before and after pictures of male to female vaginoplasty.
Harold M. Reed, M.D.
The Reed Centre for Transgender Surgery | Dr. Harold Reed | Miami
After picture of vaginoplasty revision (patient of Dr. Reed)
After picture of vaginoplasty, note the urethral meatus is well below the pubis
(patient of Dr. Reed)