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Preparation for MTF vaginoplasty. 6.5 years of cross dressing, dances, exercises daily

Dear Dr. Reed,

Seriously looking at having an MTF sex change vaginoplasty at the Reed Cenhtre for Transgender Surgery.  You’re in Miami, right?  What All Do  I need to do before the proceedure like i know about the crossdressing i been doing that for 6 1/2 years and im in very good shape i dance and excersies daily. I have no bodly infections or dieases either. I’m just wondering what all I need to do and what is the price of the full surgery too?

Terry,

Good morning Terry,

Please call Anne at the office for affordable vaginoplasty price. Regarding time to do the procedure… feminizing vaginoplasty is certainly not the operation I want to rush through.

Figure about 4 1/2 to 5 hours.  Occasionally we have a tale wind and finish
a little sooner.

Here are some advisories we pass on to transgender women such as yourself.

Thanks for visiting our web-site http://srsmiami.com regarding your male to female transition.

Sounds like you are well on your way.  We have added some new approaches such as scrotal graft for more depth.

We are always heartened and flattered when a patient after careful deliberation over some really great surgeons chooses us.  Anticipate that we will show you every courtesy.

For some excellent savings, be sure to join our adult Yahoo group with over 6500 members including many MTF patients who will help you
http://groups.yahoo.com/group/MTF-SRS-FTM/

You’ll have to do about 10 key strokes to get there but once you are a member logging in is easy.

You may view our web-site under “photographic examples” for our most recent MTF sex change before and after pictures.  We trust this is what you had in mind.

Our technique continues to evolve.    http://srsmiami.com/vaginoplasty/      Photo 2/2, shows clitoral body, glans, hood and lateral sulci (groove formation) in a sexually active patient.  Please compare and contrast this with other photos on the web.   Boyfriend is not included.  Examples 3/1-2 and 10/1-4 are more recent results.

In  November, 2007 was a guest for 2 weeks at the Plastic Surgery Department, University of Gent, Belgium with the noted transsexual team over there to view the latest techniques they employ to obtain their beautiful results.  Transsexual surgery refinements continue to evolve and if there is a better way to do it, you deserve to have it.

January, 2008 and December, 2008 we had a noted urology professor as our guest with extensive experience in transgender surgery and in February, 2008  a plastic surgeon with University based experience also remarkable for his experience and peer reviewed articles.   We had a great time and he’ll be back.

Please understand that these physicians are not licensed to operate in Florida, but their recommendations and experience are invaluable.

In that fees were reduced for those weeks, the schedule filled quickly with a few standbys. As always all reservations are confirmed with a 50% non-refundable deposit, but please do not tender any funds until we have an opportunity to initiate a telephone consultation.

Our fees are posted on our web-site, $14,500 for MTF.  Miami is warm and winters and spring of course are very popular times of the year.

Scheduling of course is done at your convenience.

See if these FAQ (frequently asked questions) are of help to you.

1. Where to start?
In every major city in this country there are therapists and physicians
who will assist you. The best places to start are the web-sites of Dr. Anne Lawrence
http://www.annelawrence.com/links.html,
Dr. Becky Allison http://www.drbecky.com/therapists.html ,
Mrs. DaleLynn Sims http://www.intersexualite.org/English-Index.html
Andrea’s http://tsroadmap.com
2. How do I obtain hormones?
Hormones are helpful to assist in the real life test. If being passable is an important
consideration in your decision to undergo transition, then your first stop is to see a therapist.

Ethical and responsible medical practice would suggest that hormones should only
be prescribed by a knowledgeable doctor such as an endocrinologist, who will
request a letter of therapy clearance, follow you with appropriate lab tests and make adjustments to your dosage as needed.   We also do hormones.

Hormone changes may be irreversible and some very adverse effects may occur
with improper use. Do-it-yourselfers,  beware!

You will need to have a few baseline blood tests performed and be followed every so
often to be sure you are achieving safe and effective levels.

For those in the South Florida area, this service is provided by our office.

3. What are the therapy requirements
for transsexual surgery?
You should have lived in your chosen gender role 24//7 work and play for at least 1 year and have fulfilled the standards of care of the World Professional Association for Transgender Health (WPATH) http://www.wpath.org/uploaded_files/140/files/Standards%20of%20Care,%20V7%20Full%20Book.pdf.   Bear in mind these are guidelines.  Two therapy letters are required are required by our office, one from a therapist with a doctoral degree, could be a psychiatrist, psychologist, sexologist, nurse, or sociologist. The other letter can be written by another therapist who may not necessarily have a doctoral degree, but at least a master’s degree or its equivalent in a clinical behavioral science field. The therapist must be a graduate of an institution accredited by a recognized national or regional accrediting board and have an active license. One of these 2 therapists  has to know you for an extended period of time.

4. What are your fees?
Our affordable surgical fees are posted on our web-site. These are comprehensive fees
which include surgery at our facility, anesthesia, and 24 hours of observation (phase one) at our facility and of course any followup care that I provide. Again, consultation, lab fees, out of pocket expenses for oral medications and the like are not included.

With the new technique, we are endeavoring to do everything in one stage and our fee is now $14,500, to keep pace with our expenses.  In the event your need a scrotal extension for added depth, there is no additional charge.  In the event you require a revision or touch up, after 3 months of complete wound healing, there is no additional charge as long as when done under local with IV sedation.  In the event you require the services of an anesthesia team, the fee is an additional $1500.

In the unlikely event you require transfer to a local hospital, I will continue to follow you there at no charge and orchestrate any needed consultative care. However you are responsible for all hospital bills and consultant fees. If you are approaching surgery without any reserve to cover this contingency, please wait until you are financially more secure or have a line of credit.

We invite you to compare and contrast our fees with other centers.

MTF fees are related to a myriad of procedures which may include breast implants, tracheal shave, and other feminizing facial cosmetic procedures.  We also do breast augmentation..

Submission of medical records or letters must be accompanied by a
check for $250 annotated “for initiation of consultation and review of medical
records.”

In the event you wish to bring medical records and letters with you or simply
request a consultation, anticipate a consultation fee of $250 during your
initial visit.

This fee is not applied to surgery, but remains an independent charge.

While our initial intention has been to spare any profit and welcome aboard new patients,
certainly these fees will be adjusted upwardly within a few months. Still they will be
well below what others may charge in the USA or Canada.

Candidates who wish to secure their reservations with our facilities are required to have minimally letters of clearance and a phone consultation with a favorable response to questions of concern. Assuming this, you will be given the nod to send
in a 50% deposit which is non-refundable.

But of course you can watch and wait as there should not be any dramatic
increases for the next few months.

Please do not undergo surgery without contingency funds to cover unexpected complications, hospitalization, the costs of other consultants, and return visits to your doctor. People who are just marginally getting by should postpone surgery until their resources are more plentiful.

While deposits can be made with a personal check, the balance of payment has to be made either in cash or with a certified bank check such as a cashiers check brought into the office a day or two before surgery by the patient or your surgery will be postponed.
We are not set up to handle credit cards.

We need to meet with you at least the day before surgery about 9 AM (by appointment), ideally 2 days before surgery, to review all your pre-op letters, lab work, exam you, and answer questions.   The day before surgery you will be starting your bowel prep, so traveling on that date is ill-advised.

5. Where is surgery performed and age qualification?
If you are below 60 and in tip-top medical shape (not overweight, exercise regularly, not on insulin) you can be done as an outpatient at our facility with a 24 hour hold for observation. Both an RN and I will be in attendance during this time. Most likely
you would then be transferred to a nearby motel.  There are a few on our preferred list.

We recommend that patients over 65 be done in a hospital setting by others.  We have done a few patients in their early sixties with a sterling letter of medical clearance, a perfect thallium stress EKG, and good height-weight conformation..  If you have any reservations that you may not qualify, please ask before initiating a consultation.

Well controlled diabetics on oral medications can be done at our facility, however, diabetics on insulin need to be done in a hospital environment in other locales, unless as in rare instances there is no evidence of systemic disease and a glycosylated hemoglobin A1C shows excellent control.
.
For  the only 2 motels on our preferred list (where rounds are made daily) we recommend Daddy O Hotel, 3 star.  Daddy O  is located at 9660 E. Bay Harbor Dr, Bay Harbor Islands, FL 33154, one block from our office  (305-868-4141).   Ask for Courtney.  Please make reservations as soon as you obtain a surgical date and specify a room on the ground floor.    Some discount is usually given to our patients.

Less expensive is the tourist class motel� Beach Place Miami, 8601 Harding Avenue Miami Beach, FL 33141 (305) 866-3313.  These hotels are the exception to the concept that doctors don�t make house calls anymore.

Please do clarify “two for the price of one” when making the reservation .

While you are there, I will see you every day and do dressing changes and whatever is needed to keep you comfortable and happy. A catheter will drain your urine. At least
you won’t have to get out of bed to void. On the 7th post-operative day (1 week later) you will have vaginal packing removed, your first douche, suspension sutures removed, and introduced to dilating with stents.. Your may shower. Your catheter will remain indwelling for 5 more days.

6. How long does it take to heal?
You can leave Bay Harbor Islands as a rule on your 7th post-operative day, and return to
an office environment in about 1 to 2 weeks after that.

Please no penetrating sex for a good eight weeks following surgery or until delayed wound healing is complete.

Premature sex can be very traumatic and may open up incision lines and can incite
inflammation and infection, so exercise all due caution and gentility.

7.  Establishing a physician contact to follow you�
in your home town is very important, although usually small problems can be sorted out with E-mail photos.  You should do this before you come to Miami and provide us their name and contact number before you have surgery.   Phone service to me is available
virtually 24/7.

8. Do you require prior hair removal?
Definitely yes. Please confer with us about the areas that need to be done. Essentially you will require complete removal of any hairs on the shaft, and a ring or path around the base of the penis 1 inch wide. If you wish to be pretty, then also have removed any hairs on the scrotum under the “shadow” of the penis down to and around the anal verge. This is optional. Removal of any other pubic hair is also purely optional.

Ideally electrolysis to include all above mentioned areas should be “first pass” completed 3 months before surgery. This allows enough time for a secondary pass 1 month later as some hair follicles may regenerate.

Laser hair removal is OK also. The skill of your licensed technician is more
important than the method is used.

For those with blond or light hairs, please mention Meladyne, an FDA approved cream
which is reputed to darken hairs. Regretfully the experience has been mixed, so confer
with your technician.

Try to get your electrolysis completed a good month before surgery so your tissues have a chance to recover.

9. Also would like to know what your scheduling backlog is like?
Presuming you have fulfilled the WPATH  criteria, we are available every month for the balance of this year.

10.  How soon may I have penetrating sex?
Although you could have penetrating sex within 6 to 8 weeks following vaginoplasty, as you understand, a refinement labiaplasty will be offered about 3 months later.
Your rites of passage include the obligation to insert a vaginal stent or tutor 3 times a day for a 20 minutes for 6 months. You’ll be amazed how in most cases you can pick up an extra inch and a half of depth.  (see FAQ # 13). Safe sex is course an alternative way.
Douching is encouraged starting a week after your vaginoplasty.

11. Will I need a PAPS test and pelvic exams
annually following my surgery?
Perhaps this question has been answered best by Dr. Anne Lawrence (see her full paper)
http://www.symposion.com/ijt/ijtvo01no05_01.htm
Essentially she concludes “cytology examinations (Pap smears) probably have limited value following vaginoplasty. MTF transsexuals should receive annual pelvic examinations following vaginoplasty, but there no evidence to suggest that they would benefit from vaginal cytological screening in most cases. However, if the glans penis
has been retained as a neo-cervix, cytological examination of the neo-cervix is a reasonable practice.”

12. Will I be able to feel the pleasure of intercourse as a woman does
when I have had the operation?
Yes, if there has been a careful preservation of the neurovascular bundle and creation of a clitoris from glanular tissue, orgasm will most likely continue. We are very fussy about this aspect of surgery. Appearance, function, and pleasure are all interrelated.

13. Is there some way that my vagina can always be moist
like 100%…all day long?
Yes, this may be accomplished by inversion of a urethral strip as a part of the vaginal vault or extension of an opened urethra to the base of the clitoris. The provides a natural way to achieve moisture as well as lubrication during sex. Please see “photographic examples” on our web-site.   Patients who simply have penile skin inversion fare quite
well also, and we are starting to re-think whether the extra time and somewhat enhanced potential for complications makes urethral strip inclusion really worthwhile.

14. Do you also provide a surgery in which I will obtain breasts?
Yes, our all inclusive fee is $5,000 for saline implants.
Silicones are $6000.. Please see our photographic examples on our srsMiami web-site.

While some doctors do both procedures at the same
time, I think that may be a little too adventuresome and would caution you to stage that either as an independent procedure or reserve breast augmentation for the time of your labiaplasty.  As you know, estrogen therapy will feminize your breasts.
For some MTF patients, that end point is a good resting place.
It has been recommended that you be on hormone therapy for at least 24 months before insertion of breast implants.

We use the Tebbetts’ formula to determine the appropriate size. That is large breast prostheses can only be put in if there is enough home grown breast tissue to cover.  Also please keep in mind, very large breasts, natural or prosthetic, are prone to droop in 6 years or so, and you’ll be back on the table for a lift.  These incision lines as contrasted with a small initial incision are not all that pretty.

15. Do you perform tracheal shaves?

Tracheal shave surgery is performed by others.

16. Can you make a man have sex organs that can reproduce offspring
and go through a period every month?
Perhaps in the future.

Uterine transplants are being done in New York Downtown Hospital on natal women.
Tap in msnbc.com to research this subject or view

http://www.msnbc.msn.com/id/16532785/
http://www.msnbc.msn.com/id/16637583/

More uterus transplants to begin in U.S.   Mother of 3 adopted children is first U.S. uterus transplant recipient as per http://www.cnn.com/2016/03/07/health/uterus-transplant-first-u-s-patient/index.html

“We anticipate she’ll be here for a month or two … then she should be able to have a normal life,” said Dr. Andreas Tzakis, director of the Cleveland Clinic transplant program and the lead investigator of the uterus transplant clinical trial there.
Lindsey’s normal life will include taking anti-rejection medication and returning to Cleveland for monthly checkups until she is ready to become pregnant.
“Uterus transplant is not just about a surgery and for moving a uterus from here to there. It’s about having a healthy baby, and that goal is still a couple of years away,” Cleveland Clinic Ob-Gyn surgeon Dr. Rebecca Flyckt said.
Lindsey has uterine factor infertility; she was born without a uterus but has normal ovaries that produce healthy eggs. She is not alone, according to Dr. Tommaso Falcone, chairman of the Cleveland Clinic’s transplant center and an Ob-Gyn surgeon. One in 5,000 women are born without uteruses. But not all of the women selected for the trial have this condition. Some have a uterus that is not working properly or that has been removed.

Prior to receiving the uterus, Lindsey underwent in vitro fertilization so she and Blake could bank about six to 10 embryos. Doctors will wait at least a year before they consider transferring one of those embryos into Lindsey’s transplanted uterus. The wait will allow her doctors to reduce the amount of anti-rejection medication she is taking. Only one embryo will be transferred at a time.
Flyckt said each patient in the trial can have one to two babies, to be delivered by cesarean section, and then the uterus will be removed, so the patient doesn’t have to keep taking anti-rejection drugs.
Uterus transplant recipients cannot become pregnant spontaneously, Falcone explained. That’s because the fallopian tubes, which carry the eggs from the ovaries to the uterus, are not transplanted.
Doctors in Sweden have performed the experimental procedure using living donors, in some cases relatives, in nine women since 2012. There have been five successful live births.
When or how soon this exciting, new technology will be applied to transsexual patients is uncertain.

17. Even though I am overweight, may I still schedule surgery?
While individual consideration is given in every case, we are disinclined to operate on obese people in an outpatient – 24 hour hold setting, as they pose a greater risk for complications. For your information, smoking and obesity are the two most
preventable causes of early death in the United States. If you would call the office and give us your height and weight, we’ll tell you where you stand on the charts. You may
wish to review the “ideal weight charts” for women and men http://www.healthdiscovery.net/links/calculators/ideal_bodyweight.htm
http://www.halls.md/ideal-weight/body.htm

Clearly the first recourse for obese patients is weight reduction. For those patients who have not responded well to dieting, please consider a hospital environment for the benefits of supportive nursing care and respiratory therapy.

Occasionally we had experienced some misrepresentation when arriving patients are weighed here in our office. Please do not tell me you gained weight unexpectedly because you were told to stop smoking, or that you are 5′ 2″ and weigh 180 pounds but “you can’t see it,” or have big bones, or had silicone injections or breast implants, or don’t have a scale at home, or do not weigh yourself regularly, or “my scale must be broken,” or “your scale is broken,” etc. There is no shortage of scales in our medical community.

There’s not a line we haven’t heard. After spending your hard earned money to travel here perhaps with a friend or loved one, arrange to take a leave of absence from your job, making a reservation at the nearby motel, you will find your case has been
cancelled only to be rescheduled when you are at the suggested weight.

There is an acceptable range and yes we can cut you some slack if you are a few pounds over, that’s not 10 or 20 pounds over.

Overweight people are more difficult to manage pulmonary wise, have heavier legs with the threat of neural or circulatory compression, and are technically more difficult to operate on. Beyond that you are giving their poor heart an extra work assignment to pump blood into tissues which are not needed for appearance or function.

Most importantly, do not take Ephedra (or like drugs). It’s
a killer. You will have a tachycardia (fast heart rate) on the
operating room table and your case will be cancelled.

18.  Even though I am thin may I still schedule surgery?   How thin is thin would be the next question.   Your BMI, a relation of weight to height will give us some idea.  Please see http://www.mayoclinic.com/health/bmi-calculator/NU00597 to obtain your BMI.  Here is a BMI table for reference.

  • Underweight = 18.5 or less
  • Normal weight = 18.5-24.9
  • Overweight = 25-29.9
  • Obesity = 30 or greater

Vaginoplasty is a more stressful procedure than a breast implant or facial surgery and the incision lines are a lot longer.  Your torso weight, which could be 80 pounds or more, on your perineal incisions contributes to wound separation.   For this reason I propose for optimal wound healing, your BMI be 22 or higher.  If your BMI is below 22, please consider a medical evaluation, and consume more calories preoperatively .   Many patients will lose 10 pounds after surgery for a while, and which places them in a underweight
category.

19. Alternate centers?
During Thanksgiving week 2003, I visited with Dr. Sanguan Kunaporn of Phuket, Thailand who operates at the Phuket International Hospital. Dr. Kunaporn is a very versatile plastic surgeon who has trained in the United States. His fees
are comparable to ours and his technique and facility are first class. The nurses are exceedingly attentive, the rooms are spotless, the food is more hotel quality than hospital fare, the operating room environment is very quiet and well organized, every
staff member knows exactly what to do, blood loss is minimal. More than that I can assure you he is completely focused on what he is doing and fusses over every stitch. The eye contact with patients is very good. In all, a very high class ethical operation.
“Kunaporn” <kunaporn@phuket.ksc.co.th>

20. Will I need a medical grade vaginal dilator or dildo
post operatively?
Yes, you certainly will.  We will provide the standard set of medical grade stents for 350, but recommend that you purchase an additional smaller set for 150 as well in that  many patients are too tender to use the standard size set one week after surgery..  You may be able to purchase stents less expensively, but the vendor will not be there for you if your misapply and traumatize yourself.  Please avoid stent with grooves as on withdrawal they tend to pull the vagina outwards (vaginal prolapse).  Avoid nesting hollow stent sets with one interchangeable handle, as the narrowest sizes are way too short.

21. Are any of your patients amenable to speaking
with me?
As you may know the new HIPAA laws are very strict about patient confidentiality. However a recent patient of ours, has chronicled her personal experiences
on the web at http://www.mindspring.com/~kd4mxk/brooks/
I am given to understand that upon completion of her second stage labiaplasty, she’ll release some photos.  Best to let her do the talking.

22. Any special pre-operative instructions?

A CBC should be performed 2 months before your scheduled procedure. If your blood count is low normal or below normal values, a hematology consult may be needed.
Better to learn of this well in advance.

Within 10 days before surgery, all patients are required to have these blood tests: a CBC (again), PT, PTT, and platelet count. Our lab fee is $100, but you could have this done in your home town perhaps more reasonably.

All patients require a letter of medical clearance with reference to an EKG and chest  X-ray to be obtained within 7 to 10 days  before your scheduled procedure.  If you have cardiovascular risk factors or are over 40, you may also require a thallium stress EKG.

REGARDLESS if you are having a first stage vaginoplasty, a touch up or revision (2nd stage vaginoplasty), or even an orchiectomy, STOP  estrogens a good month before surgery, as this may predispose to thromboses or emboli (unwanted clotting including the potential for fatal pulmonary emboli, coronary events, and/or stroke) .  If you do not do this, your case may very well be cancelled.  You may resume 10 days after surgery.

Also stop spironolactone within 2 weeks of your procedure as this medicine may interfere with the response of certain drugs administered during anesthesia called vasopressors.

No aspirin or aspirin products, no anti-inflammatory drugs such as Motrin, Advil, Alleve, or Cox 2 inhibitors such as Celebrex or Vioxx for a week before surgery. No Vitamin E,
fish oil, or excessive alcohol or spices for a week before surgery as this may promote bruising.

Bruising can be reduced (many believe) with Bromelain 500 mg 1 twice a day,
Arnica montana (Boiron brand) dose 30C (take 4 small tablets sublingually, 4 times a day), vitamin C 500 mg (3 times a day) starting 1 week before surgery. Do take these medications unless there are specific reasons why you choose not to and let’s discuss it beforehand.

If for any reason, despite tight scheduling arrangements and eager anticipation of being converted, you have contracted an illness such as a flu like syndrome with coughing, sore throat, fever, or diarrhea, please reschedule allowing a good two weeks for recovery. These things happen and we are very sympathetic. Surely we do not want any patient with a very recent cold to have general anesthesia. If you have gained weight, please advise
as we may have to postpone surgery.

If you are a smoker, you must stop completely for 2 months before surgery and please never again.  Smoking causes vaso-spasm, impairs wound healing, produces excessive scarring, tissue necrosis, irritates and inflames pulmonary membranes and enhances anesthetic risk.

This goes also for any products containing nicotine or nicotine like agents including nicorette gum, nicotine patches, Nicotrol inhalers, and second hand smoke. Again not for 8 weeks before and not for 8 weeks afterwards. Hopefully never again.

If you have a history of inflammatory bowel disease, such as Crohn’s or regional enteritis, please get clearance from your GI doctor, as rectal inflammation can be an inciting factor for the post-operative complication: rectal-vaginal fistula.

A medical study relating to wound healing and diet classified patients into 3 groups, pure vegetarians, those that also ate chicken and fish, and those that ate all common foods including red meats

Those who eat red meats heal the best and quite honestly probably have the best iron reserves to assist with making more red blood cells to replace a loss.

Personally, I do not believe irregular bowel movements and constipation should ever be accepted as a way of life. Such patients are prone to ano-rectal disease including diverticulosis (-itis), hemorrhoids, fissures and fistulas.

We use the technique of pull up sutures to prevent prolapse. These sutures are removed on the 7th post-operative day. Usually what you see at the end of the operation is pretty much what you get, but not always.

Obtain one pair of anti-embolism thigh high stockings. T.E.D. (by Futuro) or Jobst are common brand names.  Yes, do try these on before you come here to be sure they fit comfortably. If you wash or dry them in a hot cycle, they may never fit properly again. So best not to wash them at all until after surgery.

As a courtesy to the hotel, please obtain and bring with you a bundle of “chucks” or disposable superabsorbent pads with plastic liner on underside (typically 24 by 36 inches) to conserve hotel laundry and bedding.

Please be sure both left and right index finger nails are not covered with nail polish or artificial fingernails. We need to see a pink nail bed for an accurate pulse oxymetry (oxygen level monitoring during anesthesia).

A bowel prep should be started 24 hours before surgery which will include clear liquids only, a half a bottle of citrate of magnesia at 8 AM and the other half at 4 PM, a Fleet’s enema at 10 AM, 3 PM and on the morning of surgery. Also on the day before surgery,
neomycin sulfate 1 gram and Flagyl 1 gram, to be taken by mouth at 1 PM, 2 PM and 11 PM.

Please keep up with a good fluid intake the day before surgery.

Nothing by mouth after midnight unless otherwise instructed.  Do not shave yourself as we will do that for you.

Please remove all piercings and body jewelry (especially tongue, belly, lip, etc.) before anesthesia along with jewelry and store them ideally at your hotel.

Ring pillows should not be of the inflatable variety as they may deflate unexpectedly.

23. Any special post-operative instructions?

(These instructions may be individualized, as patient needs vary.)

1.  DIET. Regular Diet, avoid spices and alcohol for 1 week.  Increase fluid intake to 3 quarts per day for the next 3 days.  Anything in the fluid family counts.

2.  ACTIVITIES. Convalesce for one week. Out of bed by the 2nd post-op day in graduated amounts and ambulate.  Wiggle toes and move feet up and down and bend knees 20 to 100 times a day.  Avoid strenuous  activity, possibility for pelvic injury, and contact sports for 4 weeks.  No running, or extensive walking for 4 weeks.  No sexual activity until you have been medically cleared.

3.  MEDICATIONS. Cipro 500 mg, #14 1 twice a day for 7 Days.   (as a rule diabetic patients will be prescribed Keflex unless allergic) Try Tylenol, 2 tablets as needed for moderate pain.  Ultram, 1 tablet every 6 hours as needed for severe pain (#10).
Resume hormones on your 12th post-op day usually reducing estrogens by 1/3rd and discontinue spironolactone (if taken previously).  After being in estrogens for one month have a serum estradiol level drawn and you may wish to confer with Dr. Reed.

4.  FOLLOW-UP.   Surgery is the zero day. You may shower on the 7th day post-op
and also consider tub baths with cup of either table salt or Epsom salt for 15 to 20 minutes, 1 to 2 times a day to promote wound healing and reduce swelling.
Sutures to be removed on the 14th day. Your healthcare professional may choose to leave them in longer if there is not sufficient closure.  Catheter to be removed on the 12th  day by cutting the side arm and wait 30 seconds for 2 teaspoons of water to drip out;  gently tug and out it comes. Wear a sanitary pad to protect the incisional site and apply a dab of betadine ointment if any open areas or raw tissue. Do not pack the vagina.

5.   DRIVING.  You may resume driving when you feel capable, not during the 1st week  after surgery.  Have a friend or loved one stay with you for the first few days after surgery.

6.  STENT USAGE:  15 to 20 minutes, lying down on your back, 3 to 5 times daily beginning on the 7th post-operative day (always start with the narrowest stent).  Once inside the vagina, do not push down or up or you may perforate the rectum or urethra (very serious complications).  Push towards your head parallel to the floor with sustained gentle pressure, not enough to produce pain.

7.  DOUCHE afterwards with equal parts of peroxide and Betadine solution  not Betadine scrub or shampoo (povodine iodine is the generic name)  to which you add 4 parts warm water. Use the red catheter and piston syringe as instructed daily from post-op day 7 to 14 and for the next week  every other day and thereafter every 3rd day to remove jelly and cleanse but remember this does not have to be done frequently as you dilate.

8.   DILATE:  Always use a water soluble lubricant.  Dilation with a stent should be done
when you are lying flat in bed over a protective underpad.  Using the narrowest of stents that goes in easily, drop (place) that stent (hand held) into the pocket preceding your vagina.  The outer web will be removed during your second stage labiaplasty.  Do not push downwards as you will soon be inside your rectum (a very serious complication).  Do not push upwards as you will be inside your urethra (urinary tube).

Using you hand,  guide the hand held end of the stent in an arc downwards while pushing the inside end towards your head, but parallel to the floor.  The stent must be advanced parallel to the floor.  Never force.  Use gentle sustained pressure for 15 to 20 minutes, 5 times a day.  Doing this patients report gains of 1 to 2 inches in a few months.

This exercise will be demonstrated to you by Dr. Reed or his staff before you leave.
If you have any questions about techniques, please ask while you are on the table in the exam room.

9.   CIRCULAR PILLOW.  Yes, please bring a circular or donut pillow (not self inflatable, pre-inflatable ok) ) with you so you do not sit directly on your suture line for at least 3 weeks.  Very important especially if traveling by car or plane.  Then remember to bring this back with you for your labiaplasty.  Labiaplasty sutures especially are very delicate and are not designed to withstand the pressure of your torso.

MTF SURGICAL CHECK OUT LIST (abbreviated for simplicity)

1.  2 Therapy Letters

2.  Medical clearance

3.  Blood work, Stress EKG, Chest X-ray

4.  STOP all Estrogens and Spironolactone as mentioned above, for all MTF surgical procedures including primary vaginoplasty, revisions, orchiectomy, etc. as mentioned in
# 20. “special pre-operative instructions”

5.  No aspirin/products

6.  Bromelain and Arnica Montana and vitamin C

7.  Ted Hose (thigh high anti embolism stockings), advisories, underpads (CVS)

8.  Must stay at either  Daddy O Hotel, 3 star.  Daddy O  is located at 9660 E. Bay Harbor Dr, Bay Harbor Islands, FL 33154, one block from our office  (305-868-4141).   Ask for Courtney.  Please make reservations as soon as you obtain a surgical date and specify a room on the ground floor.    Some discount is usually given to our patients.

Less expensive a tourist class motel�  Beach Place Hotel at  8601 Harding Avenue, Miami Beach, FL 33154   (305) 866-3313.  These hotels are the exception to the concept that doctors don�t make house calls anymore.

9.  A female friend or loved one to stay with patient

10.  A physician to follow you when you return home

11.  Bowel prep

12.  Fax or mail Rx’s

13.  Stents (dilators)

14.  Electrolysis

15.  Ring (circular) pillow

16.  Cotton gown that buttons or snaps in the front

We would consider it a great honor to be looking after you and be assured we will show you every courtesy.

If our office may be of further service, please feel free
to call.

With best wishes for a
complete fulfillment of your goals,

Harold M. Reed, M.D. FICS
Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
Founding Member Sexual Society of North America
International Society for Sexual Medicine, full member
World Professional Association for Transgender Health

305-865-2000

P.S. Please also consider joining a very stimulating
new discussion group with posted topics that could
be of interest http://groups.yahoo.com/group/MTF-SRS-FTM/

We hope you’ll join us!

Sincerely,

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

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