Dear Dr. Reed, Am considering a few surgeons here in the US to perform my vaginoplasty and am seeking your objectives, hopefully my objectives.
First, you need (in our practice) to be a surgical candidate. This means have 2 letters of therapy clearance, one written by a therapist with a doctoral degree. Next you need to have goods height weight conformation. Not too thin, as this means poor wound healing, and not obese, as a torso weight for example of 120 pounds will split you incision lines, and fat against fat does not heal well. You will need a letter of medical clearance with reference to a chest X-ray and EKG. That’s routine.
Having said that, I am assuming your are orgasmic now (*with or without a partner) and wish this pleasure to continue. So that is definitely a goal. You would like to be moist down below and maintenance of a portion of your urethra which forms part of the vulvar plate certainly is helpful. You want a vaginal opening (introitus) hat is approach both when you are lying on your back as well as from behind. You want a clitoral body, and cleavage as these are defining features and a turn-on of female anatomy. Yoiu want a symmetrical labial appearance, and ultimately you will want the upper labia to meet in the midline, just as seen on natal woman.
You want depth. If you are 5′ 4″ a goal of 5 to 5 1/2″ is reasonable, and if you are 5′ 7″ , perhaps more like 6 inches. If you are having penile skin inversion (good because it is sensate) the pelvic space cannot be made too deep, lest your surgeon enters your abdominal cavity. A patient under anesthesia, cannot say “ouch”, but later on with cautious use of dilators you can enhance what the surgeon has accomplished. Frequency of penetrating sex may also help.
You want your urinary stream to be directed downwards into the commode now splashing against the rim of the toilet seat. You want any urethral spongy tissue to be obliterated or removed as best as possible so when you are aroused, this area does not swell (not seen in natal women), and compromise the vaginal opening. You would ideally like neat incisions lines that scream out and say, you are trans. Lastly and I cannot provide this for you, if you are like most patients, you need a lover who admires you totally, not just because you have a vagina, who is caring and supportive, and pleasant to be with.
I wish you all of the above,
Harold M. Reed, M.D.
The Reed Centre for Transgender Surgery – Miami
Approachable either way