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Professional Advice for Screenplay about MTF Vaginoplasty

Hello Dr. Reed,

I am sorry to bother you as this is not a proper email you would expect to get. I am a student and am writing a screenplay for a project, and it is about a transgender patient. As a professional, I was hoping you may be able to give me some answers to several questions, and clear up any inaccuracies, as I do not want to offend anyone, as several of my friends identify as trans (though they have not yet gotten srs).

I understand you may be very busy, so please, do not feel the need to immediately respond answering the questions (though if this is the case, could you email me to tell me that you do not have the time, this would be much appreciated). Thank you! The questions are below, if you do have the time to answer (it seems google has failed me in providing the clarification for these, so I hope you could help).

1. The character of the short film takes pills and medication to deal with depression and anxiety, in real life, would this be safe for someone to do before a srs?

2. What is immediately recommended for a patient to do after a surgery, do they need to stay at the clinic/hospital or can they go back home? Also, the character in my current screenplay falls asleep on the floor after the surgery, would it be recommended to change this?

3. How long is the surgery, a couple hours?

Thank you very much!!

Lauren P

February 27, 2016

Good morning Lauren,

Taking your thoughtful questions in the order posed….

1. The character of the short film takes pills and medication to deal with depression
and anxiety, in real life, would this be safe for someone to do before a srs?

Firstly in our practice the patient has to receive 2 letters of therapy clearance, one written
by a therapist with a doctoral degree saying she is mentally stable (that means the potential for
a psychotic break under stress) is very low and that she is well controlled on medications
with new recent institutionalization for depression and related disorders.  Next we would recommend she continue ion her medications to ensure her psychic stability.  As we have mentioned on our site recently if she is on a Prozac type drug (SSI uptake inhibitor) we have to be careful about the types of pain medicine I prescribe.

2. What is immediately recommended for a patient to do after a surgery,
do they need to stay at the clinic/hospital or can they go back home?

If the patient is a moderate risk patient we recommend they be done in a hospital setting and stay there until they have their “sea legs” (can ambulate without help) and attend to themselves once discharged.  This could mean staying for an additional 2 days.  If they are done at our office, they stay overnight with myself and an RN in attendance (one on one) until the following morning when she is conveyed by myself and a nurse to a nearby hotel
with a round the clock woman (usually a friend) to sound the alarm if there are any concerns.

Regardless I see my patients daily for 1 week.  If they live in another town, for sure they cannot go back home for several times.  Dressing change is usually done on the 3rd post-operative day, a drain  is removed on day 5 to 6 depending, packing removal and showing the patient how to use the dilators and douche is done on the 7th post-operative day.

Out of town patients cannot undergo surgery unless they specify a doctor in their locale who is knowledgeable in wound care (could be a general surgeon or gynecologist) and has agred to see them for any concerns.

Also, the character in my current screenplay falls asleep on the floor after the surgery, would it be recommended to change this?

We cannot permit anyone to sleep on the floor after surgery, as what nurse or doctor is going to bend/stoop over to take care of them.  If I knew this in advance, I would suggest they go elsewhere.

3. How long is the surgery, a couple hours?

Vaginoplasty (in our hands) is performed in 3 3/4 to 4/12 hours.  Couple meaning 2 hours is not “real”.  Adding to their stay in the operating room is time to induce anesthesia, position and prep the patient (a half hour) and getting the patient off the table. which includes installing the vaginal packing, washing the perineum applying a compressive dressing, taking the patient out of anesthesia. and transferring to a stretcher..

When a patient is stable, in optimal condition, and under excellent anesthesia, you can do many beautiful things.  No need to rush.

Lauren, hoping this is of help.

Harold M. Reed, M.D.
Transgender Surgery – Miami

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