Author Topic: Looking at peritoneal vaginoplasty with Dr. Gallagher  (Read 13396 times)

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Offline Nozomi

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Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
« Reply #200 on: October 06, 2020, 04:32:08 pm »
I found studies before that compared ileal (small intestine) to peritoneal when used for Mullerian agenesis and CAIS and upper grade PAIS patients. Both performed as expected but the study showed significantly lower blood loss and complication risk with peritoneal. Surgical times were also much shorter. Some later studies following patients of peritoneal vaginoplasty showed that the peritoneal tissues become almost indistinguishable from natal vaginal lining tissues after 6 month to a year. This is because the outer layers of the peritoneal tissues have epidural like cells for the membrane but continue to allow the inner cells secretions through. The secretions are pH similar to natal vaginal secretions as well.

All of the studies following cis girls who had the Peritoneal method for Mullerian agenesis has shown that not only does the peritonium become indistinguishable from natal vaginal lining cells but that the natural secretions take on the same natural pH and the same microflora as a cis vagina.

Dear Josie,

21.   I searched based on the words in these quotes. but I could only find references A and B below. I've added a long quote at the top to help you remember which document it came from.
Could you please show me the supporting paper, especially indicating that secretions are pH similar to natal vaginal secretions?

A)   Dr. Mhatre’s “New laparoscopic peritoneal pull-through vaginoplasty technique” (PMCID: PMC4229793)
“The peritoneal lining changes to stratified squamous epithelium resembling normal vagina and having acidic Ph.”

B)   “Analysis of the artificial vaginal microecology in patients after laparoscopic peritoneal vaginoplasty”
(PMCID :PMC6560037)
“approximately 57.4% of the patients had vaginal pH ≤ 4.5”
“as time goes by, the artificial vaginal microecological condition gradually becomes normal.”

22.   In the latter paper B,
“39.1% of the patients who had the operation at least 2 years ago exhibited dysbiosis”
“In patients with congenital vaginal atresia who have undergone laparoscopic peritoneal vaginoplasty, the vaginal microecology generated exhibits dysbiosis in varying degrees.”
“To understand the flora of the vaginal microecological condition after laparoscopic peritoneal vaginoplasty and explore appropriate adjunctive therapies, it will be beneficial to establish a normal vaginal microecology in an artificial vagina.”
Are you taking measures against dysbiosis as high as 39.1%? If so, what are your measures?

Best regards,
Nozomi

Offline josie76

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Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
« Reply #201 on: October 06, 2020, 05:53:33 pm »
I'll have to look for the other references but as far as dysbiosis, what you are really speaking of is bacterial vaginosis. There were things I did early on. Using a warm water dueshe bag with a couple drops of idiodine solution once a week. Daily dueshing with "hippacleanse" type body wash other days.

No now I have not needed to use either for some time.
04/26/2018 bi-lateral orchiectomy
09/11/2019 PPV at IU Health (DaVinci robot laparoscopic Davydov with modified Chonburi Flap) w/ Dr. Gallagher, Dr. Koch, Dr. Roth assisting urology
03/02/2020 revision labiaplasty at IU Health w/ Dr. Gallagher

A lifetime of depression and repressed emotions is nothing more than existence.
I for one want to live now, not just exist!

Offline Nozomi

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Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
« Reply #202 on: October 06, 2020, 08:55:16 pm »
Thank you for your prompt reply to #22.
I'm sorry to have taken your time about #21.

Offline josie76

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Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
« Reply #203 on: October 06, 2020, 11:01:08 pm »
Nozomi, some info

"a study using a Kaplan-Meier analysis to assess the long term functional outcome of women who had undergone peritoneal vaginoplasty showed that good functional outcome and sexual activity satisfaction were near 100% one year after surgery, with continued sexual satisfaction in 80% of patients at 15 year follow-up.
The Female Sexual Function Index (FSFI), a brief questionnaire measuring sexual function in women encompassing six domains (desire, arousal, lubrication, orgasm, satisfaction, and pain), revealed no significant difference between patients of laparoscopic pelvic peritoneal vaginoplasty and laparoscopic sigmoid vaginoplasty (Cao et al., 2013; Wu et al., 2016)."



"there are many advantages of using a pelvic peritoneal flap for SRS. Owing to its anatomical location within the body and close proximity to the neovaginal introitus, the neovagina has a natural axis suitable for sex, there is no danger of flap necrosis or failure of a graft to take, and it allows for a minimally invasive approach with minimal scarring, which is a distinct advantage (Rangaswamy et al., 2001)."


Zhou JH, Sun J, Yang CB, Xie ZW, Shao WQ, Jin HM. 2010.
Longterm outcomes of transvestibularvaginoplasty with pelvic peritoneum in 182 patients with Rokitansky’s syndrome.
FertilSteril 94:2281–2285.

Neovaginal Construction with Pelvic Peritoneum: Reviewing an Old Approach for a New Application
Clinical Anatomy · November 2017
DOI: 10.1002/ca.23019

Sexuality after Laparoscopic Peritoneal Vaginoplasty in Women with Mayer-Rokitansky-Kuster-Hauser Syndrome
The Journal of Minimally Invasive Gynecology 2009
DOI: 10.1016/j.jmig.2009.07.018
04/26/2018 bi-lateral orchiectomy
09/11/2019 PPV at IU Health (DaVinci robot laparoscopic Davydov with modified Chonburi Flap) w/ Dr. Gallagher, Dr. Koch, Dr. Roth assisting urology
03/02/2020 revision labiaplasty at IU Health w/ Dr. Gallagher

A lifetime of depression and repressed emotions is nothing more than existence.
I for one want to live now, not just exist!

Offline Nozomi

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Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
« Reply #204 on: October 07, 2020, 03:04:37 am »
Thank you very much for the information.
Especially the first !

Offline Nozomi

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Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
« Reply #205 on: October 07, 2020, 05:36:26 pm »
"a study using a Kaplan-Meier analysis ...
"there are many advantages of using a pelvic peritoneal flap for SRS. ...
Longterm outcomes of transvestibular vaginoplasty with pelvic peritoneum in 182 patients with Rokitansky’s syndrome.
Neovaginal Construction with Pelvic Peritoneum: Reviewing an Old Approach for a New Application
Sexuality after Laparoscopic Peritoneal Vaginoplasty in Women with Mayer-Rokitansky-Kuster-Hauser Syndrome

Dear Josie,

I got that the 1st and the 2nd important paragraphs are from the 4th (Neovaginal Construction with Pelvic Peritoneum).
Your pickup is essential.

The 3rd includes evidence of the 1st.

The 5th includes concrete evidence, indicating "Laparoscopic Davydov is a safe, effective treatment of Mayer-Rokitansky-Kuster-Hauser syndrome with minimal invasion and a relatively low complication rate."

Thanks again.

Offline josie76

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Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
« Reply #206 on: October 08, 2020, 08:02:43 am »
Yes the first and second were quotes from that citation.
Neovaginal Construction with Pelvic Peritoneum: Reviewing an Old Approach for a New Application
Clinical Anatomy · November 2017
DOI: 10.1002/ca.23019

those paragraph also reference earlier studies
Cao, et al, 2013
Wu, et al, 2016
Rangaswamy, et al, 2001


Cao L, Wang Y, Li Y, Xu H. 2013. Prospective randomized comparison of laparoscopic peritoneal vaginoplasty with laparoscopic sigmoid vaginoplasty for treating congenital vaginal agenesis.
Int Urogynecol J 24:1173–1179.

Wu J, Guo R, Chu D, Wang X, Li L, Bian A, Zhao Q, Shi H. Comparison of two techniques of laparoscopy-assisted peritoneal vaginoplasty.
J Minim Invasive Gynecol. 2016 23(3):346–51.

Rangaswamy M, Machado NO, Kaur S, Machado L. 2001. Laparoscopic vaginoplasty: using a sliding peritoneal flap for correction of complete vaginal agenesis.
Eur J ObstetGynecolReprod Biol 98:244–248.

---------------------------------------------------------

Then some other citations used in that paper

Marques Hde S, dos Santos FL, Lopes-Costa PV, dos Santos AR, da Silva BB. 2008 Sep. Creation of a neovagina in patients with Rokitansky syndrome using peritoneum from the pouch of Douglas: an analysis of 48 cases.
FertilSteril 90:827–832.


-------------------------------------------------------------------
then repeating the first ones from above to make a more complete list.

Zhou JH, Sun J, Yang CB, Xie ZW, Shao WQ, Jin HM. 2010.
Longterm outcomes of transvestibularvaginoplasty with pelvic peritoneum in 182 patients with Rokitansky’s syndrome.
FertilSteril 94:2281–2285.

Neovaginal Construction with Pelvic Peritoneum: Reviewing an Old Approach for a New Application
Clinical Anatomy · November 2017
DOI: 10.1002/ca.23019

Sexuality after Laparoscopic Peritoneal Vaginoplasty in Women with Mayer-Rokitansky-Kuster-Hauser Syndrome
The Journal of Minimally Invasive Gynecology 2009
DOI: 10.1016/j.jmig.2009.07.018


04/26/2018 bi-lateral orchiectomy
09/11/2019 PPV at IU Health (DaVinci robot laparoscopic Davydov with modified Chonburi Flap) w/ Dr. Gallagher, Dr. Koch, Dr. Roth assisting urology
03/02/2020 revision labiaplasty at IU Health w/ Dr. Gallagher

A lifetime of depression and repressed emotions is nothing more than existence.
I for one want to live now, not just exist!

Offline Nozomi

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Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
« Reply #207 on: October 08, 2020, 04:23:25 pm »
Thank you very much !

I read those Abstracts of first 4 papers that are new to me,
and am particularly interested in Cao's paper.
This shows some of the advantages of laparoscopic peritoneal vaginoplasty over laparoscopic sigmoid vaginoplasty.

Thanks

Offline Nozomi

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Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
« Reply #208 on: October 10, 2020, 10:13:11 pm »
Dear Josie,
23.   In the web of “Peritoneal Pull Through Vaginoplasty Procedure - Dr. Heidi ...”
“Peritoneal pull through has the theoretical benefit over the penile inversion technique of having lubrication, needing less dilation, less douching, less maintenance, and more depth.
This option may be less risky than sigmoid colon vaginas; not having the risk of anastomosis breakdown, having less risk of prolapse, not having odorous mucus discharge, no need for monitoring colon pathology.”

The benefits over the “Penile Inversion Vaginoplasty” and the benefits over “Sigmoid Colon Vaginoplasty” are discriminated.
So I added P or S to below.
Here, P is the benefits over the “Penile Inversion Vaginoplasty” and S is the benefits over “Sigmoid Colon Vaginoplasty”

Could you add S or P to the underlined part, respectively? For example, if requiring douching with PPV is less than that with Sigmoid Colon Vaginoplasty, please add S:  As a result, “4. Requires less douching PS
In the web of "Vaginoplasty: Peritoneal | mozaic - Dr. Heidi Wittenberg", #3 seems to be P, and the others seems to be PS.
but #3 is the most important question for me:
If dilation with PPV is less painful and easier than dilation with sigmoid vaginoplasty, please do add S to 3.

Please copy the following and paste to your reply field. So you don't have to change the color yourself.

Potential benefits of PPV (some updated according to the web of “Peritoneal Pull-Through Vaginoplasty - MTF Surgery”)
1.   Self-lubricating lining with some elasticity    P
2.   More vaginal depth         P
3.   Requires less dilation          P
4.   Requires less douching         P
5.   Requires less pre-op hair removal   P
6.   Less risk of prolapse         S
7.   May be less risky than Sigmoid Colon Vaginoplasty, plus no odorous mucus discharge and no need to monitor colon pathology         S


24.   “less dilation” in 3 above does not mean “requiring dilation frequency is less”, it means “dilation is easier based on less pain” Is my understanding correct?

25.   in 6 above, the risk of vaginal prolapse is lower. Because the intestine is closer to the vaginal opening than the peritoneum?


At my first meeting with Dr. Gallagher she said the first urologist she was talking to had concerns that a PPV would not work on a male pelvis because it is narrow and deeper. Turns out this definitely won't stop good doctors.
So if they could not have pulled the peritoneal tissue down far enough safely, Dr. Gallagher can use a portion of penile skin for the outer entrance (introitus).

26.   As for the problem of male narrow pelvis,
the peritoneal tissue may be not able to be pulled down far enough safely. In such a case. penile skin or scrotal skin could be used. Is my understanding correct?


I'm at home now. It was a 4 hour car ride on just a doughnut cusion. I did take oxi for the ride home but oh how I dislike the comedown from that stuff. Back on just Tylenol.

27.   Is oxi a painkiller? Oxycodone (OxyContin)

Best regards,
Nozomi

Offline josie76

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Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
« Reply #209 on: October 11, 2020, 06:26:39 am »
Dear Josie,
Best regards,
Nozomi


Potential benefits of PPV (some updated according to the web of “Peritoneal Pull-Through Vaginoplasty - MTF Surgery”)
1.   Self-lubricating lining with some elasticity    P
2.   More vaginal depth         P
3.   Requires less dilation          P
4.   Requires less douching         SP
5.   Requires less pre-op hair removal   SP
6.   Less risk of prolapse         SP
7.   May be less risky than Sigmoid Colon Vaginoplasty, plus no odorous mucus discharge and no need to monitor colon pathology         S



1. It definitely produces some internal moisture. This is very comparable to a cis woman's. This makes additional lube for dialation unneeded. However for penatrative sex to be comfortable I like any woman need to be turned on enough first so that my body releases fluid from the bulbourethral glands. The only difference is in a cis woman these have ducts that lead near both sides of the vaginal introitus where as in AMAB these are connected to the urethra. However its the same glands no matter which sex you were born with.

2. more depth than with penile inversion for certain. Colon may be able to have similar depth.

3. dialation has no pain inside the body. The only areas of potential pain is around the introitus and in relaxing the pelvic floor muscles. After healing I have had almost no pain or discomfort. However due to my lack of dialating for many weeks this year due to family issues and stress, I have had to work back up to the larger 2 dialators. The constriction occurs at the skin not the peritoneum.

4. I have not needed to douche in over 6 months. After surgery I was told to douche and shower daily. Then after so long just once a week. Now its not neccesary. The internal secretions make it "self cleaning" just slowly.

5. I had zero pre-op hair removal

6. There is no risk of prolapse when done in the Davydov style. This is because the vaginal lining remains part of the abdominal peritoneum tissue. One of the studies mentioned that the risk was eliminated with this method.
Other methods require tying the inverted penile skin or colon section to a pelvic ligament with surgical thread. If this thread tears the tissue or breaks the vaginal cavity can prolapse, or turn partly inside out of the body. With the Davydov, the vaginal tissue is connected directly to the abdominal pouch as it continues to be supplied blood through its existing vessels.

7. It is less risky than colon based method for certain. There is no need for a "bowl prep" or cleaning before surgery. There is no cutting of the bowl so no risk of sepsis from gut bacteria infecting the body cavity. There is no risk from rejoining the ends of the bowl together after cutting out a section for sigmoid colon method. The only risk of bowl issues would be the surgeon cutting the bowl while working inside. From what I've been told the robotic tools make this extremely unlikely. A skilled surgeon can avoid cutting the bowl even with the old hand operated laparoscopic tools.

8. I am adding this as an addendum to question 7. Smell: After surgery for a while I had a very strong odor of iodine. The packing they used at first was soaked in it. After that initial odor faded, my discharge had the odor of inner body fluid. This slowly changed and now I can admit the secretions smell like any woman would. Kinda gross thing to talk about but it seems an important observation.

26. This was a concern of some of the doctors evaluating the idea. However, AFAB with mullerian agenesis has a pouch in a similar low position inside the pelvis as AMAB. Generally in AMAB the pouch should go as low as just above behind the prostate.
However if this was an issue yes penile or scrotal skin could be used to connect to the peritoneum.

My pelvis is sort of half way between a "normal female" and "normal male". But from what I heard from the doctors during my follow ups, it didn't sound like the pelvis was an issue in the procedure.

I hope this meets site requirements?
Comparison-of-male-and-female-anatomy-of-the-pelvis-Used-with-permission-of-Xochitl

27. Yes oxicodone is an opiod based pain killer similar to hydrocodone
04/26/2018 bi-lateral orchiectomy
09/11/2019 PPV at IU Health (DaVinci robot laparoscopic Davydov with modified Chonburi Flap) w/ Dr. Gallagher, Dr. Koch, Dr. Roth assisting urology
03/02/2020 revision labiaplasty at IU Health w/ Dr. Gallagher

A lifetime of depression and repressed emotions is nothing more than existence.
I for one want to live now, not just exist!

Offline Nozomi

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Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
« Reply #210 on: October 11, 2020, 04:07:45 pm »
Thank you very much for your reply. 
espeecially,
23-3 "After healing I have had almost no pain or discomfort." & "The constriction occurs at the skin not the peritoneum."
23-4 Requieres less douching "SP" & "I have not needed to douche in over 6 months."
23-8 "now I can admit the secretions smell like any woman would."
and other explanation.

As for #26, the attached figure was very helpful for understanding.

I'm sorry, but I repeat the following two questions that are important to me.
In general maintaining one time per week now should keep everything fine for me now.

"one time per week" is similar to the frequncy of the dilation of Sigmoid Colon Vaginoplasty after one year.
24.“less dilation” in 3 above does not mean “requiring dilation frequency is less”, it means “dilation is easier based on less pain” Is my understanding correct?
23-3': Two acquaintances had Sigmoid Colon Vaginoplasty and told that postoperative dilation was extremely painful.
There are individual differences in pain.

"By avoiding the areas of potential pain, there is little pain in PPV dilation for everyone consistently after surgery.
while the dilation pain of Sigmoid Colon Vaginoplasty may be large for some time after surgery and may be relieved a year later."
Is my understanding correct? If not, please correct my understanding as much as possible.
« Last Edit: October 12, 2020, 02:41:28 am by Nozomi »

Offline josie76

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Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
« Reply #211 on: October 13, 2020, 06:38:17 am »
Nozomi

"less dialation" first there is no internal pain from dialation. Simply a matter of the healing of skin around the introitus. Second, for now dialation once a week seems like a good practice if you are not having penetrative sex. Going for longer without only seems to be an issue if the peritoneum has not fully epthilized or for skin and external area concerns.

There is little pain with PPV. Again only the outer part where skin exists and healing still needs to happen.
04/26/2018 bi-lateral orchiectomy
09/11/2019 PPV at IU Health (DaVinci robot laparoscopic Davydov with modified Chonburi Flap) w/ Dr. Gallagher, Dr. Koch, Dr. Roth assisting urology
03/02/2020 revision labiaplasty at IU Health w/ Dr. Gallagher

A lifetime of depression and repressed emotions is nothing more than existence.
I for one want to live now, not just exist!

Offline Nozomi

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Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
« Reply #212 on: October 13, 2020, 03:21:37 pm »
Thank you very much for your reply !!

Offline Nozomi

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Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
« Reply #213 on: October 20, 2020, 05:08:37 pm »
Dear Josie,
2 weeks after surgery
Right now it seems it just means it will take longer to heal on the outside. I may have to deal with pain when dialating in that spot because what is called granulation tissue is often painful to touch until a new layer of skin grows across it.
I have to wonder that if I had not had dissolvable stitches if I might have been spared this external pain and only had the swelling underneath.

7 weeks after surgery: The last time of “granulation” in this forum before I ask.
So I saw Dr. Gallagher this week. Turns out everything is healing as expected. I have what seems like a big hump that is the opened urethra tissue that she kept for the vestibule floor. She said it often swells up that much and takes a long time but it will go down to a normal appearance in time. She had just one tiny spot she treated with silver nitrate for hyper granulation.

28.   As for granulation
28.1.   Has the granulation tissue healed?
28.2.   What has it changed to?
28.3.   When (how many weeks or months after surgery) did it heal?
28.4.   After that, did you need to avoid the part in the dilation?

I'm on the wait list for PriyaMed when the hospital there opens it up for regular use.

29.   Do you know how long the waiting time is? More than 1 year less than 2 years?
Best regards,
Nozomi 

Offline josie76

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Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
« Reply #214 on: October 21, 2020, 05:01:08 am »
Dear Josie,
2 weeks after surgery
7 weeks after surgery: The last time of “granulation” in this forum before I ask.
28.   As for granulation
28.1.   Has the granulation tissue healed?
28.2.   What has it changed to?
28.3.   When (how many weeks or months after surgery) did it heal?
28.4.   After that, did you need to avoid the part in the dilation?

29.   Do you know how long the waiting time is? More than 1 year less than 2 years?
Best regards,
Nozomi 

28) granulation: When a wound opens to the air (such as when the skin pulls away from stitches exposing the underlying tissue) the exposed tissue will regenerate a new section of skin. While this happens there is rapid growth of nerves and blood vessels. This makes the area easily aggrivated by touch. It is painful to put any pressure on this new growth until a skin layer is done forming.

this happens when the wound is open. In my case there was some skin near the introitus and the skin flap around the lower outer radius cut of the surgery that "pulled" loose from the underlying tissue because the stitches fell out so quickly.
When a section of skin flap pulls away from the underlying tissue like this, that section of loose skin will die off as it separates from the blood supply it would be forming to the underlying tissue. This was not unexpected in general. Its a very common even in any such surgery. In my case had the stitches not dissolved so quickly I would have not had any significant amount of granulation to deal with.

I had some happen around the end of the urethral lining used as the floor of the vestibule. The tissue was swollen and the stitches dissolved leaving one small area that exposed enough to be treated. Otherwise I had one region at the vaginal introitus and around the lower incision that also had normal granulation. This made the start of dialation a bit painful but only while inserting the dialator. While simply holding the dialator in place it caused no extra pain.

28.1) Yes it all healed as expected.
28.2) The exposed surface heals into skin tissue.
28.3) Its been so long ago its hard to remember. I would say it had mostly healed closed by the 6-8 week timeframe.
28.4) No I never avoided it during dialation. There was a section of skin that had failed (pulled up and died off) at the introitus. When this happened it was painful just when the dialator was moving past the tissue. Lube was needed at this time as it helped keep the exposed tissue from dragging on the dialator. Once in place it caused no pain to keep the dialator there.

Granulation is very common in genital region surgery. With penial inversion and scrotal skin graft it can be very painful when it occurs inside the neovagina. Since my vaginal canal is peritoneum there is no issue with pain internally or the issue with failed skin grafts internally. Everything that caused me discomfort was external.

29) No I do not know what Pryamed's wait time is. I know from their FB posts that they stopped surgeries when COVID got bad in India. I haven't noticed if they have said anything about restarting. Most hospitals will do surgeries again. The schedule is just more spread out.

Where I went in Indianapolis, IN. USA they are doing surgeries. However IU Health University Hospital would require medical insurance to be able to pay for it there. At the time my spouse had insurance that covered GCS from her workplace. I had to pay a $300 facility fee and the second urologist who was in on my surgery (Dr. Roth) was not preapproved so I ended up paying his time fee of $800. The total bill from the hospital was over $80,000 but I think the insurance ended up paying close to $50,000. Without US type medical insurance it is too expensive to get done there. This makes places like Pryamed a more viable option as the costs for medical care and surgery at the hospital in Mumbai, India is so much less than in the US.

04/26/2018 bi-lateral orchiectomy
09/11/2019 PPV at IU Health (DaVinci robot laparoscopic Davydov with modified Chonburi Flap) w/ Dr. Gallagher, Dr. Koch, Dr. Roth assisting urology
03/02/2020 revision labiaplasty at IU Health w/ Dr. Gallagher

A lifetime of depression and repressed emotions is nothing more than existence.
I for one want to live now, not just exist!

Offline Jane.Shannon

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Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
« Reply #215 on: October 21, 2020, 08:49:29 am »
Josie,
Thank you for your detailed and thoughtful responses.  Like most detailed responses they create more questions.
I know one of the "cons" of PvP is that since the peritoneum is an internal organ it does not have touch sensation.  As your's has epthilized has it gained touch sensation?  Perviously, you mentioned you feel a pressure or "fullness" when something is inside you, has that sensation changed as you have healed?

I know cis vaginas have a decreasing amount of sensation as they go towards the cervix.  My thought would be to have the first 1 to 2 inches of the neo vagina made with skin (I am not sure which to be honest, but something sensate) and the remainder with peritoneal tissue.  This might give a little more sensation inside the neo vagina, while maintaining the benefits of using peritoneal tissue for the deeper internal structures.

Thanks,
Jane

PS.  As I wrote "inside you" I was thinking how thrilling it would be to say "inside me."  I am increasingly ready to get serious about GCS.
July 2020: Full Time
Aug 2019: Started HRT
Dec 2019: Hair Feminization Surgery

Offline Nozomi

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Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
« Reply #216 on: October 21, 2020, 01:44:27 pm »
28) granulation ...29)
Josie,

Thank you very much for your detailed reply!!

Thanks
Nozomi

Offline josie76

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Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
« Reply #217 on: October 21, 2020, 04:38:31 pm »
Josie,
Thank you for your detailed and thoughtful responses.  Like most detailed responses they create more questions.
I know one of the "cons" of PvP is that since the peritoneum is an internal organ it does not have touch sensation.  As your's has epthilized has it gained touch sensation?  Perviously, you mentioned you feel a pressure or "fullness" when something is inside you, has that sensation changed as you have healed?

I know cis vaginas have a decreasing amount of sensation as they go towards the cervix.  My thought would be to have the first 1 to 2 inches of the neo vagina made with skin (I am not sure which to be honest, but something sensate) and the remainder with peritoneal tissue.  This might give a little more sensation inside the neo vagina, while maintaining the benefits of using peritoneal tissue for the deeper internal structures.

Thanks,
Jane

PS.  As I wrote "inside you" I was thinking how thrilling it would be to say "inside me."  I am increasingly ready to get serious about GCS.

Hi Jane.
To answer your question: The surface lining itself is not sensate. Cis vaginas are also not sensate on the surface of the lining tissue. What I feel is the pressure and internal sensations. I'm not quite sure how else to explain that part.  ;)
The feeling has changed in a way since right after surgery. Obviously the swelling is gone from the outer tissues. Oh boy was there swelling at first. Right after surgery and for some weeks after, the swelling of the lower perinial tissues added at least 2 inches to the amount of the dialator that was covered. So don't worry as it looks like you loose depth after surgery, It's just the swelling goes away.
I have an average depth (according to the internet) with a firm bottom. At least that's how I feel it.  :o

One of the pluses is that I never have to worry about vaginal prolapse from a torn suture like is possible with penial/scrotal skin inversion. My vagina also aligns with the center of my body. That was an issue with early penial inversion as the doctor had to tie the neovaginal skin to a pelvic tendon on one side of the sacrum/tailbone.
04/26/2018 bi-lateral orchiectomy
09/11/2019 PPV at IU Health (DaVinci robot laparoscopic Davydov with modified Chonburi Flap) w/ Dr. Gallagher, Dr. Koch, Dr. Roth assisting urology
03/02/2020 revision labiaplasty at IU Health w/ Dr. Gallagher

A lifetime of depression and repressed emotions is nothing more than existence.
I for one want to live now, not just exist!

Offline Nozomi

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Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
« Reply #218 on: November 02, 2020, 10:48:29 pm »
Dear Josie,

I'm not in a hurry for your reply: After or before the presidential election vote doesn’t make any difference to me.

1. 
In Japanese hospitals that perform Davidoff surgery, a device called a prosthesis is inserted into the vagina for a certain period of time to prevent the vagina from narrowing (Please see the figures below).
If the prosthesis is in the vagina and it is difficult to defecate, you can remove the prosthesis from the vagina yourself only during defecation.
The prosthesis is also used in the paper "Clinical pilot study to evaluate the neovaginal PACIENA prosthesis® for vaginoplasty without skin grafts in women with vaginal agenesis”
Did you use a vaginal prosthesis?





The shape from the tip in the 2002 paper, which could have been further improved.


A Japanese woman with vaginal hypoplasia wrote on her blog:
“I started using Atom Medical's vaginal prosthesis 20 years ago. I was 16 years old. One paper states that it will be retained at night, but I consulted from myself and started retaining it at bedtime a few years ago.”


2.
You can add me to the PPV list..
I’ll be having my surgery on the 9th November in Canberra, Australia with Dr Kieran Hart..
I’ll be the first or second in Au to have primary PPV surgery..

there’s also a number of girls in Australia booked in for surgery between November and February 2021.

Cheers
Angela

As far as I searched in Canberra Australia Dr Kieran Hart
I didn't know if his PPV is Davidoff-based surgery or not.
If you don’t mind, by asking Angela the right question to her post,
Would you please determine if his PPV is a Davidoff-based PPV surgery or not?

After your judgment
I will modify the table of Sept 20th in https://www.susans.org/forums/index.php/topic,243884.msg2388511.html#msg2388511.
In doing so, I will exclude Rachel Bluebond-Langner of NYU.

Best regards,
Nozomi

Offline josie76

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Re: Looking at peritoneal vaginoplasty with Dr. Gallagher
« Reply #219 on: November 03, 2020, 07:49:49 am »
Dear Josie,

I'm not in a hurry for your reply: After or before the presidential election vote doesn’t make any difference to me.

1. 
In Japanese hospitals that perform Davidoff surgery, a device called a prosthesis is inserted into the vagina for a certain period of time to prevent the vagina from narrowing (Please see the figures below).
If the prosthesis is in the vagina and it is difficult to defecate, you can remove the prosthesis from the vagina yourself only during defecation.
The prosthesis is also used in the paper "Clinical pilot study to evaluate the neovaginal PACIENA prosthesis® for vaginoplasty without skin grafts in women with vaginal agenesis”
Did you use a vaginal prosthesis?



No they did not use a prosthesis. For the first week I had a standard catheter. Along with this I was to keep the surgical tape on with the dressing on the outside. This kept packing inside. The packing was surgical guaze soaked in iodine.
At my 1 week appointment the nurse removed the catheter, dressing, and packing. She then had me insert a dialator to make sure I could use it properly. I was to dialate daily at first after that and then cut down to once a week.
I lost some depth when family drama happened and I did not dialate for some time. In the early stages it was not uncommon for webbing like tissue to come out with the dialator. This is the self sealing property of the peritoneum. This is what the dialation is to prevent until epthilation occurs.
At first with the external swelling I am guessing depth was nearly 9 inches. As the swelling went down this decreased. Simply because the outer tissues were not swollen as much. After the swelling was gone I would say I had a good 7 inch depth. After I missed dialating last spring I lost some of that. I now still have an average normal depth around 10+ cm. The lack of dialating caused the deeper portions that had not epthilized to seal closed against itself. This was my mistake but life got in the way for a time.
04/26/2018 bi-lateral orchiectomy
09/11/2019 PPV at IU Health (DaVinci robot laparoscopic Davydov with modified Chonburi Flap) w/ Dr. Gallagher, Dr. Koch, Dr. Roth assisting urology
03/02/2020 revision labiaplasty at IU Health w/ Dr. Gallagher

A lifetime of depression and repressed emotions is nothing more than existence.
I for one want to live now, not just exist!