Post-op gynecological health care

[Eurydike]

Hi girls,

I have some questions to those of you with more experience and knowledge: if one knows well how to perform a breast self-exam regularly and goes about once a year to have her prostate checked, is it absolutely necessary to go for a yearly gynecological checkup?

I am asking this because I may have to look for a new gynecologist and finding one who is knowledgeable about trans issues might not be too easy for me. What is your experience with gynecologists sometime after GRS?

Did you tel them about your history, did you allow them to get puzzled  when an ultrasound or a PAP-smear or didn't they do all that didn't even found out?

Is it true a GP performing a manual pelvic exam may not find out, as my current GP has told me? (I don't remember exactly if she said that judging the outer appearance or after she performed the actual examination with two of her fingers).

Also, is this just my paranoia or do many doctors exaggerate a a little bit (as usual*) the necessity of yearly prostate checkups, as prostate cancer risk diminish dramatically after GRS?

Or should we say we should have our prostates checked just like every other woman?

Thanks in advance for your answers!

Eurydike


PS.- Sorry if this topic already exist in some manner, but I couldn't find all the answers in other threads.

* I'm saying there may be some exaggeration in medical standards because pretty much every woman can get hormones prescribed without blood tests and surgeries scheduled without psycho letters (provided they're not MAAB), while so called SOC and lots of doctors are, to say the least,  "overprotecting" and "conservative" in providing medical treatments for trans people. Also, I always had the impression that many medical professionals tend to stress and exaggerate the health risks, at least compared to cis people, while underestimating or ignoring many psychological and social factors of transition.

[Flan]

A GP claiming that surgery is not detectable is probably being nice. That said, it's probably overkill for yearly gyno checkups beyond the usual physical exam.

Breast exams are much more important than prostate exams and yearly is overkill since hormone therapy should have worked that out. Exams there should use age guidelines and the ubiquitous PSA test.

(disclaimer: my OB/GYN specializes in trans* health so I'm going by the clinic's standard of care)

[Eurydike]

(disclaimer: my OB/GYN specializes in trans* health so I'm going by the clinic's standard of care)

Thanks for you answer. About OB/GYN specializing in trans issues, they are not easy to find in every town. That's the problem.

As you have one (lucky you!), what "standards of care" do you mean? Do you mean OB/GYN clinical standards or specific trans standards, perhaps something detailed I've missed in the WPATH's SOC?

A GP claiming that surgery is not detectable is probably being nice.

Agree. At least as far as thorough manual pelvic exam goes. Thing is, I am not sure if she said that referring just to the outer appearance. Could be. I do not remember exactly. (I'll edit just in case).

That said, it's probably overkill for yearly gyno checkups beyond the usual physical exam.

Right, so you also think it is simply too often/ too much/ not absolutely necessary.
But then, what do you mean by "usual physical exam"? Could you please be more precise?

Breast exams are much more important than prostate exams and yearly is overkill since hormone therapy should have worked that out. Exams there should use age guidelines and the ubiquitous PSA test.

Agree. But that was the point: many doctors are too busy complying themselves to gatekeeping and anit-trans bias, so they insist in yearly urological prostate checkups and tell you nothing about learning to perform manual self-breast-examinations on a regular basis.

Thanks again for your answers! BTW, are you perhaps medical personnel?

Cheers,
Eurydike

[Flan]

(disclaimer: my OB/GYN specializes in trans* health so I'm going by the clinic's standard of care)

Thanks for you answer. About OB/GYN specializing in trans issues, they are not easy to find in every town. That's the problem.

As you have one (lucky you!), what "standards of care" do you mean? Do you mean OB/GYN clinical standards or specific trans standards, perhaps something detailed I've missed in the WPATH's SOC?

A GP claiming that surgery is not detectable is probably being nice.

Agree. At least as far as thorough manual pelvic exam goes. Thing is, I am not sure if she said that referring just to the outer appearance. Could be. I do not remember exactly. (I'll edit just in case).

That said, it's probably overkill for yearly gyno checkups beyond the usual physical exam.

Right, so you also think it is simply too often/ too much/ not absolutely necessary.
But then, what do you mean by "usual physical exam"? Could you please be more precise?

Breast exams are much more important than prostate exams and yearly is overkill since hormone therapy should have worked that out. Exams there should use age guidelines and the ubiquitous PSA test.

Agree. But that was the point: many doctors are too busy complying themselves to gatekeeping and anit-trans bias, so they insist in yearly urological prostate checkups and tell you nothing about learning to perform manual self-breast-examinations on a regular basis.

Thanks again for your answers! BTW, are you perhaps medical personnel?

Cheers,
Eurydike

Just a future doctor. The standard of care is unique to the clinic chain (which my doctor heads its trans* care guidelines). "Usual exam" refers to a regular checkup (exam of breast, lung sounds, heart sounds, thyroid cancer check, abdomen exam) with or without blood labs for hormones and liver health.

Post-op gyno exams are generally restricted to making sure everything went OK from surgery and from there the it's mostly the same sexual health issues that cis women get (pending complications to vaginal maintenance).

[Eurydike]

Just a future doctor. The standard of care is unique to the clinic chain (which my doctor heads its trans* care guidelines). "Usual exam" refers to a regular checkup (exam of breast, lung sounds, heart sounds, thyroid cancer check, abdomen exam) with or without blood labs for hormones and liver health.

Thanks for your answer! I wish you good luck with your medical career.

Interesting to know there is a clinic chain somewhere where a trans specialized ob/gyn doctor is in charge of trans health issues (if I understood you correctly). I guess that's as far as it goes by now regarding clinical care for trans people beyond specialized genital surgeons and other areas of specialization like psychotherapy/psychiatry or speech-language pathology. Some things do get better 

I see you call "usual exam" what here is something like a general health exam by a GP, even regarding some hormone levels of special interest for the trans population. As far as one of my current research topics of interest goes, such "usual" exam can be performed without informing your GP about some specific details of one's past medical history. Please, do correct me if I'm wrong.

Post-op gyno exams are generally restricted to making sure everything went OK from surgery and from there the it's mostly the same sexual health issues that cis women get (pending complications to vaginal maintenance).

Yep. That's my point. No uterus, no much gyno worries besides assuring Op-results are good. Ok, there are the usual girl problems like UTI, but actually nothing an OB/GYN must specifically address through checkups as regular as once a year. Which makes me ask again: besides general health and hormone levels, which can be checked at any good GP and/or endo, there is no big need for very regular urological and gyno checkups?

BTW, how often are mammographies recommended?
(I've heard different versions concerning this question)

[Bookworm]

I would guess that breast exams should be as regular as a cis woman's. This can very though. What I mean is I think this is up to the individual's health. I have a friend who goes often because she is extremely predisposed to breast cancer, so she wants to make sure that if she starts to develop it at all that she can catch it and treat it right away.

[Vicky]

Bad news, good news -- I was treated for a vaginal yeast infection three weeks post op, (bad news)  and found that my major health plan had trained several Ob/Gyn's to handle post op TS folk very well (Good news).  I was given an introduction to a speculum so she could check the entire inside lining, which was less thrilling than my dilator was at the time.  The infectiion cleared up in a few days, and my dilator got much more comfortable.  That was all good news

Because of my age, a mammogram was ordered for me (OK news) but the picture they got showed some suspicious tissue in my breast (bad news).  A needle biopsy was ordered, which was scary ( ucck news), but the biopsy came back as benign fibrous tissue. Very good news.

A 90 day follow-up on my Ob/gyn and another vaginal inspection front to back with a bigger speculum, and the evaluation was that surface healing was about as complete as it was going to get, and scar tissue was minimal.  Not bad for a diabetic who heals slowly.

I don't need to see the ob/gyn unless something female specific cuts loose, and have a standing prescription for the yeast medication if I need it again.  My GP is going to see me on the schedule I had been pre-op, likewise my hematologist.  Just another one of the girls now that my SS records are changed.

[Eurydike]

I would guess that breast exams should be as regular as a cis woman's. This can very though.

Exactly. Different women have their mammographies done at very different regularity intervals (trans, cis or otherwise ) Some take extra care, as you say, and some have a more flexible approach. Right, predisposition as in "cases in the family" are a warning signal for getting it done regularly. But in "average" cases I usually get different answers: once a year, once in two years or even once a year only if you're over 50. All these answers also vary across countries. And when friends tell you how often theirs are, the aswers multiply again. BTW, can you get a mammography done in stealth modus or would there be something noticeably different, e.g. less milk ducts?

[Tristan]

I go see my gyno once a year. But aside from that I only go if I'm having trouble down south.

[Eurydike]

Bad news, good news -- I was treated for a vaginal yeast infection three weeks post op, (bad news)  and found that my major health plan had trained several Ob/Gyn's to handle post op TS folk very well (Good news).  I was given an introduction to a speculum so she could check the entire inside lining, which was less thrilling than my dilator was at the time.  The infectiion cleared up in a few days, and my dilator got much more comfortable.  That was all good news

Because of my age, a mammogram was ordered for me (OK news) but the picture they got showed some suspicious tissue in my breast (bad news).  A needle biopsy was ordered, which was scary ( ucck news), but the biopsy came back as benign fibrous tissue. Very good news.

A 90 day follow-up on my Ob/gyn and another vaginal inspection front to back with a bigger speculum, and the evaluation was that surface healing was about as complete as it was going to get, and scar tissue was minimal.  Not bad for a diabetic who heals slowly.

Wow, I'm happy to know you're and the biopsy result was benign! Thanks for telling and congratzs for the good results and for keeping in good health!

I am also happy to know there seems to be more and more trained ob/gyns with knowledge ogf some trans specifics.

I don't need to see the ob/gyn unless something female specific cuts loose, and have a standing prescription for the yeast medication if I need it again.  My GP is going to see me on the schedule I had been pre-op, likewise my hematologist.  Just another one of the girls now that my SS records are changed.

Yep. I am also "just one of the girls" with some doctors already. But I've been only once to the ob/gyn (btw next appt approaching) and as I'm considering to widen my stealth compartments I'm wondering about regularity intervals for checkups, time gaps between finding new docs in a new town or what is "detectable" by whom, when, and why. So thanks again for the info!

All the best,
Eurydike

[Jenna Marie]

I checked with my doctor at my physical, and he said the protocol is to tell women who've had a hysterectomy that removed the cervix that they don't need yearly internal exams either. (Obviously, no cervix = no Pap smear, and that's the only reason to do it.) They can see a gynecologist if some health issue comes up, of course, but otherwise no need for it. He says that as far as he knows, the same is true for a trans woman who's fully healed up; internally and externally she is functionally identical to a cis woman who has no uterus or ovaries. It's also why it's safe for me to be taking estrogen-only HRT, which can increase the risk of uterine cancer.

As for not being able to tell, I dunno. I was in the ER a few months back for an unrelated issue and did have my pants off - but no speculum exam inside - and nobody batted an eye. I'm betting it depends on the skill of the surgeon and probably the time elapsed post-op. My GP found some scar tissue inside, but I was only four months post at that point; it also wouldn't surprise me if the external and even internal results could pass inspection by a GP but an experienced gynecologist would wonder.

We *definitely* need breast exams, both the self-exam and the doctor checkup.  My GP and endo both do this at every [well-patient] visit, just to be sure.

As for the prostate exam, since it can now be checked from inside the vagina, I'm OK with doing it but I gather that the prostate shrinks enough on estrogen that the risk drops off sharply compared to cis men. I don't want the PSA test because apparently the risk of false positive is serious enough that it's being recommended against even for cis men with no other risk factors, now.

[Megan Rose]

I saw a gynecologist four times right after returning from SRS.  And have been very lucky.  She is a surgeon who already knew me from my work in the operating room, and I knew her as a top-notch surgeon.  But, she had done her homework when I got there, knew all the right questions to ask and what to look for.  She helped me out with a few sutures that were problematic, with wound care, by loaning me dilators when my own were not working, and by treating a yeast infection. 

We've seen each other at a distance in the operating room since then,  always with smiles and a wave.  It's been about two months since seeing her, and I've made a complete recovery.  Today I found a moment when she wasn't occupied to say hello again and thank her for making my surgery a success.   And, she again asked all the questions that were pertinent to my recovery - swelling, pain, urine stream, dilation - it turned out to be an informal follow up exam.

I have no plans for regular visits with her, but I see her frequently, and she's made it clear that it only takes a phone call for care of bladder infections or the like. 

I will see my GP for mammograms - but haven't worked up the courage for that yet.  I don't know if my mammos are big enough to gram anyway...

[mintra]

I'm 1 year post op but never had to see a gynecologist yet. I think I'll just see one if I had a problem but so far everything was perfect.

[milktea]

i'm very perturbed about going to a gp/gyne in town...it is in my impression that none are trained to handle my situation and perhaps even overly curious, too curious for my benefit  so i'm taking my chances with things and go back to my surgeon after the 1 yr mark.

[Nicole]

twice a year for me.
I do self tests on my boobs, thats once a week, if i feel anything new, I run to the doctor

[Northern Jane]

One of the problems with having undergone SRS so long ago is that nobody knows exactly WHAT should be done or what is advisable so I got used to being a Guinea Pig 

I found my first gynecologist when I was 16 (1966) - he was the first doctor who seemed to understand and was supportive. He started me on HRT when I was 17 (still one year under legal age), arranged my 'psyche evaluation' at age 20, and was trying to find a surgeon for me. (Back then SRS was extremely hard to come by.) When I did find a surgeon (age 24) he was my biggest supporter and provided my follow-up care until I moved away.

I didn't see a gynecologist again for many years after I found a GP in my new city. My GP looked after everything. She made inquiries but found there weren't any 'accepted standards' for post-op care - of course not! - I was in the first wave you might say.

Though I don't have a cervix, PAP smears were recommended every few years just to be safe. Although my prostrate was undetectable (I may never have had one?) she suggested a PSA test in my 50s and boy did that cause a stir in the lab! The lab techs thought my doctor made a mistake and raised quite a fuss about it. I do have mammograms every few years and I do see an endocrinologist regularly now but the only time I have seen a gynecologist in the last 39 years was a few years ago when I complained about a loss of elasticity - he wasn't much help - he said it is normal with aging.

Maybe in time doctors will figure out how to deal with us long-term post-op but for now they are just guessing. They will have to wait until enough of us Guinea Pigs have been around long enough to produce some statistics. So far we seem to be immune form most sex-specific ailments 

[Eurydike]

Though I don't have a cervix, PAP smears were recommended every few years just to be safe.

Sounds like pre-emptive care. But the PAP-test aims at detecting pre-cancerous and cancerous anomalies in the cervix. Could it be used to detect similar problems in the vagina? If not, I wonder what for...?

Although my prostrate was undetectable (I may never have had one?) she suggested a PSA test in my 50s and boy did that cause a stir in the lab! The lab techs thought my doctor made a mistake and raised quite a fuss about it.

I've heard that the PSA-test delivers too high a number of false positives. In some countries it's not recommended under the age of 50, in others it is not even recommended if there are no symptoms/problems.

I do have mammograms every few years and I do see an endocrinologist regularly now but the only time I have seen a gynecologist in the last 39 years was a few years ago when I complained about a loss of elasticity - he wasn't much help - he said it is normal with aging.

I know some cases, all postmenopausal. Some OB/GYN recommended lube, others lube and postmenopausal HRT. Of the cases I know a bit more directly (three menopausal heterosexual cis women not having regular penetrative sex) only one went for HRT because of hot flashes. As you say, post-op care was and still is in some kind of experimental stadium, so if we maintain adequate E levels long-term through HRT in advanced age perhaps not all post-op women will experiment vaginal loss of elasticity. Anyway, thanks a lot for pioneering!