Tips for educating a gynaecologist

[Julia-Madrid]

Ladies, your help please!

As I near my SRS date I am trying to arrange for a good gynaecologist to be available once I return to Madrid, just in case, and also for the longer term.  Unfortunately post operative gynaecology in Madrid is pretty poor, and the two gynaecologists I've been referred to so far with trans experience have left me totally unimpressed.

So, as I've done for many things in my process, I'd rather find a highly competent gynaecologst working with cis women, and educate her into trans women's health issues. 

My request to you is whether you are aware of any good reference material?  Do you have  any tips and observations from your personal experience?

Thanks soooooo much!   
Julia

[Rejennyrated]

An interesting point.

The difficulty that trans women pose for gynaecology is that we don't have the parts of the female anatomy that a gynaecologist is principally interested in, namely a cervix, uterus, tubes, and ovaries. Yes you may have a vulva and vaginal opening, but even that is not quite the same in its construction as the "factory fitted" option.

For example the skin in the vagina in your case will be keratinised squamous epithelium derived from the ectodermal stem cell line, where a natal female will have stratified squamous epithelium derived from the endodermal cell line. It's a small histological difference and of no consequence to anyone other than an expert... but it's a difference – and therein lies the problem.

Another example – you will still have a prostate inside you, which makes a substantial difference to the arrangement of your internal and external urinary sphincters.

We probably actually need our own medical discipline, because in the current state of what can be achieved by medical rearrangement, gynaecology doesn't really cover the resultant anatomical mix. As better treatments come along that may change, but not for some while I fear.

**EDIT** Maybe I should add that in 30 years of being post op I have never needed a gynaecologist.

[Julia-Madrid]

Thanks for that update Jenny!  I am obviously hoping that there will be no need for anything other than the occasional checkup, but I'm the kind of person who likes to have things prepared, just in case.

I did manage to find some good medical journal papers on transgender post-op care, and these will be a good starting point for any candidate gynaecologist.

xxx
J

[Eveline]

...
**EDIT** Maybe I should add that in 30 years of being post op I have never needed a gynaecologist.

Wow, Rejennyrated, that's interesting. I was thinking I would need a gyno after GCS.

In your experience, has a family practice GP been sufficient?

[Rejennyrated]

Wow, Rejennyrated, that's interesting. I was thinking I would need a gyno after GCS.

In your experience, has a family practice GP been sufficient?

Entirely yes... And as someone who will almost certainly be a GP myself within five or six years from now, when I finish my residency, I would hope that I would be up to the job. There isn't much that can go wrong with the "bits" as long as you look after them, so it's mainly normal monitoring.

In fairness you should probably bear in mind that it wasn't entirely by accident that I was accepted for medical school at my ridiculous age. I've had a bit of an interest in all thing medical since I left school (back before wireless was invented) and so under the watchfull eye of my GP I mostly did my own bloodwork and titrations, but my impression is that this sort of basic endocrinology and metabolic monitoring is all pretty standard GP fare.

[Eva]

Well my doc who prescribes my HRT has 30+ years experience as an OB/GYN.... He has very little experience with MtF HRT and other issues but he wants to learn... I like to think Im teaching him something here and its good to know when the time comes he'll be there if I need him

[AnonyMs]

I did manage to find some good medical journal papers on transgender post-op care, and these will be a good starting point for any candidate gynaecologist.

Would you mind posting references to those papers? I'd be interesting in looking at them.

I read a number of times of post-ops seeing a gynecologist to treat granulation.

[Julia-Madrid]

...and so under the watchfull eye of my GP I mostly did my own bloodwork and titrations, but my impression is that this sort of basic endocrinology and metabolic monitoring is all pretty standard GP fare.

Now I wouldn't exactly say that I'd want to do my own bloodwork and whatnot, but I'd entirely agree with you, Jenny, that the basic monitoring is pretty standard and doesn't in fact need to be referred to a specialist.  If anything is found to be out of normal limits, only then would I call on a specialist.

On a separate topic, I am sometimes perplexed at the piecemeal,  non-holistic way that transgender care is often provided, and I cannot help wondering how to glue all the various medical specialiities together in a cohesive manner.  For example, while an endo would prescribe HRT, it may need the collaboration of a digestion specialist to catch any liver function issues, as well as a psychiatrist for those cases where HRT may have negative effects or where depression or other mental illness is already present.  Add to that post-operative gynaecological care, and that's a lot of people who, if properly involved, could ensure a far superior level of care.

Some day this may become standard care, but we're quite far off from it right now...

Hugs
Julia

[Julia-Madrid]

Would you mind posting references to those papers? I'd be interesting in looking at them.

I read a number of times of post-ops seeing a gynecologist to treat granulation.

Hi AnonyMs.  Of course.  Below are the two titles you can find from a web search and they're freely available as PDF.  I also found a paper on the interpretation of mammogram results in transgender women, but that required paid journal access.  If you find any other useful papers, please won't you post their names here.

Gynaecological aspects of the treatment and follow-up of transsexual men and women

Microflora of the penile skin-lined neovagina of transsexual women

Regards
Julia

[AnonyMs]

Thanks Julia,

I'm not sure I liked that first paper, or that I'd give it to a gynecologist. It's hard to express why exactly, but it didn't seem quite right. I can't help but want to argue with whoever wrote it, which is stupid considering I'm not even in the medical field.

There appears to be an error in the in the recommend blood levels for estradiol, where on page 40 it states "A serum level of 200 ng/ml is usually more than sufficient." I think its supposed to be 200pg/ml, which is 1000 times less.

Here's some links if anyone else is interested.

Gynaecological aspects of the treatment and follow-up of transsexual men and women
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154336/

http://www.biomedcentral.com/1471-2180/9/102
Microflora of the penile skin-lined neovagina of transsexual women

I could't get the mammogram one either. You can probably get it free from a university library.

[Laura_7]

You could ask a mtf group in your place for a referral...

and you could think about asking a gyn treating menopausal woman... a combination of estrogen, bioidentical progesterone and even a low dose of testosterone might be an idea, all of them are used... topical or via implants... and levels are not the only factor, decisive is how it makes you feel... people are different....

hugs

[mrs izzy]

Many are scared of the neo-vagina.

My doctor said it is as a post hysterectomy menopausal Vagina

So it's real.  Healing I found many of the girls I know have had ob/gyn set up to have been dropped after the fact being they had no idea on care.  It's a vagina, if there is a infection treat it,  if scar granulation treat it.

So as I said in a post months ago.  Just do not ask but visit your gyn beforehand and give them your surgeons phone or contact info so they can ask your surgeon questions up front.

Not many complications happen.  When they do you need not trying to scramble finding  someone being your doctor decided they have lost there willingness to treat.

[Julia-Madrid]

Thanks everyonefor your comments.

Laura, I belong to the only gender clinic in Madrid, and they are the people referring me to gynaeologists I wouldn't want to touch me.  Bizzarely these gynaecologists don't even collaborate with the clinic, which I find kind of baffling    It's just such a small community here, and being so small, the resources are very light. 

Mrs Izzy, I think your point is probably right about the scary neo-vagina.  But if we start from the assumption that it's a post-hysterectomy menopausal vagina we're probably in an ok place.

AnonyMs - thanks for pointing out the nanogram/picogram issue.  To be honest, I have only skimmed the two papers.  It was to have something to use as an introduction, so that the poor gynaecologist wouldn't be stuck like a bunny in the headlights...

Hugs to y'all
Julia

[Isabel]

Hi Julia,

I live in Barcelona and here I know of some "trans-friendly" gynaecologists.

If you can afford to travel from Madrid to Barcelona from time to time, maybe you should check this option if you don't "trust" gynaecologists in your area.


Regards,

Isabel.

[Julia-Madrid]

Hi Isabel

Thanks for your reply.  It wouldn't be the worst thing in the world to catch the AVE to Bacelona for a consultation.  I lived there for 12 years, so I do like to go back occasionally.

If you do know some gynaecologists, could I ask you to send me a personal message with their names - I'd be very grateful.

Thank you/gracias/merci
Julia