You have an inverted penis

[Karen_A]

I support the view of Kelly and Victor. Stating a medical fact is not an insult. There is no similarity between the female reproduction system and those of male.

So medically, how are post-ops THAT different medically from an XX woman who has had a total hysterectomy?

And I any case that MD had no reason to be so rude... to me that means the response was based on prejudice rather than medicine.

- Karen

[xFreya]

I support the view of Kelly and Victor. Stating a medical fact is not an insult. There is no similarity between the female reproduction system and those of male.

Firstly there are a lot of similarities between female and male reproduction system because they start from the same point and develop differently depending on the presence of testosterone and anti mullerian hormone. Some parts become more different, some more similar.
Anyway a post-op vagina isn't a male organ. with modern techniques labia majora, labia minora, clitoris are all made of their homologues so there is not much difference there. urethra length is same.
Vaginal lining can be made from penile skin, scrotal skin, colon graft and nowadays peritoneal graft. I don't think the doctor even asked about it in this case. While it is different from a healthy cis female's, like stated a few times there are cis women who were born without it and they get vaginoplasty too.
Despite difference in vaginal walls it is still a vagina with possibilities of BV, yeast infections, tears etc (common problems) which wouldn't normally happen to a male?

If there seems to be a problem that wouldn't normally happen to cis woman he can ask/refer to someone else but it should be rare.

So what if there is no cervix and uterus? Less things to worry about for the doctor. There are cis women without them.

There is the prostate which is unlikely to cause problems under female hormone levels but if it did one would go to a urologist I guess.

While I'm interested in biology I'm not a doctor so I might be missing some details. But regardless I can't see who should be more qualified to see a post-op trans woman. If a gynecologist still doesn't feel confident about it they can kindly refer the patient to one with more experience.

When it involved a medical visit, I don't mind exposing myself as a male in order to receive the correct treatment.

This would make even less sense outside of reproductive system problems. (treating you as male I mean, unless you are not doing HRT)

[Jacelyn]

So medically, how are post-ops THAT different medically from an XX woman who has had a total hysterectomy?

And I any case that MD had no reason to be so rude... to me that means the response was based on prejudice rather than medicine.

- Karen

Post-op women will not have the reproductive system of the xx woman, for example being dependent of hormone treatment, whereas the xx woman can produce own hormone, and treatment would be different for them. Any medical traditions will have different treatment for male and female, this is not an exception to western medicine. Before any treatment can begun, the first thing they must know is the original gender of the patient, in term of xx or xy, regardless of post-op or not, because SRS merely change the cosmetic of the gender organ, and does not bestow the biological mechanism of the xx woman.

I don't think this criteria as a fact being communicated (as an ethical necessity in medicine) to the patient is a form of insult (or rude) just because she is a post-op, unless she valued unethical medical practices that is out to win her respect and trust to spend for a certain treatment (as prevalent in illegal medical practices). Any post-op with such mind-set can become easy victim, hence such negative attitude toward an MD (who do the right thing by telling the fact, except that the fact hurts) should not be encourage.

[Jacelyn]

Firstly there are a lot of similarities between female and male reproduction system because they start from the same point and develop differently depending on the presence of testosterone and anti mullerian hormone. Some parts become more different, some more similar.

This is only to say that they have the same origin, but develop differently due to the condition of the genes (xx or xy) and hormone is only part of the causes, not all, and as such required a different treatment for them. The saying that the thing start from the same point and develop differently is the same as saying they are similar is flawed. Any small differences required a different medical treatment, and the differences of male and female reproduction system and their treatment is clearly documented in all tradition of medicines. Any competent MD should be aware of them, and it is their responsibility to apply the right treatment to the right patient (male or female), and where it is outside their area of competence, it is their responsibility to make it clear, in various method of expressing it, even if some of the words may be hurtful for some patient.

Anyway a post-op vagina isn't a male organ. with modern techniques labia majora, labia minora, clitoris are all made of their homologues so there is not much difference there. urethra length is same.
Vaginal lining can be made from penile skin, scrotal skin, colon graft and nowadays peritoneal graft. I don't think the doctor even asked about it in this case. While it is different from a healthy cis female's, like stated a few times there are cis women who were born without it and they get vaginoplasty too.
Despite difference in vaginal walls it is still a vagina with possibilities of BV, yeast infections, tears etc (common problems) which wouldn't normally happen to a male?

1. The current (common) trend for the construction of post-op vagina is of penile skin, although there are better alternative such as using inner skin of mouth and stomach, these procedures are still new and experimental.

2. The upper half of the penile gland being used for the construction of clitoris has no match to the nervous density of a cis female clitoris (the penile gland in unmodified conditioned is also no match in nervous density of the cis female clitoris). Keeping the penile gland and fore-skin intact and unmodified is the only way to remotely simulate a feminine sexual sensation, SRS procedure destroyed nervous tissues at disturbing level, that's why the procedure is considered unethical in medical practices.

3. The neo vagina required completely different maintenance and the associated health care product used are different from those for cis female. A good example is the cis female vagina can absorbed sperm and hormone placed in it, and any toxic substance placed in it can be lethal, the same is not true for a neo vagina.

4. The cis woman's labia majora, and labia minora expand and changed colored, become self lubricated when sexually arosed, the neo vagina, no matter how cosmetically perfect, it has no such function. However, such bodily sexual response is the main cause of attraction for the man.

5. When view from the back, the part between the neo vagina cavity and the anus will collapse due to the absence of support of the inner portion of the penile shaft, whereas in a cis woman, this area is surrounded by strong muscles that can contract the vagina opening. Visually when this part collapse, it become less sexually attractive for the man who view from behind. This may have detrimental effect for anal sex as this part (space) need to be either filled with muscles (as in cis woman) or a penile shaft, but not a collapsed pile of skin where next to the anal cavity is directly the neo vagina cavity. Since there is no support, there is lesser sensation from either anal or neo vagina sex, due to no possibility of contraction with the muscles or in contacting with the inner portion of hardened penile shaft.

If there seems to be a problem that wouldn't normally happen to cis woman he can ask/refer to someone else but it should be rare.

Only MD familar with SRS experience is the most suitable for such treatment, because SRS procedure create a new condition for the patient that required such special treatment. Otherwise, the patient should only see the MD specialize in his/her birth gender.

So what if there is no cervix and uterus? Less things to worry about for the doctor. There are cis women without them.

MD specialized in cervix and uterus, may not be familar with male penile skin related problem (especially when the skin is inverted and concealed in a cavity), and the new condition created by the SRS procedure, which is a combination of plastic surgery field and male reproduction system field of specialization.

There is the prostate which is unlikely to cause problems under female hormone levels but if it did one would go to a urologist I guess.

The problem is we need to go through a diagnostic phase, in order to determine an ailment before the right treatment can be prescribed, this phase will screen the person's birth gender and the right advice and recommendation for the right doctor will be given. The problem with most post-op patient is that they will get emotionally hurt in the process, that is not the fault of modern medical procedure, it just that the patient need to learn the proper attitude for being a post-op in dealing with the medical officers.

While I'm interested in biology I'm not a doctor so I might be missing some details. But regardless I can't see who should be more qualified to see a post-op trans woman. If a gynecologist still doesn't feel confident about it they can kindly refer the patient to one with more experience.

While they explained the fact and make the recommendation, a post-op patient should learn to differentiate a medical fact from an insult.

[Complete]

And thank you Viktor, no need to compound the ignorance of this doc by putting forward your incorrect assumptions about the difference between vaginal and penile skin. In fact the only difference in the vaginal lining is that in natal females that skin responds to estrogen and produces some lubrication. It's still skin and it's healthy state is the same, i.e. colonized by microflora consisting of primarily lactobacillus.

I am not sure that this is factually correct. It my experience that there is a significant difference between the lining of a female vagina and penile skin. The main one is that while, as you say, penile skin is just skin, the lining of a female vagina is made up of mucosal tissue; much like the inside of your mouth.

[SadieBlake]

I am not sure that this is factually correct. It my experience that there is a significant difference between the lining of a female vagina and penile skin. The main one is that while, as you say, penile skin is just skin, the lining of a female vagina is made up of mucosal tissue; much like the inside of your mouth.

Not according to my surgeon who's training and background is as a urogynecological surgeon. Mucosa *always* exudes moisture in fairly large amounts which vaginal walls only do when blood-engorged during arousal.

Edit -- The only difference as far as I can ascertain between external skin and internal is the presence of a layer called the stratum corneum, aka keratinized skin. I know about this personally because that layer was shed from my vaginal walls between weeks 6-7 post op.

[Complete]

Not according to my surgeon who's training and background is as a urogynecological surgeon. Mucosa *always* exudes moisture in fairly large amounts which vaginal walls only do when blood-engorged during arousal.

Edit -- The only difference as far as I can ascertain between external skin and internal is the presence of a layer called the stratum corneum, aka keratinized skin. I know about this personally because that layer was shed from my vaginal walls between weeks 6-7 post op.

I guess the only way to know for sure is to feel around the inside if an unaroused vagina.  I do know that the inside of mine is always wet and gets very, very wet when aroused.

[SadieBlake]

Sure, mine is always damp, but not dripping. Sigmoid colon grafts weep significantly all the time. The keratinized exterior layer of exterior skin is the main barrier to moisture loss.

[Complete]

Sure, mine is always damp, but not dripping. Sigmoid colon grafts weep significantly all the time. The keratinized exterior layer of exterior skin is the main barrier to moisture loss.

I would not say that mine weeps significantly all the time. Only when stimulated, during and after sex. Are you saying you can be penetrated without using lube? That would be great. I wonder if anybody else has that experience.
Also, you might want to reference Jacelyn's comments above.

[SadieBlake]

Nope, not here - tho I check my self lubrication as often as possible. Current technique often (usually) includes using the excess urethra in the neovagina. My doc uses it to line the inner labia. Post op MTF women should also retain the Cowper's glands which create pre ejaculation fluid (the purpose of that is to adjust pH prior to ejaculation)

Again, sigmoid colon graft procedures do provide self lubrication, however as far as I know, that usually also requires use of pads to keep underwear from being wet.

[Complete]

Again, sigmoid colon graft procedures do provide self lubrication, however as far as I know, that usually also requires use of pads to keep underwear from being wet.

Good lord! I never cease to be amazed at the amount of misinformation on these forums. The only time l need
to use a pad is after sex. I usually get a small amount of "drip", probably from my hubby's ejaculation and usually one pad does the trick.

[Karen_A]

Post-op women will not have the reproductive system of the xx woman, for example being dependent of hormone treatment, whereas the xx woman can produce own hormone, and treatment would be different for them.

I hope you realize that what you are saying has little to no bearing when comparing a gg  who had a total hysterectomy and a post-op... which is  what I asked you about...

A woman that had one in her 20's or 30's or even 40's, would almost certainly be prescribed pretty much the same HRT a post-op takes,  as she can no longer produce her own hormones...

Do you know what a total hysterectomy is? Would you tell a gg what had one not to see a gyn as she no longer has a "female reproductive system"?

- Karen

[Karen_A]

I am not sure that this is factually correct. It my experience that there is a significant difference between the lining of a female vagina and penile skin.

While I have never checked (I over 19 years post-op), I was told that over time the skin adapts to being "inside" and changes because of it. In my case I was rather "small" in that department (unfortunately that was the ONLY small thing about me) so a significant amount of vaginal canal is from scrotal tissue.

What I do know is that I  had a nurse practitioner in a busy GYN office do a PAP smear on me and not realize i was not gg. The Gyn told me that when she told the nurse, teh nurse was very surprised... so it can't be THAT different.

- Karen

[SadieBlake]

Good lord! I never cease to be amazed at the amount of misinformation on these forums. The only time l need
to use a pad is after sex. I usually get a small amount of "drip", probably from my hubby's ejaculation and usually one pad does the trick.

Good for you. From chett's website

Self-lubrication
Standard SRS = come from the secretion of preserved para-urethral gland and cowper's gland.
SRS with colon graft = come from the secretion of mucus gland which varies from small amount of discharge to abundant discharge

If that's misinformation it didn't originate here.

[Complete]

I hope you realize that what you are saying has little to no bearing when comparing a gg  who had a total hysterectomy and a post-op... which is  what I asked you about...

A woman that had one in her 20's or 30's or even 40's, would almost certainly be prescribed pretty much the same HRT a post-op takes,  as she can no longer produce her own hormones...

Do you know what a total hysterectomy is? Would you tell a gg what had one not to see a gyn as she no longer has a "female reproductive system"?

- Karen

Karen.  I hope you are not arguing that a neovagina is anything like a normal female one. The differences go beyond the abbreviated quote you are using. Please try re-reading Jacelyn's entire post. I think she describes at least 5 or 6 significant differences. As she suggests,  would you not prefer competent care from someone who actually understood the structures and reconstruction of male to female genitals to someone inexperienced in such matters?

[Jacelyn]

Not according to my surgeon who's training and background is as a urogynecological surgeon. Mucosa *always* exudes moisture in fairly large amounts which vaginal walls only do when blood-engorged during arousal.

Edit -- The only difference as far as I can ascertain between external skin and internal is the presence of a layer called the stratum corneum, aka keratinized skin. I know about this personally because that layer was shed from my vaginal walls between weeks 6-7 post op.

Vaginal wall of cis woman can be blood-engorged during arousal, no neo vagina can do it, not even with using mucosal tissue taken from the inside of one's mouth or stomach.  The mechanism involved with the natural vaginal has a complexity beyond the imagination of the creators of neo vagina.

The skin from the inverted penis has no comparison to it, which is the reason it required a life time of regular maintenance with dilation method, if it can even remotely similar to mucosal tissue, after a period of time as you have assumed that the external skin has shed from your vaginal walls between 6-7 weeks post op, to reveal the internal layer called the stratum corneum, aka keratinized skin as similar to mucosal skin, you would have no need for regular maintenance or dilation. Our community is in need practical facts, not medical theory.

Another thing is the circular muscle surrounding the vagina, this is one critical component that is missing in neo vagina, it is beyond the imagination of cis woman that an intercourse with a neo vagina is matter of purely creating fiction between the surface of of two penile skin of two persons, where there is complete absence of interactive as well as involuntary muscular contraction of the vagina.

Given these major differences, how do you expect a doctor from the woman clinic know about your neo vagina and not confused treatment for those of cis women?

[Complete]

Good for you. From chett's website
If that's misinformation it didn't originate here.

I didn't see where that said anything about wearing a pad all the time. Like l said,  "always wet ", except after sex, then abundantly wet.😊😄😃😀😆😆😆😆

[Lisa_K]

2. The upper half of the penile grand being used for the construction of clitoris has no match to the nervous density of a cis female clitoris (the penile grand in unmodified conditioned is also no match in nervous density of the cis female clitoris). Keeping the penile grand and fore-skin intact and unmodified is the only way to remotely simulate a feminine sexual sensation, SRS procedure destroyed nervous tissues at disturbing level, that's why the procedure is considered unethical in medical practices.

Wait, what? Are you saying SRS is considered an "unethical medical practice"? Tell me then why most of those that had this surgery report a high rate of sexual satisfaction including orgasm? Have you had this surgery? Speaking from my own experience, I've been completely happy with my own response regardless of the fact of not matching the nervous density of natal females and regardless of the fact I had an older style procedure performed 40 years ago in 1977. In fact, with my older surgical technique, the penile glans and associated nerves and blood supply was used to create a pseudo cervix rather than the clitoris and I have a great deal of sensation inside. I really have no visible clitoris as with in modern procedures as it is rather buried but the lump or bundle of nerves or corpus spongiosum that was used to create it is still highly sensate and can be stimulated alone to climax.

3. The neo vagina required completely different maintenance and the associated health care product used are different from those for cis female. A good example is the cis female vagina can absorbed sperm and hormone placed in it, and any toxic substance placed in it can be lethal, the same is not true for a neo vagina.

Granted the first part of this holds some merit but I'm going to have to contest some of your assertions in the second. Hormones placed in the "neo vagina" can indeed be absorbed into the blood stream and can have direct affect on the tissues involved as well. Ask anyone who has ever used Premarin vaginal cream and the notion that a toxic substance could be inserted into an aftermarket vagina would have no affect is a downright dangerous suggestion.

4. The cis woman's labia majora, and labia minora expand and changed colored, become self lubricated when sexually arosed, the neo vagina, no matter how cosmetically perfect, it has no such function. However, such bodily sexual response is the main cause of attraction for the man.

Indeed, lubrication and getting wet is a sign of sexual arousal but that can be discretely simulated but to suggest engorgement of the clitoris, labia minora and vestibule area is impossible is simply not correct, at least in my case and the surgical techniques that were used. In fact, I've heard of those having revision surgery because this engorgement has been problematic for some extending from the clitoris all the way into the vaginal opening. I definitely "get hard" when aroused due to some retention of the corpus spongiosum and due to blood flow, my whole vulva gets warmer and while not inter vaginally, some natural amount of lubrication or a moistening, probably from the Cowpers glands does happen.

5. ... Since there is no support, there is lesser sensation from either anal or neo vagina sex, due to no possibility of contraction with the muscles or in contacting with the inner portion of hardened penile shaft.

Another thing is the circular muscle surrounding the vagina, this is one critical component that is missing in neo vagina, it is beyond the imagination of cis woman that an intercourse with a neo vagina is matter of purely creating fiction between the surface of of two penile skin of two persons, where there is complete absence of interactive as well as involuntary muscular contraction of the vagina.

What? I can't say I understand all of this. Are you saying the muscles connected to the "neo vagina" are incapable of contraction? Ever done kegal exercises? I can definitely contract the muscles at the opening of my vagina enough to be felt by a partner. Maybe I just don't get what you're talking about? Possibly not what you mean but my vaginal opening is surrounded by a ring of muscles extending inside an inch or so and can easily be felt with fingers. At climax, these muscles or whatever the hell is in there definitely spasm rhythmically and involuntarily.

Only MD familar with SRS experience is the most suitable for such treatment, because SRS procedure create a new condition for the patient that required such special treatment. Otherwise, the patient should only see the MD specialize in his/her birth gender.

No, preferably an MD should specialize in or have experience with the procedures and conditions specific to those that have had SRS. Saying a post surgical transsexual female should only see a doctors that specializes in their birth gender is quite frankly stupid.

While they explained the fact and make the recommendation, a post-op patient should learn to differentiate a medical fact from an insult.

As well as they should learn to differentiate between medical incompetence, ignorance and flat out insensitivity and bias from a medical practitioner. Yes, our bodies are not the same as natal females and we do retain vestiges of the male reproductive system such as the prostate gland but to suggest we are entirely and wholly different from natal females in all aspects simply isn't entirely accurate either.

The skin from the inverted penis has no comparison to it, which is the reason it required a life time of regular maintenance with dilution method, if it can even remotely similar to mucosal tissue, after a period of time as you have assumed that the external skin has shed from your vaginal walls between 6-7 weeks post op, to reveal the internal layer called the stratum corneum, aka keratinized skin as similar to mucosal skin, you would have no need for regular maintenance or dilution. Our community is in need practical facts, not medical theory.

Perhaps some need less practical facts and to listen more closely to those with more actual experience in these matters especially from those long term post surgery? The inside of my vagina is indeed far more mucosal than your comments would tend to believe is possible. Yes, I have to dilate to maintain depth and width if not having regular intercourse and do need to use lubrication for comfort but the inside my vagina does maintain its own moisture, contains the same vaginal flora, taste and smell as a natal female and is equally capable of having yeast infections, etc., which wouldn't happen if it was the dried out cavity as you suggest.

Healthcare from uneducated and inexperienced doctors that aren't familiar with our special bodies and needs is a problem and should we encounter a physician that isn't, ignorance and insensitivity are to be expected and anticipated but while we aren't natal females, we aren't exactly male either and it isn't rocket science especially if we have symptoms or problems that are common with natal women.

[xFreya]

This is only to say that they have the same origin, but develop differently due to the condition of the genes (xx or xy) and hormone is only part of the causes, not all, and as such required a different treatment for them. The saying that the thing start from the same point and develop differently is the same as saying they are similar is flawed. Any small differences required a different medical treatment, and the differences of male and female reproduction system and their treatment is clearly documented in all tradition of medicines. Any competent MD should be aware of them, and it is their responsibility to apply the right treatment to the right patient (male or female), and where it is outside their area of competence, it is their responsibility to make it clear, in various method of expressing it, even if some of the words may be hurtful for some patient.

After SRY gene on Y chromosome makes undifferentiated gonads into testicles(or not) sexual differentiation is caused by hormones through expression of different genes. That is why if there is no working SRY gene you can get XY female phenotype person. Or you can get an XX male if there is an SRY gene.

1. The current (common) trend for the construction of post-op vagina is of penile skin, although there are better alternative such as using inner skin of mouth and stomach, these procedures are still new and experimental.

I think scrotal skin or partly penile partly scrotal skin graft might be more common these days. Regardless all of these are possible what is your point?



Lisa_K said most things I would say so I won't repeat them, but I will just say I experience engorgement and some lubrication during arousal and I can contract the muscles in the vagina too. No offense but it almost sounds like you decided not to get SRS for whatever reason (which is perfectly fine) and are reminding yourself reasons why a "neo vagina" is bad. But a lot of these aren't true or not very relevant here.

Only MD familar with SRS experience is the most suitable for such treatment, because SRS procedure create a new condition for the patient that required such special treatment. Otherwise, the patient should only see the MD specialize in his/her birth gender.

There isn't always an SRS surgeon around. And since "plastic surgery + originally male equipment" is close to natal female genitals, in most cases a gynecologist is the next best option.



Edit: I decided I don't even want to continue this debate. If I wanted to read and answer to stuff about how SRS is "medically unethical" and how trans women should be categorically denied from gynecological services because they are completely their birth sex, or beautiful things like "an intercourse with a neo vagina is matter of purely creating fiction between the surface of of two penile skin of two persons" I would go to youtube comment section or something, not a trans forum.

[Jacelyn]

Wait, what? Are you saying SRS is considered an "unethical medical practice"? Tell me then why most of those that had this surgery report a high rate of sexual satisfaction including orgasm?

The study on sexual satisfaction of post surgery patients is inconclusive:

"The very high rates of subjective satisfaction and the surgical outcomes indicate that gender reassignment surgery is beneficial. These findings must be interpreted with caution, however, because fewer than half of the questionnaires were returned." c.f. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4261554/

We need to question the standard of treatment that involved SRS:

"Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. " c.f. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043071/

Previously, the law make SRS a necessity for the recognition of desired gender. The new law will make SRS unnecessary and so is the use of transgender as a mental disorder as the reason for SRS:

"The World Health Organisation (WHO) is the principal public health body of the United Nations (UN) and it recently announced it is beginning to take steps to remove being transgender off its classification list of mental and behavioural disorders."

The medical code of ethics is not to harm the patient, SRS is considered unethical since it harm the patient's fertility by destroying the reproductive system, as well as partially destroying the nervous tissues (this is important for a TS) associated with the patient's sexual happiness.

Have you had this surgery? Speaking from my own experience, I've been completely happy with my own response regardless of the fact of not matching the nervous density of natal females and regardless of the fact I had an older style procedure performed 40 years ago in 1977. In fact, with my older surgical technique, the penile glans and associated nerves and blood supply was used to create a pseudo cervix rather than the clitoris and I have a great deal of sensation inside. I really have no visible clitoris as with in modern procedures as it is rather buried but the lump or bundle of nerves or corpus spongiosum that was used to create it is still highly sensate and can be stimulated alone to climax.

A lot of pre-op are happy too just the way they are and they don't need to go through all the trouble surgery which is not without risks and short comings.

While after surgery, you treasure the remaining parts that were left that contribute to your sensation, but a pre-op will always have their parts untouched, unmodified, and so able to enjoy full sensation without being compromised by the surgery.

The corpus spongiosum should not be removed in its original place, I am more than happy to not have a vagina but enjoy better anal sex with this thing intact (when it gets hard, then the pleasure intensify), and able to show sign of arousal (erection) in the absence of a functioning labia majora, and labia minora, something which I will never get even with surgery (I'd rather have some bodily sign of arousal to show my bf during the erotic moment, than having nothing to show due to the surgery).

Granted the first part of this holds some merit but I'm going to have to contest some of your assertions in the second. Hormones placed in the "neo vagina" can indeed be absorbed into the blood stream and can have direct affect on the tissues involved as well. Ask anyone who has ever used Premarin vaginal cream and the notion that a toxic substance could be inserted into an aftermarket vagina would have no affect is a downright dangerous suggestion.

Absorbing such medicine is not the purpose of my comparison between the natural and neo vaginal, my focus is daily functionality of the organ, a natural vagina can absorb the sperm of one's partner without needing to clean afterward and sperm is known to be beneficial to the woman's mental health as well as improving the body's immunity. But a neo vagina has no such function and it must be cleansed or risk infestion after a period of time.

Indeed, lubrication and getting wet is a sign of sexual arousal but that can be discretely simulated but to suggest engorgement of the clitoris, labia minora and vestibule area is impossible is simply not correct, at least in my case and the surgical techniques that were used. In fact, I've heard of those having revision surgery because this engorgement has been problematic for some extending from the clitoris all the way into the vaginal opening. I definitely "get hard" when aroused due to some retention of the corpus spongiosum and due to blood flow, my whole vulva gets warmer and while not inter vaginally, some natural amount of lubrication or a moistening, probably from the Cowpers glands does happen.

You do know that this phenomena is not universally apply to all, and depend on the doctor as well as luck. We should not rely on anything that is based on luck, at least we should not encourage others to take the risk knowing that it exists, that is considered unethical in a medical case.

What? I can't say I understand all of this. Are you saying the muscles connected to the "neo vagina" are incapable of contraction? Ever done kegal exercises? I can definitely contract the muscles at the opening of my vagina enough to be felt by a partner. Maybe I just don't get what you're talking about? Possibly not what you mean but my vaginal opening is surrounded by a ring of muscles extending inside an inch or so and can easily be felt with fingers. At climax, these muscles or whatever the hell is in there definitely spasm rhythmically and involuntarily.

What you experience is the muscle responsible for the contraction of the anus, since it is linked to the same area, it will have some effect on the neo vagina, but a cis woman's vagina has its own ring of muscles, at least 8 as shown in the picture: https://i1.wp.com/midwiferytraditions.com/wp-content/uploads/2015/11/pelvic-floor-exercises-4.jpeg?w=400&ssl=1

No, preferably an MD should specialize in or have experience with the procedures and conditions specific to those that have had SRS. Saying a post surgical transsexual female should only see a doctors that specializes in their birth gender is quite frankly stupid.

Only for area with access to the SRS specialist, otherwise, the only choice is a doctor specializes in male patient.

As well as they should learn to differentiate between medical incompetence, ignorance and flat out insensitivity and bias from a medical practitioner. Yes, our bodies are not the same as natal females and we do retain vestiges of the male reproductive system such as the prostate gland but to suggest we are entirely and wholly different from natal females in all aspects simply isn't entirely accurate either.

Of course if you are looking for treatment that is not gender related, then simply go to a general doctor or a specialist of that respective field. But I assume that what we discussed here is a gender related health issue.

Perhaps some need less practical facts and to listen more closely to those with more actual experience in these matters especially from those long term post surgery? The inside of my vagina is indeed far more mucosal than your comments would tend to believe is possible. Yes, I have to dilate to maintain depth and width if not having regular intercourse and do need to use lubrication for comfort but the inside my vagina does maintain its own moisture, contains the same vaginal flora, taste and smell as a natal female and is equally capable of having yeast infections, etc., which wouldn't happen if it was the dried out cavity as you suggest.

No one denial the neo vagina can maintain moisture, but the contributing factor is certainly not of the penile skin but of other gland that is placed there during the SRS procedure. What I am saying is that the neo vagina cannot exhibit sign of sexual arousal that cause the increase of blood to the area and resulted in more increase of secretion than in normal state. I did not suggest it is a dry out cavity but a place where self cleansing cannot occurred and so all waste inside must be cleanse regularly.

Healthcare from uneducated and inexperienced doctors that aren't familiar with our special bodies and needs is a problem and should we encounter a physician that isn't, ignorance and insensitivity are to be expected and anticipated but while we aren't natal females, we aren't exactly male either and it isn't rocket science especially if we have symptoms or problems that are common with natal women.

We cannot expect others to think and behave what we expect them to. Being defensive only show one's own insecurity and lack of self-confident in being a transwoman. That's the reason a few words is all that is needed to make them lose their manner. Being a transwoman, one's character and mannerism should be that of a woman, not a man that easily react to anger anymore.