Peritoneal Graft & Vaginoplasty

[amandam]

what is rhe dilation schedule like?

[Complete]

what is rhe dilation schedule like?

Dilation?  What's that?  Oh, you mean when l get it on with my hunk of love husband? Gee....that would be as often as we're able.😃😆😀😃😃😃😄😉😈😇

[MamaBear318]

what is rhe dilation schedule like?

The nurse practitioner at Mt. Sinai said 2x's a day!  My daughter was thrilled to hear that!

[Bestk]

Dr. Kathy Rumer also performs this surgery. Dr. Rumer performs 25-30 vaginoplasties per month in Philadelphia. Her wait list is approximately 2-1/2 months. Her email address is info@rumercosmetics.com and their phone number is 855-782-5665.

[Complete]

Dr. Kathy Rumer also performs this surgery. Dr. Rumer performs 25-30 vaginoplasties per month in Philadelphia. Her wait list is approximately 2-1/2 months. Her email address is info@rumercosmetics.com and their phone number is 855-782-5665.

Of the 300 or so grs surgeries that Dr. Ruler performs per year,  how many use peritoneal tissue and what are the VERIFIED results?

[trs2468]

Hi I am a tranaexual women from Nepal. & I want to have vaginoplasty using peritoneal graft. Does Dr Jess Ting perform vaginoplasty using peritoneal graft ? How much does it cost?

[AnonyMs]

Dr. Kathy Rumer also performs this surgery. Dr. Rumer performs 25-30 vaginoplasties per month in Philadelphia. Her wait list is approximately 2-1/2 months. Her email address is info@rumercosmetics.com and their phone number is 855-782-5665.

If you search you'll find a fair lot of negative reviews about her.

[TinaVane]

I think this is great news.l had colonovaginoplasty 35  years ago and it made  a huge difference in my love life.  No more dilation or lube.Now you have all that w/o all the potential side effects.

So this new peritoneal gives the same length/depth as the colovaginaplasty?


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[IsabellaSwan]

I would like to know this as well ^^

[steph2.0]

For anyone still following this thread, I have information to add. I too was very interested in this procedure based on all the previous posts here. I did a lot of other research, including reading the ->-bleeped-<- thread of the woman mentioned in the Pink News article. It sounded great, and Dr. Ting is in-network with my insurance.

I set up a appointments with Dr. Ting's team, including consultations with a social worker, a psychiatrist, and a member of his medical team. Communication was sparse, but when I went to New York everyone was friendly and extremely competent.

However, during the consultation with Dr. Zil Goldstein of the medical team, I found out that the peritoneal method we've been reading about isn't the be-all and end-all that the hype has led us to believe.

My appointment was in the middle of March, and I've been thinking about alternatives. To verify that I truly understood what I was told, I emailed Dr. Goldstein. Here's my message and her reply:

Hello Zil,

Thank you again for our consultation on March 16th. I'd like to verify that I understand clearly the differences between using peritoneal tissue for vaginoplasty versus the standard inversion technique. There seems to be a lot of misinformation being spread, some from one of Doctor Ting's patients.

So, as I understand it from our consultation:

*   The peritoneum is taken from the inside of the scrotum, not from the abdomen lining.
*   The peritoneum is used only to supplement the scrotal skin as additional graft material, simply for additional depth.
*   There are no additional "self-cleaning" or lubrication advantages.
*   Post-op dilation schedules are similar with both methods.

The reports I've been reading online indicate that all the above are much better using peritoneal tissue. I'd just like to make sure that I fully understand the pros and cons. If you have anything to add, I would be much appreciative.

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

It seems like you have a good understanding of the procedure. All of that is correct.



Zil Garner Goldstein, FNP-BC
Assistant Professor of Medical Education
Program Director
Center for Transgender Medicine and Surgery at Mount Sinai

It's very disappointing, but the only advantage I can see from the way they're doing it at Mt. Sinai (as opposed to the full Davydov method) is the added depth. I was told they can get 9 inches with the additional graft material. That isn't important to me. That, combined with not being able to even meet with Dr. Ting until September, no possibility of surgery before the 2nd quarter of 2019, and the high cost of having to stay in NYC for three weeks, has me looking elsewhere.

I hope somebody finds that information useful.

Stephanie

[josie76]

Well that is disappointing to read. 

I've seen a good number of medical papers published now on the "pull through laproscopic peritoneal vaginoplasty" using abdominal peritoneal tissues used on cis women with Mullerian Agenesis and CAIS. One study followed their patients from getting surgery done as teenagers through adulthood beginning in 2003. Earlier surgeries were done and published with more invasive methods in Russia in the 1990's.

What the papers I have read describe is benefits including:

self lubrication
secretions match pH of natal vaginal secretions
according to the "sex" survey-
no dialation with normal intercourse
secretions lubricate, "taste" like natal vaginal secretions
no excessive secretions in daily living

This procedure has been done by enough surgeons now that it baffles why SRS specializing doctors have not taken the time to get practice under those who have done it whenever possible. 

[steph2.0]

Well that is disappointing to read. 

I've seen a good number of medical papers published now on the "pull through laproscopic peritoneal vaginoplasty" using abdominal peritoneal tissues used on cis women with Mullerian Agenesis and CAIS. One study followed their patients from getting surgery done as teenagers through adulthood beginning in 2003. Earlier surgeries were done and published with more invasive methods in Russia in the 1990's.

What the papers I have read describe is benefits including:

self lubrication
secretions match pH of natal vaginal secretions
according to the "sex" survey-
no dialation with normal intercourse
secretions lubricate, "taste" like natal vaginal secretions
no excessive secretions in daily living

This procedure has been done by enough surgeons now that it baffles why SRS specializing doctors have not taken the time to get practice under those who have done it whenever possible. 

Exactly, Josie. "Disappointing" and "baffling" are exactly the right words. To think that such a method is known, and have to resort to the tried and true inversion technique is also "frustrating."

Stephanie

[josie76]

Exactly, Josie. "Disappointing" and "baffling" are exactly the right words. To think that such a method is known, and have to resort to the tried and true inversion technique is also "frustrating."

Stephanie

I'm not financially in a position to get GCS done, so I suppose I have time to wait and see if thing progress. If cash was no object I'd have the zero depth done and after it heals go find one of those surgeons that have done the peritoneal to get the finished up part done. Maybe things will improve by the time I can get it done.

[Becca Kay]

now i'm very confused.  i've read several articles that describe the surgeries being done by Ting as pull through peritoneal vaginoplasty.  using tissue from the scrotum is very different.  why is it being reported this way?

[Doreen]

Well that is disappointing to read. 

I've seen a good number of medical papers published now on the "pull through laproscopic peritoneal vaginoplasty" using abdominal peritoneal tissues used on cis women with Mullerian Agenesis and CAIS. One study followed their patients from getting surgery done as teenagers through adulthood beginning in 2003. Earlier surgeries were done and published with more invasive methods in Russia in the 1990's.

What the papers I have read describe is benefits including:

self lubrication
secretions match pH of natal vaginal secretions
according to the "sex" survey-
no dialation with normal intercourse
secretions lubricate, "taste" like natal vaginal secretions
no excessive secretions in daily living

This procedure has been done by enough surgeons now that it baffles why SRS specializing doctors have not taken the time to get practice under those who have done it whenever possible. 

I too have read these reports specifically because of some of my own symptoms.. So here's what baffles me personally.

I can't verify the taste of my vagina vs a natal female.. yuck lol. but.. I had reconstructive surgery back in 2001 with the equipment I possessed.  While mine didn't look precisely male, it was enough to label me as such from birth & thus needed correction.  I saw Dr. Kunaporn in Thailand in 2001 who utilized what I had to give me external female genitals & the vagina. 

What I don't get is my vagina IS self lubricating, has a more acidic ph balance.  I didn't have colon resegmentation.  Every time I kept hearing 'no it doesn't lubricate' I'm like.. .but mine does?  When I play with myself down there, I produce copious secretions after orgasm to make penetration / dilation easy.  It always baffled me why mine was so different than everyone elses.  Then again everything about me from the time I was spawned hasn't fit any pattern.
Its certainly not urine, and it lubricates the interior as well as the exterior of the vagina. 

On top of that I have no prostate to provide said secretions.. one explanation many tried to give me.  I was born without one.  I've asked ob/gyn's and endocrinologists and they don't have any idea why I'm not 'standard'.  I sometimes have to wear a pad if I notice excessive secretion issues.. as well as I continue to have spotting bleeding for whatever stupid reason.  My dilation schedule? Pretty much whenever I get an inkling to do it which is maybe once a week... used to be once a year lol.  I still have relatively the same depth/width.  I'm a terrible example, and don't try this at home kids.

My question  is does anyone that went through SRS / GCS have secretion/lubrication naturally?  Or am I like the only one in a sea of individuals.  Does orgasm provide lubrication naturally inside?  I would actually like to know.

[Maria77]

This is odd.  The story on wired.com discusses the use of peritonieal tissue from the abdomen.  I can't imagine getting much from the scrotum (yuck I hate even typing that word!)

[josie76]

This is confusing for certain?? 

Doreen, I wonder if given your particular biology, if you have some of the "normal" female glands that in cis women lubricate the vulva and vaginal entrance? Since you weren't born with a prostate maybe that gland structure and what would be a cowplers gland formed the cis-female counterparts? I'm just throwing out guesses though. 

From other's reports of standard penile inversion, there is only minimal secretions from the skin. Then some surgeons will cut a strip of skin away before inversion and take the penile section of the urethra and stitch it in. The urethra has lubricating glands down its length. That is supposed to help with just keeping it naturally moist but not enough for lube.

TMI warning 
I've wondered about that because where I have a split penile raphe and my urethra is basically only skin deep, I have natural moisture for lack of a better word. When I tuck, the area between becomes slightly slick. Even if I wasn't tucking, the bottom side of the penis has a slicker feeling on that area. This seems to have increased since on HRT. But then again the groin area skin sebaceous glands all seem to be more active. The skin in the legpits ?? (armpit of the leg ) has darkened some.

[mistyjensen]

Hi,

I didn't know that peritoneal tissue existed in the scrotum. I did come across this paper related to the subject at https://www.ncbi.nlm.nih.gov/pubmed/15756559. But there is no definitive link... 

I find Dr. Ting to be very approachable and responsive by email. I highly recommend emailing him to get further clarification about his peritoneal technique, if you haven't already. As you may know, his email address is at http://www.mountsinai.org/profiles/jess-ting

Full disclosure - Dr. Ting performed my vaginoplasty in October 2016 - can't believe it's almost going to be 2 years since then - using his form of the traditional penile inversion surgery. I'm pleased with the results of my surgery.

[Doreen]

This is confusing for certain?? 

Doreen, I wonder if given your particular biology, if you have some of the "normal" female glands that in cis women lubricate the vulva and vaginal entrance? Since you weren't born with a prostate maybe that gland structure and what would be a cowplers gland formed the cis-female counterparts? I'm just throwing out guesses though. 

From other's reports of standard penile inversion, there is only minimal secretions from the skin. Then some surgeons will cut a strip of skin away before inversion and take the penile section of the urethra and stitch it in. The urethra has lubricating glands down its length. That is supposed to help with just keeping it naturally moist but not enough for lube.

TMI warning 
I've wondered about that because where I have a split penile raphe and my urethra is basically only skin deep, I have natural moisture for lack of a better word. When I tuck, the area between becomes slightly slick. Even if I wasn't tucking, the bottom side of the penis has a slicker feeling on that area. This seems to have increased since on HRT. But then again the groin area skin sebaceous glands all seem to be more active. The skin in the legpits ?? (armpit of the leg ) has darkened some.

I do know that skin discoloration can occur on estrogen... Skin 'patches' are also seen in inviduals with xx xy mosaicism / chimera types.   That might also be a possibility, who knows.  Only way to find out is a complete genetic panel, and even then they don't always easily see the genetic cause.  I know the geneticist that I saw had that as one of his suspicions too... we'll see, its all pretty much guess work at this point.

In the end what I did was I never rule out anything until its ruled out   I've ruled out XXY Klinefelters so far, CAIS and Swyers obviously.. though not variants of that, because that fits me a lot closer.  If I were in your shoes I'd probably take a guess at PAIS possibility. 

Even if you were completely (or me) m2f that's nothing to be ashamed of either.   I suspect far too often people try to glom onto the intersexed tag because they feel internally its somehow better than being m2f.  Its funny how our brains rationalize.. because ultimately being m2f in my honest opinion is a mental version of intersexed in the first place, and certainly nothing shaming to it (Despite what families & society try to make us think).

Your specific physical symptoms you were describing, I've not really heard myself though that isn't terribly surprising. I suspect most doctors wouldn't know either unless they deal with intersexed people all the time either, or specialize in m2f anomalies.  That's a pretty narrow specific field to find for sure.

[josie76]

I do know that skin discoloration can occur on estrogen... Skin 'patches' are also seen in inviduals with xx xy mosaicism / chimera types.   That might also be a possibility, who knows.  Only way to find out is a complete genetic panel, and even then they don't always easily see the genetic cause.  I know the geneticist that I saw had that as one of his suspicions too... we'll see, its all pretty much guess work at this point.

In the end what I did was I never rule out anything until its ruled out   I've ruled out XXY Klinefelters so far, CAIS and Swyers obviously.. though not variants of that, because that fits me a lot closer.  If I were in your shoes I'd probably take a guess at PAIS possibility. 

Even if you were completely (or me) m2f that's nothing to be ashamed of either.   I suspect far too often people try to glom onto the intersexed tag because they feel internally its somehow better than being m2f.  Its funny how our brains rationalize.. because ultimately being m2f in my honest opinion is a mental version of intersexed in the first place, and certainly nothing shaming to it (Despite what families & society try to make us think).

Your specific physical symptoms you were describing, I've not really heard myself though that isn't terribly surprising. I suspect most doctors wouldn't know either unless they deal with intersexed people all the time either, or specialize in m2f anomalies.  That's a pretty narrow specific field to find for sure.

Well as far as my body anomolies, I know I have XY chromosomes and was able to produce viable sperm. I've had two doctors say MAIS is likely because if my skeletal shape. One my regular general doctor (internist) and one the urologist who just did my orchiedectomy. The MAIS would explain some the penile and perennial raphe as it would make those areas less responsive to DHT that normally completes the male changes there.

I guess I really meant in the last post is that with the penile raphe being just a skin layer over my urethra, that whatever glands are in the urethra seem to get through to outside of my skin there. Given a matching set of bumps in my skin just under the end, one doctor said it might show that I had a hypospadias stitched closed when I was born. If so it was done during the circumcision and they never said anything was unusual to my mom. The hospital records were destroyed about 30 years ago as in IL they only have to keep records for 10 years. Doctors all long gone as well so no actual record of anything for me to find.
For me the search was just to answer why I was different as a kid. When I finally came to terms with being transgender I started putting my life puzzle together. My body caused me distress growing up while trying to be a boy. I wanted to understand why. The more information I get and the more I learn the more I find any real answers are hard to come by.