Dr. Oates, Vaginoplasty review

[transgirl34]

I have not received vaginoplasty from Dr. Oates yet. But since there seems to be a lack of information regarding Dr. Oates (and Transgender Medicine and Surgery at Boston Medical Center in general), I have to decided to do a full review. I will be updating this regularly as I progress through my journey to getting vaginoplasty. So let me just get right into it!
Consultation
I was a little nervous going into the consultation. Since Dr. Oates is a new surgeon, I wasn't sure I was going to feel comfortable with him performing my surgery. I also had a couple bad experiences over the phone with his staff. I tried to have BMC submit a prior authorization so my consultation fee of $170 would be covered. They told me they had never heard of submitting a prior-auth in order to have a consultation covered. I guess they were correct in some way, not really sure. The good news is that I got my consultation covered after calling my insurance, being assigned a case manager, and having them do all the work as to figuring out which doctor needed to do what in order for my consultation to be covered. I believe it ended up being that my endocrinologist (who referred me to BMC) ended up submitting the prior-auth (or some other sort of paperwork). Either way, I GOT IT COVERED - YAY! I should mention, for insurance comparison purposes, that I am not from Mass and do not have Mass health insurance. But I do have Medicaid in another neighboring state. Anyways, I was kind of put-off by the fact that the staff couldn't point me in the right direction for dealing with insurance, but it worked out. Also, Dr. Oates assistant/coordinator Erica Baptista, was sort of rude and off-putting over the phone. She seemed annoyed that I wasn't sure if my insurance was going to cover my surgery. Also, the front desk staff aren't very warm and welcoming. The person who accompanied me to my appointment told me "this is how all city hospitals are".
Alright, so now let's dive into the actual sit-down consultation. Dr. Oates came into the waiting room to get us, which I thought was nice (every other doctors office has a nurse or some other staff retrieve patients from the waiting room). He started by asking me about letters of recommendation (because apparently the letters I had sent in weren't scanned into the system yet). He also asked me about fertility, and if I had ever considered stopping hormones in order to freeze my sperm. I started hormones at 14, so pre-hormones I wasn't thinking about having kids (and doubt my sperm count was enough to impregnate anyone). Now, at 18, I'm content with staying on hormones until my surgery and not being able to have biological kids. Dr. Oates was also a little off-putting at first, he didn't really introduce himself or smile. He just sat me down and started asking questions, and seemed a little annoyed I hadn't brought my letters of recommendation (because I had already scanned them and assumed he had seen them, but I guess that is his staff's fault). We quickly warmed up to each other. I think he realized very quickly that I knew my stuff (regarding surgery and surgical technique), and that I was very intelligent and mature for my age, so he perked up a bit. He went over the process of getting a surgery date, which is basically that you HAVE to have COMPLETED genital hair removal before they will bring your case to the committee. Then of course they bring your case to the committee, and if you are given the green light, they will set up a surgery date with you. There are a couple appointments you have to have between the time you are approved by the committee and your actual surgery date. I guess these appointments are to meet the other doctor (Dr. Slama), fill out paperwork, pre-op examination, etc. I asked a bunch of questions. Apparently Dr. Oates first learned how to perform SRS/GRS/GCS 20-something years ago, down in Houston (not sure what SRS doctor used to operate out of Houston). He has also trained with some people in Michigan. I didn't retain all the details, because I'm sure his training credentials are online somewhere. He has performed 40 vaginoplastys as of my consultation date (May 2018). I was a little scared by that number, but by the time my surgery comes around, he should have competed another 40 or so. I mean, penile inversion vaginoplasty is a pretty standard procedure. He is a board certified urologist, so I believe he knows what he's doing. I will be uploading the documents they sent me in their welcoming package, these describe how he performs SRS and also what hair in the genital area needs to be removed. He said insurance covers revision surgery if needed/wanted. He also said that BMC does the all the work in getting the procedure covered by insurance (which makes up for their lack of help getting the consultation covered). He told me all I needed to worry about was finishing genital hair removal, and getting my letters of recommendation. I also asked him flat-out "Are you confident in performing vaginoplasty", and without hesitation he replied positively. The current wait list is about a year, so I should be getting surgery next summer. During consultation, Dr. Oates does not show pictures of his work. He said that I can make an appointment with one of his staff (Pam Klein), and that she can spend a considerable amount of time going over pictures, what to expect, hair removal advice, etc. He does perform a genital exam (to make sure there is enough material). This is the part I was nervous about, because my male puberty was stopped so early, I didn't have much penile growth (plus 4 years of estrogen). During the genital exam, he didn't even hesitate to tell me that everything should be fine and that I have enough material to work with. He did mention that a scrotal graft to line the inside of the vagina would probably be necessary. He also asked if I planned on having "heterosexual" sex. I guess this is because he told me that some women he has treated were okay with shallow depth because they didn't plan on having penetrative sex. I also asked about orgasm, and he said that most patients who wanted to have an orgasm were able to achieve one. On the topic of self-lubrication, he said that no-surgeon could really provide a trans-woman with a self-lubricating vagina because it's all just skin (which I've long suspected anyways, some girls who are operated on by Thai surgeons say they can soak through sheets, but I'm not sure how this is possible). He does use urethral tissue between the urethral opening and neo-clitoris, so that should provide some lubrication, he said.

That's all I've got for right now! Ask me any questions you may have!

[Devlyn]

Nice work, I love that you're sharing information to help others. 

Hugs, Devlyn

[ryokohimura]

Thank you.

I just got my letter of recommendation done and this, at least, let me know that Dr. Oates seems to know what he's doing. There seems to be a lot of conflicting information out there and this really did ease my mind as to going forward

[cargurl72]

Very good info. Thanks for sharing with us. I'm 2 months in on HRT, so this is all great future info.

[sfbarbie]

Great to see. I emailed you earlier you can still email me if you like but I didn't realize you were from out of state! Also I was told by a caseworker elsewhere that you don't need letters of recommendation if you're over 21? Does anyone know if this is true? I'm 32 and have been living full time for about 6 years I think?

[Maybebaby56]

On the topic of self-lubrication, he said that no-surgeon could really provide a trans-woman with a self-lubricating vagina because it's all just skin (which I've long suspected anyways, some girls who are operated on by Thai surgeons say they can soak through sheets, but I'm not sure how this is possible). He does use urethral tissue between the urethral opening and neo-clitoris, so that should provide some lubrication, he said.

Thanks, Transgirl, for posting a very nice synopsis!

I quoted the above section because there seems to be so much misinformation about "self-lubrication".  I had SRS with Dr. McGinn, and she said pretty much the same thing Dr. Oates did.  The neovagina is a skin graft.  It is not, nor will it ever be, the same as a "factory-installed" vagina.

BTW, Dr. McGinn also uses the technique of fabricating the labia minora from urethral tissue, which is secretory.  A male friend of mine noted I was "moist" inside of my vagina, and after some digital stimulation, I made "squishy sounds" like a genetic female. So it is possible to get some self-lubrication, but this is not from the vaginal walls.

This has been confirmed in one study (however, note the sample size is small):

Do Histologic Changes in the Skin-Lined Neovagina of Male-to-Female Transsexuals Really Occur?
Judith J. M. L. Dekker; J Joris Hage; Refaat B. Karim; Elisabeth Bloemena
Annals of Plastic Surgery. 59(5):546-549, NOV 2007

Abstract: Controversy exists on whether or not the epidermal keratinizing squamous epithelium of skin grafts and flaps applied to line a neovagina changes histologically to a nonkeratinizing mucosal type squamous epithelium after vaginoplasty in male-to-female transsexuals. To end this discussion, the aim of this study was to objectify the short-term and long-term histologic aspect of this neovaginal epithelial lining.

Biopsies were taken from the epithelium lining of the neovagina of 9 male-to-female transsexuals, from the moment of vaginoplasty up to 14 years after. These were stained with hematoxylin-eosin and periodic acid-Schiff stain for histologic comparison to normal vaginal biopsies. Because no changes that might have been induced by local influences or hormonal therapy were found, we concluded that short-term and long-term changes in the histologic aspect of inverted skin flaps do not occur after penile and scrotal skin vaginoplasty in male-to-female transsexuals.

But that is one study with only nine patients.  Later, there was another article:

Cytology of the neovagina in transgender women and individuals with congenital or acquired absence of a natural vagina
Dekker, Judith J. M. L. MD; Hage, J Joris MD, PhD; Karim, Refaat B. MD, PhD; Bloemena, Elisabeth MD, PhD
CYTOPATHOLOGY   Volume: 28   Issue: 3   Pages: 184-191   Published: JUN 2017

Abstract: The primary objective of this study was to describe the cytological findings of bowel and (penile) skin‐lined neovaginas in patients with gender dysphoria (GD) and individuals with a congenital or acquired absence of a natural vagina. The secondary objective was to correlate the cytological findings with clinical characteristics such as oestrogen replacement therapy (ERT).

A retrospective review of an institutional pathology archive over a 15‐year‐period was performed to identify cytological samples of neovaginal vaults. The medical and surgical records of the patients identified (n=20) were evaluated. Well‐preserved nucleated squamous cells were found in 70% (14/20) of patients. Neovaginal samples showing superficial, intermediate and parabasal cells plus Döderlein flora similar to normal cervical cytology were present in only 10% (2/20).

Conclusion: Cytological findings of the neovagina resemble normal cervical cytology with superficial, intermediate and parabasal cells as well as Döderlein bacilli in a minority of cases. Because precancerous lesions and invasive carcinoma may develop in the neovagina, patients with neovaginas should be subject to cancer screening programmes.

Now that's a little different from the first study, but please note how narrowly-defined the conclusion is.  It says that in 10% of the cases studied, the cytology of a neovagina looked like a normal vagina.  It does not say it functions like one.

Being my usual pedagogical self,

Terri

[transgirl34]

How do I edit my original post? I have an update

I went to BMC again last week. This appointment was just so I could meet the nurse liaison Pam Klein. I was able to view pictures of GCS results, and I must say they looked the same as any other surgeons. I asked her why BMC doesn't post result pictures on the website (instead of having patients book a whole appointment just to view pictures) and she said it was something to do with consents. She said it might change in the future, and that they might make vaginoplasty results public on their website (it is a topic of discussion for their next staff meeting). She didn't have that many pictures so we spent the rest of the time going over what it would be like to get surgery. She said they perform the surgery on a Tuesday, and I stay overnight in the hospital till Friday. I will go home for the weekend, and then come back Monday. She mentioned a few others things, like the point at which I would get the packing and catheter removed, but I forget lol. I did ask her if Dr. Slama and Dr. Oates were focusing on transgender medicine now, or if they still did other work within their respective specialities (plastics and urology). She said they still do work outside of transgender medicine and that transgender medicine isn't their sole focus (which is a little unnerving). I also asked why there are two surgeons, and she said because Dr. Oates does first part, like penile dissection, and that Dr. Slama comes in and does the cosmetic part (like labiaplasty and such). The front desk was much friendlier this time around.

[Dena]

How do I edit my original post? I have an update

Posts lock after 24 hours and only staff has the ability alter posts. Besides that, altering a post won't flag the thread active so previous views will not be aware of the update. Updates are best tagged on the end of the tread so they can be properly viewed.

If something is seriously wrong with a post, contact a moderator and we will fix it for you but it's not something we do on a regular bases.

[sfbarbie]

Did you have to get naked for an exam during ur consult? I'm going to Oates this week!!!

[Devlyn]

Did you have to get naked for an exam during ur consult? I'm going to Oates this week!!!

I had an orchiectomy with Dr Oates and the consult was very quick, and fully clothed. All subsequent visits involved showing my junk to both Dr Oates and the med student of the day, all of whom seemed to be girls in their twenties. You will be asked for permission to allow them to accompany Dr Oates during your appointment. I gave consent hoping it makes for a more experienced GRS surgeon for the next girl.

BMC is a teaching hospital affiliated with Boston University  for those who don't know.

Good luck, I thought Dr Oates was great, you will find my reviews in a couple places online.

Hugs, Devlyn

[Devlyn]

Great to see. I emailed you earlier you can still email me if you like but I didn't realize you were from out of state! Also I was told by a caseworker elsewhere that you don't need letters of recommendation if you're over 21? Does anyone know if this is true? I'm 32 and have been living full time for about 6 years I think?

I'm 56, I  needed a letter of recommendation from my primary care, a letter from a therapist, and a letter from a psychologist. I  really don't think that caseworker gave you the straight poop.

Hugs, Devlyn

[Post-Operative Lady]

Transgirl34,

Some surgeons do something called colon grafting during SRS. That will enable you to lubricate. Other surgeons will leave something called the Cowper's gland intact to help with lubrication. It depends on who works on you.
I'm 14 years post-op and don't lubricate since neither procedure was carried out during my SRS procedure in Bangkok. Personal lubricants found in the Family Planning isle of your local drug store will do the trick. Just don't use anything oil based since anything other than water-based will break a latex prophylactic down within sixty seconds enabling pathogens to travel through(ie: HIV).
I am a former patient of Oates and Slama. As with all surgeons, do your homework. I wish you the best. Nowadays with the required insurance coverage for transgender surgeries, you can be quite selective. Back in 2004, I had to take what I could get. My surgery turned out well, but the cosmetic result left something to be desired.
Good luck